Feasibility and acceptability of oral cholera vaccine mass vaccination campaign in response to an outbreakand floods in Malawi

Abstract

IntroductionDespite some improvement in provision of safe drinking water, proper sanitation and hygiene promotion, cholera still remains a major public health problem in Malawi with outbreaks occurring almost every year since 1998. In response to 2014/2015 cholera outbreak, ministry of health and partners made a decision to assess the feasibility and acceptability of conducting a mass oral cholera vaccine (OCV) as an additional public health measure. This paper highlights the burden of the 2014/15 cholera outbreak, successes and challenges of OCV campaign conducted in March and April 2015.MethodsThis was a documentation of the first OCV campaign conducted in Malawi. The campaign targeted over 160,000 people aged one year or more living in 19 camps of people internally displaced by floods and their surrounding communities in Nsanje district. It was a reactive campaign as additional measure to improved water, sanitation and hygiene in response to the laboratory confirmed cholera outbreak.ResultsDuring the first round of the OCV campaign conducted from 30 March to 4 April 2015, a total of 156,592 (97.6%) people out of 160,482 target population received OCV. During the second round (20 to 25 April 2015), a total of 137,629 (85.8%) people received OCV. Of these, 108,247 (67.6%) people received their second dose while 29,382 (18.3%) were their first dose. Of the 134,836 people with known gender and sex who received 1 or 2 doses, 54.4% were females and over half (55.4%) were children under the age of 15 years. Among 108,237 people who received 2 doses (fully immunized), 54.4% were females and 51.9% were children under 15 years of age. No severe adverse event following immunization was reported. The main reason for non-vaccination or failure to take the 2 doses was absence during the period of the campaign.ConclusionThis documentation has demonstrated that it was feasible, acceptable by the community to conduct a large-scale mass OCV campaign in Malawi within five weeks. Of 320,000 OCV doses received, Malawi managed to administer at least 294,221 (91.9%) of the doses. OCV could therefore be considered to be introduced as additional measure in cholera hot spot areas in Malawi.

Oral cholera vaccine coverage in hard-to-reach fishermen communities after two mass Campaigns, Malawi, 2016

“…Malawi has conducted several OCV campaigns since 2015. Following the reactive campaign conducted in 19 refugees camps (Nsanje district, 2015), the at-least-one-dose coverage was 86% and the two-dose coverage of 68% [5] . Following the pre-emptive campaign conducted in Kapise refugee camp (Mwanza district, March-April 2016), the coverage was 93% and 56%, respectively [6] .…”

The multi-sectorial emergency response to a cholera outbreak in Internally Displaced Persons camps in Borno State, Nigeria, 2017

“…In sum, quantitative studies have analysed humanitarian crises-related cholera intervention measures in isolation focusing on sanitation54 55 in refugee camps, water/hygiene/treatment,56 57 and OCV6–10 58 in IDP camps. Without down playing the rigour of these quantitative studies, excepting Spiegel et al, 11 qualitative studies are needed to explore comprehensive cholera emergency response measures in humanitarian crises including IDPs camps, WASH, case management, surveillance, OCV, coordination, logistics and communication.…”

“…Given the challenges associated with restoring disrupted WASH systems and health facilities to vulnerable populations in IDPs camps and other conditions, the oral cholera vaccine (OCV) has been implemented as part of comprehensive measures to cholera control in endemic,2 outbreak and humanitarian crises settings 5. Quantitative studies have looked into OCV interventions in IDPs camps 6–10. However, excepting Spiegel et al, 11 there is scarcity in qualitative comprehensive analysis of cholera emergency response measures in humanitarian crises setting with focus on IDPs camps.…”

Comparing alternative cholera vaccination strategies in Maela refugee camp using a transmission model

“…Observational studies have estimated one-dose vaccine effectiveness to be between 32.5% [21] and 87.3% [9], though the lower bound was not found to be significant. Despite logistical challenges, cholera vaccination in refugee camps has been found to be feasible and acceptable [16,22,23] and has been recommended as a potential key intervention to prevent and control cholera transmission in these settings.…”