Implementation research: reactive mass vaccination with single-dose oral cholera vaccine, Zambia

Objective:To describe the implementation and feasibility of an innovative mass vaccination strategy ­ based on single-dose oral cholera vaccine ­ to curb a cholera epidemic in a large urban setting.Method:In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.Findings:Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign ­ 2.31 United States dollars (US$) per dose ­ included the relatively low cost of local delivery ­ US$ 0.41 per dose.Conclusion:We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered

Oral cholera vaccination in hard-to-reach communities, Lake Chilwa, Malawi

Objective To evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak. Methods We performed a two-stage cluster survey. The population interviewed was divided in three strata according to the second-dose vaccine distribution strategy: (i) a standard strategy in 1477 individuals (68 clusters of 5 households) on the lake shores; (ii) a simplifiedcold-chain strategy in 1153 individuals (59 clusters of 5 households) on islands in the lake; and (iii) an out-of-cold-chain strategy in 295 fishermen (46 clusters of 5 to 15 fishermen) in floating homes, called zimboweras. Finding Vaccination coverage with at least one dose was 79.5% (1153/1451) on the lake shores, 99.3% (1098/1106) on the islands and 84.7% (200/236) on zimboweras. Coverage with two doses was 53.0% (769/1451), 91.1% (1010/1106) and 78.8% (186/236), in the three strata, respectively. The most common reason for non-vaccination was absence from home during the campaign. Most interviewees liked the novel distribution strategies. Conclusion Vaccination coverage on the shores of Lake Chilwa was moderately high and the innovative distribution strategies tailored to people living on the lake provided adequate coverage, even among hard-to-reach communities. Community engagement and simplified delivery procedures were critical for success. Off-label, out-of-cold-chain administration of oral cholera vaccine should be considered as an effective strategy for achieving high coverage in hard-to-reach communities. Nevertheless, coverage and effectiveness must be monitored over the short and long term

A community-wide cholera outbreak caused by drinking unsafe water: Kasese District, Western Uganda, February ­July 2015

Introduction: Kasese District is prone to cholera outbreaks and this was its third outbreak in 15 years. In May 2015, Kasese District reported a cholera outbreak that had lasted 3 months and caused >100 infections. A team from Ministry of Health set out to support the local response team in identifying the mode of transmission and informing control measures.Methods: we defined a suspected case as onset of acute watery diarrhoea from 1st February 2015 onward; a confirmed case was a suspect case with Vibrio cholerae cultured from a stool sample. We reviewed medical records for case finding and conducted a case-control study to compare the exposures of 49 confirmed cases with those of 201 asymptomatic controls, matched by village and age group. We conducted environmental assessments and tested water samples for faecal contamination.Results: we identified 183 suspected cases including 61 confirmed cases (serotype inaba) and 2 deaths from February to July. The outbreak occurred in 80 villages and affected all age groups; the highest attack rate occurred in persons aged 5-14 years (4.1/10,000). Stratified epidemic curves showed that the outbreak started in Bwera Sub-county bordering the Democratic Republic of Congo, and spread eastward. 94% (46/49) of cases compared with 75% (152/201) of controls drank water without boiling or treatment (ORM-H = 5.9; 95%CI = 1.6-22). The main water sources, public piped water (consumed by 39% of cases and 38% of controls) and stream water (consumed by 29% of cases and 24% controls), both had high levels of E. coli, a marker of faecal contamination. Environmental assessment revealed evidence of open defaecation along the streams. No food items were significantly associated with illness.Conclusion: drinking unsafe water contaminated by feces caused this outbreak. We recommended rigorous disposal of patients' feces, chlorination of piped water, and drinking boiled or treated water. The outbreak stopped 6 weeks after initiating implementation of these control measures

Cholera outbreak caused by drinking lakeshore water contaminated by feces washed down from a hill-side residential area: Kaiso Village, Uganda

