Oral cholera vaccine delivery strategy in India: Routine or campaign?—A scoping review

Ray, Arindam; Sarkar, Kaushik; Haldar, Pradeep; Ghosh, Rajshankar

doi:10.1016/j.vaccine.2019.07.082

Cited by 6 publications

(4 citation statements)

References 63 publications

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“…2,5 Oral cholera vaccines with an efficacy of roughly 65% exist, but their efficacy is lower in children in endemic areas. 6,7 It is thought that unvaccinated populations in such endemic areas could greatly benefit from additional relatively low-cost treatments that ameliorate the disease symptoms and diminish the spread to family members during an outbreak.…”

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confidence: 99%

“…Poor access to proper sanitation is believed to be the main reason that cholera persists, with the number of cases usually increasing dramatically during conflicts that disrupt access to clean drinking water. − The current gold standard treatment of severe cases consists of oral rehydration therapy with a complement of intravenous fluids. Antibiotics can also sometimes be used to help eliminate the infection. , Oral cholera vaccines with an efficacy of roughly 65% exist, but their efficacy is lower in children in endemic areas. , It is thought that unvaccinated populations in such endemic areas could greatly benefit from additional relatively low-cost treatments that ameliorate the disease symptoms and diminish the spread to family members during an outbreak.…”

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confidence: 99%

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Fucose-Galactose Polymers Inhibit Cholera Toxin Binding to Fucosylated Structures and Galactose-Dependent Intoxication of Human Enteroids

et al. 2020

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A promising strategy to limit cholera severity involves blockers mimicking the canonical cholera toxin ligand (CT) ganglioside GM1. However, to date the efficacies of most of these blockers have been evaluated in noncellular systems that lack ligands other than GM1. Importantly, the CT B subunit (CTB) has a noncanonical site that binds fucosylated structures, which in contrast to GM1 are highly expressed in the human intestine. Here we evaluate the capacity of norbornene polymers displaying galactose and/or fucose to block CTB binding to immobilized protein-linked glycan structures and also to primary human and murine small intestine epithelial cells (SI ECs). We show that the binding of CTB to human SI ECs is largely dependent on the noncanonical binding site, and interference with the canonical site has a limited effect while the opposite is observed with murine SI ECs. The galactose−fucose polymer blocks binding to fucosylated glycans but not to GM1. However, the preincubation of CT with the galactose−fucose polymer only partially blocks toxic effects on cultured human enteroid cells, while preincubation with GM1 completely blocks CT-mediated secretion. Our results support a model whereby the binding of fucose to the noncanonical site places CT in close proximity to scarcely expressed galactose receptors such as GM1 to enable binding via the canonical site leading to CT internalization and intoxication. Our finding also highlights the importance of complementing CTB binding studies with functional intoxication studies when assessing the efficacy inhibitors of CT.

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confidence: 99%

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Fucose-Galactose Polymers Inhibit Cholera Toxin Binding to Fucosylated Structures and Galactose-Dependent Intoxication of Human Enteroids

et al. 2020

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“…This has been seen to be effective in countries such as Uganda, DRC and Burundi, which are also all working towards elimination [7,61,62]. The predictable geographic location and seasonality of the outbreaks could be used to envisage the location and size of repeat vaccination campaigns with the possibility of pre-emptive campaigns timed before the rainy season to be included in the expanded program for immunizations [63][64][65]. Excitement surrounds the recent WHO prequalification of Euvichol S®, a simplified version of the Euvichol Plus® that is easier to produce but just as efficacious as its predecessors.…”

Section: Discussionmentioning

confidence: 99%

Navigating the Cholera Elimination Roadmap in Zambia - a Scoping Review (2013-2023)

