Effectiveness of Mass Oral Cholera Vaccination in Beira, Mozambique

Lucas, Marcelino; Deen, Jacqueline; Seidlein, Lorenz von; Wang, Xuan Yi; Ampuero, Julia S.; Puri, Mahesh; Ali, Mohammad; Ansaruzzaman, M.; Amos, Juvenaldo; Macuamule, Arminda; Cavailler, Philippe; Guérin, Philippe J.; Mahoudeau, Claude; Kahozi-Sangwa, Pierre; Chaignat, Claire-Lise; Barreto, Avertino; Songane, Francisco; Clemens, John D.

doi:10.1056/nejmoa043323

Cited by 256 publications

(187 citation statements)

References 14 publications

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“…This paper reports on the feasibility, the acceptability and vaccine coverage only. The results on vaccine effectiveness are reported elsewhere [8].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban cholera-endemic setting in Mozambique☆

Cavailler¹,

Lucas

Perroud

et al. 2006

Vaccine

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CitationFeasibility of a mass vaccination campaign using a twodose oral cholera vaccine in an urban cholera-endemic setting in Mozambique. 2006, 24 (22) AbstractWe conducted a study to assess the feasibility and the potential vaccine coverage of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban endemic neighbourhood of Beira, Mozambique. The campaign was conducted from December 2003 to January 2004. Overall 98,152 doses were administered, and vaccine coverage of the target population was 58.6% and 53.6% for the first and second rounds, respectively. The direct cost of the campaign, which excludes the price of the vaccine, amounted to slightly over $90,000, resulting in the cost per fully vaccinated person of $2.09, which is relatively high. However, in endemic settings where outbreaks are likely to occur, integrating cholera vaccination into the routine activities of the public health system could reduce such costs.

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“…This paper reports on the feasibility, the acceptability and vaccine coverage only. The results on vaccine effectiveness are reported elsewhere [8].…”

Section: Introductionmentioning

confidence: 99%

Feasibility of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban cholera-endemic setting in Mozambique☆

Cavailler¹,

Lucas

Perroud

et al. 2006

Vaccine

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“…In another example, several VE case-control studies for cholera vaccines have used confirmed cholera diarrhea as cases and chose as controls persons who did not seek treatment for diarrhea -a conventional design (65)(66)(67). They then did a parallel "bias-indicator" analysis using those who sought treatment for diarrhea but did not test positive for cholera as cases and conventional controls, showing that the study design did not find measurable VE for a noncholera outcome.…”

Section: Discussionmentioning

confidence: 99%

“…• Showed that the vaccine-preventable burden of influenza mortality has been overestimated due to confounding (6,14,15) • Added confidence to several studies of cholera VE in outbreaks by showing that VE was estimated to be not statistically different from zero for non-cholera diarrhea (65)(66)(67) Substantive insights from test-negative designs…”

Section: Discussionmentioning

confidence: 99%

Observational studies and the difficult quest for causality: lessons from vaccine effectiveness and impact studies

2016

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Although randomized placebo-controlled trials (RCT) are critical to establish efficacy of vaccines at the time of licensure, important remaining questions about vaccine effectiveness (VE) -used here to include individual-level measures and population-wide impact of vaccine programs --can only be answered once the vaccine is in use, from observational studies. However, such studies are inherently at risk for bias. Using a causal framework and illustrating with examples we review newer approaches to detecting and avoiding confounding and selection bias in three major classes of observational study design: cohort, case-control, and ecological studies. Studies of influenza VE, especially in seniors, are an excellent demonstration of the challenges of detecting and reducing such bias, and so we use influenza VE as a running example. We take a fresh look at the time-trend studies often dismissed as "ecological." Such designs are the only observational study design that can measure the overall effect of a vaccination program (indirect (herd) as well as direct effects), and are in fact already an important part of the evidence base for several vaccines currently in use. Despite the great strides towards more robust observational study designs, challenges lie ahead for evaluating best practices for achieving robust unbiased results from observational studies. This is critical for evaluation of national and global vaccine program effectiveness.

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“…20 In Beira, Mozambique, mass vaccination was feasible and effective in preventing cholera in a population with a 20-30% seroprevalence of HIV. 21 More than 14,000 people received at least one dose and a case control study demonstrated 78% protection against cholera and 89% protection against cholera with severe dehydration. Of note, all strains isolated in this evaluation were El Tor variants that produced a modified form of the classical cholera toxin, representing a newer, dominant, and more severe variety of cholera.…”

Section: Killed Whole Cell Vaccine With Cholera Toxin B Subunitmentioning

confidence: 99%

Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era

Desai

Pezzoli

Alberti

et al. 2016

Human Vaccines & Immunotherapeutics

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Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic settings.

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Effectiveness of Mass Oral Cholera Vaccination in Beira, Mozambique

Cited by 256 publications

References 14 publications

Feasibility of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban cholera-endemic setting in Mozambique☆

Feasibility of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban cholera-endemic setting in Mozambique☆

Observational studies and the difficult quest for causality: lessons from vaccine effectiveness and impact studies

Achievements and challenges for the use of killed oral cholera vaccines in the global stockpile era

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