Introduction: cholera is a bacterial diarrheal disease caused by Vibrio cholerae. On 15 October 2015, a cholera outbreak involving dozens of cases and 2 deaths was reported in Kaiso, a lakeshore fishing village. The district health department responded by setting up a treatment center and sensitizing the community. Despite initial response, the outbreak persisted, prompting a detailed epidemiological investigation to identify the source and mode of transmission and recommend evidence-based interventions to stop the epidemic.Methods: we defined a suspected case as onset of acute watery diarrhoea in a Kaiso Village resident from 1st October 2015 onward; a confirmed case was a suspected case with Vibrio cholerae isolated from stool. We performed descriptive epidemiology to generate a hypothesis, and conducted a case-control study to compare exposure histories of 61 cases and 126 controls randomly selected among village residents (age ≥ 4 years in both groups). We conducted environmental assessment and obtained meteorological data from a local weather station.Results: 123 suspected cases (2 deaths) were line-listed at the village's cholera clinic. The initial 2 deceased cases had onset on 2nd and 10th October. Heavy rainfall occurred during 7­11th October, setting in a point-source outbreak which started on 12th and peaked on 13th October. Three water collection points (WCP) A, B and C were associated with the outbreak. 9.8% (6/61) of case-persons and 31% (39/126) of control-persons usually collected water from WCP A. In comparison, 21% (13/61) of case-persons and 37% (46/126) of control-persons usually collected water from WCP B (OR = 1.8, 95%CI: 0.64-5.3) and 69% (42/61) of case-persons and 33% (41/126) of control-persons from WCP C (OR = 6.7; 95%CI = 2.5-17). 100% (61/61) of case-persons and 93% (117/126) of control-persons never treated/boiled drinking water (OR = ∞, 95%CIFisher = 1.0-∞). A gully channel from a hillside open defecation area washed down feces to the lakeshore at WCP C.Conclusion: this outbreak was caused by drinking lakeshore water contaminated by feces washed down a gully from the village. We recommended water boiling and treatment, fixing the broken piped-water system, and constructing latrines. The outbreak was stopped by implementing treatment and boiling of drinking water at household level

Epidemic Cholera in Kakuma Refugee Camp; Kenya; 2009: the Importance of Sanitation and Soap

Introduction: Cholera remains a major public health problem that causes substantial morbidity and mortality in displaced populations due to inadequate or unprotected water supplies; poor sanitation and hygiene; overcrowding; and limited resources. A cholera outbreak with 224 cases and four deaths occurred in Kakuma Refugee Camp in Kenya from September to December 2009. Methodology: We conducted a case-control study to characterize the epidemiology of the outbreak. Cases were identified by reviewing the hospital registry for patients meeting the World Health Organization (WHO) case definition for cholera. For each case a matched control was selected. A questionnaire focusing on potential risk factors was administered to cases and controls.Results: From 18 September to 15 December 2009; a total of 224 cases were identified and were hospitalised at Kakuma IRC hospital. Three refugees and one Kenyan national died of cholera. V. cholerae O1; serotype Inaba was isolated in 44 (42) out of 104 stool specimens collected. A total of 93 cases and 93 matched controls were enrolled in the study. In a multivariate model; washing hands with soap was protective against cholera (adjusted odds ratio [AOR] =0.25[0.09-0.71]; p 0.01); while presence of dirty water storage containers was a risk factor (AORConclusion: Provision of soap; along with education on hand hygiene and cleaning water storage containers; may be an affordable intervention to prevent cholera

