Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study
Background: Oral cholera vaccines represent a new effective tool to fight cholera and are licensed as two-dose regimens with 2–4 weeks between doses. Evidence from previous studies suggests that a single dose of oral cholera vaccine might provide substantial direct protection against cholera. During...
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Elsevier
2016-11-01
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Series: | The Lancet Global Health |
Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X1630211X |
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language |
English |
format |
Article |
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DOAJ |
author |
Dr. Andrew S Azman, PhD Lucy A Parker, PhD John Rumunu, MPH Fisseha Tadesse, MPH Francesco Grandesso, MPH Lul L Deng, MD Richard Laku Lino, MPH Bior K Bior, PhD Michael Lasuba, MS Anne-Laure Page, PhD Lameck Ontweka, BS Augusto E Llosa, PhD Sandra Cohuet, MD Lorenzo Pezzoli, PhD Dossou Vincent Sodjinou, MD Abdinasir Abubakar, MD Amanda K Debes, PhD Allan M Mpairwe, MPH Joseph F Wamala, MPH Christine Jamet, MPH Justin Lessler, PhD Prof. David A Sack, MD Marie-Laure Quilici, PhD Iza Ciglenecki, MD Francisco J Luquero, PhD |
spellingShingle |
Dr. Andrew S Azman, PhD Lucy A Parker, PhD John Rumunu, MPH Fisseha Tadesse, MPH Francesco Grandesso, MPH Lul L Deng, MD Richard Laku Lino, MPH Bior K Bior, PhD Michael Lasuba, MS Anne-Laure Page, PhD Lameck Ontweka, BS Augusto E Llosa, PhD Sandra Cohuet, MD Lorenzo Pezzoli, PhD Dossou Vincent Sodjinou, MD Abdinasir Abubakar, MD Amanda K Debes, PhD Allan M Mpairwe, MPH Joseph F Wamala, MPH Christine Jamet, MPH Justin Lessler, PhD Prof. David A Sack, MD Marie-Laure Quilici, PhD Iza Ciglenecki, MD Francisco J Luquero, PhD Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study The Lancet Global Health |
author_facet |
Dr. Andrew S Azman, PhD Lucy A Parker, PhD John Rumunu, MPH Fisseha Tadesse, MPH Francesco Grandesso, MPH Lul L Deng, MD Richard Laku Lino, MPH Bior K Bior, PhD Michael Lasuba, MS Anne-Laure Page, PhD Lameck Ontweka, BS Augusto E Llosa, PhD Sandra Cohuet, MD Lorenzo Pezzoli, PhD Dossou Vincent Sodjinou, MD Abdinasir Abubakar, MD Amanda K Debes, PhD Allan M Mpairwe, MPH Joseph F Wamala, MPH Christine Jamet, MPH Justin Lessler, PhD Prof. David A Sack, MD Marie-Laure Quilici, PhD Iza Ciglenecki, MD Francisco J Luquero, PhD |
author_sort |
Dr. Andrew S Azman, PhD |
title |
Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study |
title_short |
Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study |
title_full |
Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study |
title_fullStr |
Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study |
title_full_unstemmed |
Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study |
title_sort |
effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study |
publisher |
Elsevier |
series |
The Lancet Global Health |
issn |
2214-109X |
publishDate |
2016-11-01 |
description |
Background: Oral cholera vaccines represent a new effective tool to fight cholera and are licensed as two-dose regimens with 2–4 weeks between doses. Evidence from previous studies suggests that a single dose of oral cholera vaccine might provide substantial direct protection against cholera. During a cholera outbreak in May, 2015, in Juba, South Sudan, the Ministry of Health, Médecins Sans Frontières, and partners engaged in the first field deployment of a single dose of oral cholera vaccine to enhance the outbreak response. We did a vaccine effectiveness study in conjunction with this large public health intervention.
Methods: We did a case-cohort study, combining information on the vaccination status and disease outcomes from a random cohort recruited from throughout the city of Juba with that from all the cases detected. Eligible cases were those aged 1 year or older on the first day of the vaccination campaign who sought care for diarrhoea at all three cholera treatment centres and seven rehydration posts throughout Juba. Confirmed cases were suspected cases who tested positive to PCR for Vibrio cholerae O1. We estimated the short-term protection (direct and indirect) conferred by one dose of cholera vaccine (Shanchol, Shantha Biotechnics, Hyderabad, India).
Findings: Between Aug 9, 2015, and Sept 29, 2015, we enrolled 87 individuals with suspected cholera, and an 898-person cohort from throughout Juba. Of the 87 individuals with suspected cholera, 34 were classified as cholera positive, 52 as cholera negative, and one had indeterminate results. Of the 858 cohort members who completed a follow-up visit, none developed clinical cholera during follow-up. The unadjusted single-dose vaccine effectiveness was 80·2% (95% CI 61·5–100·0) and after adjusting for potential confounders was 87·3% (70·2–100·0).