Mbewe,

Tembo,

Kasonde

et al. 2024

Preprint

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BackgroundCholera outbreaks are increasing in frequency and severity, particularly in Sub-Saharan Africa. Zambia, committed to ending cholera by 2025, is coming off its most significant outbreak in 2024. This review examines the perceived regression in elimination efforts by addressing two questions: (1) what is known about cholera in Zambia; and (2) what are the main suggested mechanisms and strategies to further elimination efforts in the region?Methodology/Principal FindingsA scoping literature search was conducted in PUBMED to identify relevant studies published between January 2013 and June 2024 using the search terms ‘cholera’ and ‘Zambia’. We identified 45 relevant publications. With the increasing influence of climate change, population growth, and rural-urban migration, further increases in outbreak frequency and magnitude are expected. Major risk factors for recurrent outbreaks include poor access to water, sanitation, and hygiene services in urban unplanned settlements and rural fishing villages. Interventions are best planned at a decentralized, community-centric approach to prevent elimination and reintroduction at the district level. Pre-emptive vaccination campaigns before the rainy season and climate-resilient WASH infrastructure are also recommended.Conclusions/SignificanceThe goal to eliminate cholera by 2025 was unrealistic as evidence points to the disease becoming endemic. Our findings confirm the need to align health and WASH investments with the Global Roadmap to Cholera Elimination by 2030 through a climate-focused lens. Recommendations for cholera elimination, including improved access to safe drinking water and sanitation, remain elusive in many low-income settings like Zambia. Patient-level information on survival and transmissibility is lacking. New research tailored to country-level solutions is urgently required. Insights from this review will be integrated into the next iteration of the National Cholera Control Plan and could be applicable to other countries with similar settings.Article SummaryDespite known evidence of the risks from insufficient safe water supplies, sanitation and hygiene (WASH), the protective effects of oral cholera vaccines, and a Roadmap from the Global Task Force on Cholera Control, there is a continuous increase in cholera outbreaks on the continent. Now endemic in many parts of Zambia, it is postulated that the true burden of cholera in the country is underreported due to inadequate completeness of data, particularly during outbreaks. With an increasing frequency related to climatic conditions and unplanned urbanization, it will be important to adopt a decentralised approach to cholera control in Zambia. There is a continued need to advocate strongly for multisectoral interventions aligning health and WASH investments. The findings expose gaps in the local literature, such as how to improve climate-resilient WASH infrastructure, strategies to boost vaccine availability, and also the host and environmental factors that may be protective at personal and household levels from being asymptomatic or dying of cholera. This work provides evidence-based recommendations for the next iteration of the National Cholera Control Plan for Zambia and for neighbouring countries that may be in the process of developing their own plans.

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“… 4 With an estimated incidence rate of 1.64 per 1000, India features at the top of the list of cholera-endemic countries. 5 In India, estimates show that 400 million people are at risk of cholera, with 6.7 million cases and 20,000 (3%) deaths annually. 6 Cholera occurs with marked seasonal dynamics in India, being prevalent in the hot, humid, and rainy seasons.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the immunogenicity and safety of Euvichol-Plus with Shanchol in healthy Indian adults and children: an open-label, randomised, multicentre, non-inferiority, parallel-group, phase 3 trial

Shah,

Nandy,

Sethi

et al. 2023

The Lancet Regional Health - Southeast Asia

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Oral cholera vaccine delivery strategy in India: Routine or campaign?—A scoping review

Cited by 6 publications

References 63 publications

Fucose-Galactose Polymers Inhibit Cholera Toxin Binding to Fucosylated Structures and Galactose-Dependent Intoxication of Human Enteroids

Fucose-Galactose Polymers Inhibit Cholera Toxin Binding to Fucosylated Structures and Galactose-Dependent Intoxication of Human Enteroids

Navigating the Cholera Elimination Roadmap in Zambia - a Scoping Review (2013-2023)

Comparison of the immunogenicity and safety of Euvichol-Plus with Shanchol in healthy Indian adults and children: an open-label, randomised, multicentre, non-inferiority, parallel-group, phase 3 trial

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