Coping with Cholera: the Importance of Coordinated Planning

Cholera epidemics in Zimbabwe; Haiti; and Nigeria have grabbed worldwide headlines in the last couple of years as beleagured health agencies battled to contain a rising tide of patients. Is this resurgence a pathological issue; or simply the consequence of poor public health provision? Superficially there should be little excuse for the epidemics of the size we have witnessed recently (more than 1500 died in the outbreak in Nigeria in 2010); cholera is not a mystery illness; and measures to contain an outbreak are known. But the logistics can be daunting and if health systems are weak; they can quickly become overwhelmed. Can one prepare? Of course. and in fact it is a must. As with all infectious diseases; lessons from one campaign will educate and illuminate actions for another. Hospitals and communities should be undertaking regular risk assessments; and providing quality training and resources to enable swift and decisive action the moment a problem is identified. Until the 1980s most outbreaks were managed at the local level using the best available common sense. Apart from in the most densely populated areas; this was largely successful. Slowly; public health experts started comparing notes and the compilation of guidelines for the control of cholera outbreaks started to emerge with epidemiologists from WHO helping to `join up the dots' between experiences in different continents and countries

Zimbabwe Experiences the Worst Epidemic of Cholera in Africa

A severe outbreak of cholera has been reported in Zimbabwe since mid 2008; with so far over 92;000 cases and over 4;000 deaths. This outbreak has differed from previous outbreaks in being mainly urban and with a high case-fatality rate. Breakdown in the supply of clean water has been the main underlying cause but breakdown in health service delivery in Zimbabwe has also contributed to the magnitude and severity of the outbreak

Epidemie de cholera a Bukavu (R.D.Congo) de 2006-2007: donnees epidemiologiques et de controle

Contexte : Bukavu est une des sept zones sanctuaires du cholera a l'est de la de la Republique Democratique du Congo. Cette etude a examine les aspects epidemiologiques et de controle de l'epidemie de 2006-2007. Methodes : Cette etude descriptive a porte sur les donnees de 3348 malades; collectees dans les registres du centre de traitement de cholera de l'Hopital Provincial General de Reference de Bukavu. Les donnees ont ete traitees par le logiciel Epi Info version 6.04d. Resultats : etalee sur 175 jours avec un taux d'attaque de 5;37 pour mille; l'epidemie a touche les sujets d'une moyenne d'age de 16 ans et un sex-ratio H/F de 1;05. La zone de sante la plus touchee etait celle de Kadutu (50;7). La source probable de contamination a ete hydrique (90;1). La symptomatologie clinique etait dominee par la diarrhee aqueuse (95;5). A l'admission; 63;4des malades presentaient une deshydratation severe. La duree moyenne d'hospitalisation etait de 3 jours. La letalite etait de 0;3. Conclusion : Le cholera a Bukavu a touche principalement les sujets jeunes provenant d'un conglomerat des quartiers populaires au sud de la ville. L'acces derisoire a l'eau potable et l'insuffisance des latrines ont vraisemblablement joue un role capital. La letalite etait faible ce qui denote entre autre d'une bonne prise en charge medicale des cas. Les mesures preventives semblaient etre mises en oeuvre tardivement et timidement. Cette etude fait renaitre la problematique de la rehabilitation du reseau d'adduction d'eau potable et l'hygiene de Bukavu

Diffuseur artisanal de chlore pour desinfecter les puits lors de l'epidemie de cholera de Douala (2004)

La chloration des puits est recommandee en cas d'epidemie de cholera. Mais les techniques de chloration sont mal codifiees; leur efficacite n'a pas ete prouvee; et l'on ne sait pas a quel rythme doit se faire la chloration. L'objectif etait de tester un dispositif artisanal de chloration continue; mesurer les taux de chlore residuel libre obtenus; et en suivre l'evolution; pour prevoir le delai de renouvellement. Dans 2 quartiers de Douala; 18 puits (9/quartier) ont fait l'objet de la mesure quotidienne pendant deux semaines du volume d'eau; du pH et du chlore residuel; apres installation d'un diffuseur artisanal a base de sable et d'hypochlorite de calcium dans un sachet plastique perfore; renouvele apres annulation des taux de chlore. La concentration maximumde chlore residuel libre a ete atteinte apres 1 jour (31 chlorations sur 36) ou 2 jours (5 sur 36). Elle est demeuree superieure au niveau minimum de 0;2mg/l pendant au moins 48 heures dans 33 des 36 chlorations. A J4; la moitie des puits avaient une concentration de chlore inferieure a 0;2 mg/l. La concentration de chlore etait plus elevee dans les puits familiaux que dans les puits communautaires .Malgre des difficultes de faisabilite et d'acceptabilite; le diffuseur propose a permis d'assurer la diffusion de chlore a des taux efficaces et non toxiques pendant 3 jours. Des systemes de diffusion plus prolongee et moins couteux devraient pouvoir etre proposes; dans le cadre d'actions integrees de lutte contre une epidemie de chlolera

