Use of Oral Cholera Vaccine in Haiti: A Rural Demonstration Project

Abstract

A cholera epidemic has claimed the lives of more than 8,000 Haitians and sickened 650,000 since the outbreak began in October 2010. Early intervention in the epidemic focused on case-finding, treatment, and water and sanitation interventions for prevention of transmission. Use of oral cholera vaccine (OCV) as part of a complementary set of control activities was considered but initially rejected by policymakers. In December 2011, the Minister of Health of Haiti called for a demonstration of the acceptability and feasibility of the use of OCV in urban and rural Haiti. This paper describes the collaborative activity that offered OCV to one region of the Artibonite Department of rural Haiti in addition to other ongoing treatment and control measures. Despite logistics and cold chain challenges, 45,417 persons were successfully vaccinated with OCV in the region, and 90.8% of these persons completed their second dose.

Critical Analysis of Compositions and Protective Efficacies of Oral Killed Cholera Vaccines

“…Further, the vaccine has a cold supply chain requirement that is difficult to maintain in countries where cholera outbreaks occur. As it is a two-spaced-dose vaccine, the vaccination campaign encountered logistical and cold supply chain challenges involving substantial planning and has been described as "no small task" by the field workers delivering the vaccine in Haiti (33,34). It is worthwhile to point out that the rationale for the requirement of a cold supply chain for Shanchol, a vaccine consisting largely of killed cells, has not been provided.…”

“…The vaccine's negotiated price in 2011 with the manufacturer for bulk purchase (200,000 doses) for use in Haiti for a two-dose regimen was $3.70 (33). That did not include the cost involved in actually disseminating and administering it.…”

“…As cholera is a public health problem for poor people in various regions of the world, a critical analysis of the compositions and protective efficacies of the currently available OCVs is essential, as many questions related to their compositions and protective efficacies remain unanswered. Of these two vaccines, Shanchol is now preferred for mass vaccination against cholera (33)(34)(35) and will be discussed first. There are an estimated 3 to 5 million cholera cases and 100,000 to 120,000 deaths worldwide per year, with children under 5 years of age accounting for the highest incidence of cholera and more than half of the deaths (36).…”

“…As the study was not aimed to monitor Shanchol's effectiveness, information on its protective efficacy against cholera in the Haitian population remains unknown. Although the future use of this two-dose vaccine has been proposed (33)(34)(35), concerns about the operational and logistic challenges regarding its deployment in cholera outbreaks have been raised (40). Several aspects of this vaccine related to its composition and protective efficacy require in-depth examination.…”

“…Shanchol was used in 2012 in a pilot study to demonstrate the feasibility of mass vaccination in urban and rural Haiti (33,34). As the study was not aimed to monitor Shanchol's effectiveness, information on its protective efficacy against cholera in the Haitian population remains unknown.…”