Interpretation: One dose of Shanchol was effective in preventing medically attended cholera in this study. These results support the use of a single-dose strategy in outbreaks in similar epidemiological settings.
Funding: Médecins Sans Frontières. |
url |
http://www.sciencedirect.com/science/article/pii/S2214109X1630211X |
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doaj-62b3adcc0ed74958b342df4b2abae42d2020-11-25T02:55:48ZengElsevierThe Lancet Global Health2214-109X2016-11-01411e856e86310.1016/S2214-109X(16)30211-XEffectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort studyDr. Andrew S Azman, PhD0Lucy A Parker, PhD1John Rumunu, MPH2Fisseha Tadesse, MPH3Francesco Grandesso, MPH4Lul L Deng, MD5Richard Laku Lino, MPH6Bior K Bior, PhD7Michael Lasuba, MS8Anne-Laure Page, PhD9Lameck Ontweka, BS10Augusto E Llosa, PhD11Sandra Cohuet, MD12Lorenzo Pezzoli, PhD13Dossou Vincent Sodjinou, MD14Abdinasir Abubakar, MD15Amanda K Debes, PhD16Allan M Mpairwe, MPH17Joseph F Wamala, MPH18Christine Jamet, MPH19Justin Lessler, PhD20Prof. David A Sack, MD21Marie-Laure Quilici, PhD22Iza Ciglenecki, MD23Francisco J Luquero, PhD24Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAMédecins Sans Frontières, Geneva, SwitzerlandRepublic of South Sudan Ministry of Health, Juba, South SudanEpicentre, Paris, FranceEpicentre, Paris, FranceRepublic of South Sudan Ministry of Health, Juba, South SudanRepublic of South Sudan Ministry of Health, Juba, South SudanRepublic of South Sudan Ministry of Health, Juba, South SudanRepublic of South Sudan Ministry of Health, Juba, South SudanEpicentre, Paris, FranceAMREF Health Africa, Juba, South SudanEpicentre, Paris, FranceEpicentre, Paris, FranceWorld Health Organization, Geneva, SwitzerlandWorld Health Organization, Brazzaville, Republic of the CongoWorld Health Organization, Cairo, EgyptDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USAWorld Health Organization, Juba, South SudanWorld Health Organization, Juba, South SudanMédecins Sans Frontières, Geneva, SwitzerlandDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USADepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USABacterial Pathogens Unit, Institut Pasteur, Paris, FranceMédecins Sans Frontières, Geneva, SwitzerlandDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USABackground: Oral cholera vaccines represent a new effective tool to fight cholera and are licensed as two-dose regimens with 2–4 weeks between doses. Evidence from previous studies suggests that a single dose of oral cholera vaccine might provide substantial direct protection against cholera. During a cholera outbreak in May, 2015, in Juba, South Sudan, the Ministry of Health, Médecins Sans Frontières, and partners engaged in the first field deployment of a single dose of oral cholera vaccine to enhance the outbreak response. We did a vaccine effectiveness study in conjunction with this large public health intervention. Methods: We did a case-cohort study, combining information on the vaccination status and disease outcomes from a random cohort recruited from throughout the city of Juba with that from all the cases detected. Eligible cases were those aged 1 year or older on the first day of the vaccination campaign who sought care for diarrhoea at all three cholera treatment centres and seven rehydration posts throughout Juba. Confirmed cases were suspected cases who tested positive to PCR for Vibrio cholerae O1. We estimated the short-term protection (direct and indirect) conferred by one dose of cholera vaccine (Shanchol, Shantha Biotechnics, Hyderabad, India). Findings: Between Aug 9, 2015, and Sept 29, 2015, we enrolled 87 individuals with suspected cholera, and an 898-person cohort from throughout Juba. Of the 87 individuals with suspected cholera, 34 were classified as cholera positive, 52 as cholera negative, and one had indeterminate results. Of the 858 cohort members who completed a follow-up visit, none developed clinical cholera during follow-up. The unadjusted single-dose vaccine effectiveness was 80·2% (95% CI 61·5–100·0) and after adjusting for potential confounders was 87·3% (70·2–100·0). Interpretation: One dose of Shanchol was effective in preventing medically attended cholera in this study. These results support the use of a single-dose strategy in outbreaks in similar epidemiological settings. Funding: Médecins Sans Frontières.http://www.sciencedirect.com/science/article/pii/S2214109X1630211X |