L'epidemie de cholera de 2004 a Dakar : aspects epidemiologiques; cliniques et therapeutiques

Ce travail decrit l'epidemie de cholera qui a touche Dakar en 2004; au cours de laquelle 593 cas confirmes ou probables ont ete pris en charge dans notre service. Il se fixe pour objectif de decrire les aspects epidemiologiques; cliniques; bacteriologiques et les strategies de prise en charge de cette epidemie. Pour atteindre cet objectif; nous avons mene une etude prospective a la clinique des maladies infectieuses du 11 octobre au 20 decembre 2004. L'age moyen des patients etait de 30 ans; et le sexe ratio de 1;33. La source probable de contamination a ete alimentaire et/ou hydrique dans 92des cas. La duree de l'epidemie a ete courte (75 jours). Le debut a ete brutal dans 98des cas; et la symptomatologie clinique dominee par la diarrhee aqueuse (95) et les vomissements (78). Le delai moyen d'hospitalisation etait de 11 heures et le nombre de selles emises avant l'admission superieur a 10 dans 23des cas. A l'admission; 119 malades (20;1) ont presente une deshydratation severe. Au total 250 coprocultures ont ete effectuees; dont 145 positives (58); mettant en evidence Vibrio cholerae O1 dans 112 cas (44). Les 36 souches testees aux antibiotiques ont montre une excellente sensibilite a la doxycycline et a la pefloxacine; mais aussi une resistance au cotrimoxazole; a l'amoxicilline et au chloramphenicol. La rehydratation par voie orale a ete la regle (61). La letalite a ete de 0;5. Le cholera est une urgence medicale dont le pronostic peut etre favorable a condition que l'organisation de la prise en charge soit bonne

The Cholera Epidemic of 2000/2001 in KwaZulu-Natal : Implications for Health Promotion and Education

This study was a cross-sectional; descriptive and comparative study conducted in the province of KwaZulu-Natal in the months of November and December 2001 in order to make a comparison between health districts stricken with cholera and districts not stricken with cholera with regards to well-known risk factors for cholera. Random samples of 979 and 441 participants were drawn from health districts that were not stricken with cholera and health districts that were stricken with cholera respectively. The two groups of participants in the study had similar distributions of age; gender and literacy rate. Out of the 979 people that were not stricken with cholera; 72 of them had access to tap water; 10 owned water tankers; 10 used dam or river water; 50 knew how to purify water by use of disinfectants such as JIK; 75 practised boiling drinking water; 70 used protected toilets. Out of the 441 people that were stricken with cholera; 54 of them had access to tap water; 3 owned water tankers; 38 used dam or river water; 38 knew how to purify water by use of disinfectants such as JIK; 66 practised boiling drinking water; 51significantly influenced by failure to boil drinking water; lack of knowledge of water purification methods; lack of access to tap water; as well as failure to practice proper personal hygiene. A recommendation is made to implement health promotion and education programmes in health districts stricken with cholera using primary health care principles and community-based approaches

"Evaluation d'un test d'agglutination : latex vibrio cholerae dans 01 ""AD Seiken"" dans le diagnostic rapide du cholera au Mali"

"L'epidemie de cholera qui a eclate au Mali au mois de juillet 2003 a touche presque toutes les regions du pays. Des echantillons de selles preleves chez des malades suspects de cholera etaient envoyes par les agents de sante au Laboratoire National de Reference de l'Institut National de Recherche en Sante Publique pour la confirmation. Le latex Vibrio cholerae O1 AD "" SEIKEN "" a ete utilise pour la premiere fois par le laboratoire de bacteriologie pour confirmer l'epidemie de cholera. C'est un test qui permet de faire a la fois la detection du V. cholerae O1 directement a partir de la selle et a partir des colonies isolees a la culture. L'evaluation des resultats par rapport a la culture montre une sensibilite de 96;9p.100; une specificite de 100p.100 et une efficacite de 98p.100. Les valeurs predictives positives et negatives etaient respectivement : 100p.100 et 94;4p.100. Le latex V.cholerae O1 AD "" SEIKEN "" peut etre utilise dans les regions pour la confirmation des epidemies de cholera directement a partir des selles. Ceci permettra de raccourcir le delai de notification des resultats et d'entreprendre rapidement des actions en vue de maitriser l'epidemie."

Epidémie du choléra au CHU de Treichville en 2001 : aspects epidémiologiques; cliniques et thérapeutiques

Le choléra sévit à l'état endémo-épidémique en Côte d'Ivoire depuis trois décennies. En 2001 ; des foyers épidémiques ont été signales dans plusieurs villes du pays : Abidjan ; San-Pedro; Divo; Agboville et Aboisso dans le Sud; Touba; Boundiali; Korhogo au Nord; Duekoue et baba à l'Ouest; Abengourou et Bondoukou à l'Est. Notre étude a porté sur la ville d'Abidjan ou les données hospitalières étaient plus complètes. OBJECTIFS : L'objectif de l'étude était d'analyser les caractéristiques épidémiologiques ; cliniques et pronostiques des patients traites pour cholera d'octobre 2000 à novembre 2001 au CHU de Treichville. METHODES C'est une étude prospective portant sur des malades traites pour cholera dans le Service de Maladies Infectieuses. Vibrio cholerae ayant été isole dans les selles des premiers patients ; le diagnostic probable de cholera a été ultérieurement retenu sur les arguments suivants : consommation d'aliments et/ou de jus ; d'eau manipulée ; existence de cas de choléra dans l'entourage proche (famille ; travail ; école ; hôpital); diarrhée aigue avec selles; liquides; riziformes; abondantes mais sans fièvre. RESULTATS : En 14 mois ; nous avons collige 380 cas de choléra. L'épidémie a présente deux pics ; diamétralement opposés en terme d'incidence mensuelle (16 cas pour le 1er vs 47 cas pour le 2eme ; p=0 ; 04) et de mortalité (17pour cent pour le 1er vs 0.6pour cent pour le 2ème ; p 0 ;05). Le sex-ratio H/F était de 1 ;13 ; l'âge médian de 28 ans [15-85 ans]. Le mode de contamination prépondérant était indirect par consommation d'eau en sachets domestiques. Environ 59pour cent des malades ont été admis en état de choc avec collapsus cardio-vasculaire ; contre 27pour cent avec déshydratation modérée et 14pour cent avec déshydratation infraclinique. Cependant ; tous les malades ont été réhydrates avec du Ringer lactate par 2 voies veineuses d'emblée ; puis par une voie après la phase initiale ; l'autre étant relayée par la voie orale. La quantité moyenne de soluté administre était de 12 litres. L'antibiothérapie a été associée dans 49pour cent des cas pour une durée de séjour moyenne de 60 heures. L'évolution clinique a été favorable dans 94pour cent des cas. Le taux de létalité était de 4 ;7pour cent et les facteurs de gravite étaient : la consommation d'eau en sachet ; le plan C de déshydratation et la latence d'hospitalisation 2 jours. Conclusion : L'intérêt de l'enquête est d'avoir montre le caractère endémo-épidémique du cholera avec le risque de survenir à tout moment de l'année dès que les conditions d'hygiène des populations se dégradent. La prévention doit par conséquent être permanente en faisant appel à l'assainissement ; l'accès à l'eau potable et aux mesures d'hygiène

Response to anti cholera messages: A survey of highway stopover communities

A descriptive cross-sectional study was conducted in the highway markets of Idudi; Mbizzinya; Lukaya and Namawojjolo to assess the exposure of these communities to health education messages on cholera and their response to these messages. A cholera epuidemic broke out in most parts of the country in 1997 and by December 1999; there was a cumulative total of 54;230 cases with 2;267 deaths (National Cholera Task Force). In 1999 alone there were 5;067 cases with 228 deaths giving a case fatality rate of 4.49. The Ministry of Health with support from various donors responded by treating cases at the areas where the patients were and also strengthening preventive measures across the country by carrying out educational sessions using the radio stations; newspaper inserts; posters and film vans. The messages from the Ministry of Health included among others those warning people not to eat cold food and food sold from the streets to prevent infection; and washing hands before eating. The messages also implored community leaders to ban the sale of foods on the streets. However; there are popular stopovers on the highways out of the city which responded by only reducing the selling of their foodstuffs at the height of the epidemic but resumed their brisk business soon after. It was not known how much prevention was being done by the sellers of these food stuffs and what precautions the people who ate this food took to prevent infection. It was therefore important to assess the impact of the anti-cholera messages on the sellers and their customers since the disease was still being reported in some parts of the country

Epidemiology of Cholera Outbreak in Kampala; Uganda

To provide epidemiological description of the cholera outbreak which occurred in Kampala between December 1997 and March 1998. Design: A four-month cross-sectional survey. Setting: Kampala city; Uganda. Main outcome measures: Number of cases reported per day; attach rate per age group and per parish; case fatality ratio. Results: the cholera outbreak was due to vibrio choleerae 01 EI Tor; serotype Ogawa. Between December 1997 and March 1998; 6228 cases of cholera were reported; of which 1091 (17.5) were children under five years of age. The overall attach rate was 0.62; similar in the udner fives and five and above age groups. The case fatality ratio among hospitalised patients was 2.5. The peak of the outbreak was observed three weeks after the report of the first case; and by the end of January 1998 (less than teo months after the first case); 88.4of the cases had already been reported. The occurrence of cases concentrated in the slums where the overcrowding anf the environmental conditions resembled a refugee camp situation. Conclusion: the xplosive development of the cholera outbreak in Kampala; followed bya rapid decrease of the number of cases reported is unusual in a large urban setting. It appeared that each of the affected slums developed a distinct outbreak in a non immune population; which did not spread to contiguous areas. Therefore; we believe that; a decentralised strategy; that would focus the interventions on each heavily affected area; should be considered in these circumstances

Cholera Epidemics: The Mulago Experience

"Cholera is an acute diarrhoeal disease caused by vibrio cholera or relatef vibrosis. The bacteria is usually ingested through eating or drinking contaminated food. Infective dose in with 107-109 vibrios. Typical history is of acute onset of diarrhoea with or without vomiting. The stools are greyish; turbid and liqui-characteristically called ""Rice water"". Due to marked fluid loss; patients become rapidly dehydrated. Definitive diagnosis can be made by growing the vibros from the stool."

Colera em Mocambique no seculo XIX : II. tratamento utilizado na epoca

Este e o segundo artigo de uma serie de tres; relativa a epidemia de colera que assolou a Ilha de Mocambique; de Fevereiro a Marco no ano de 1859. No presente artigo apresentam-se e analisam-se aspectos relacionados com o diagnostico e tipo de tratamento utilizado; os recursos humanos e materiais existentes e o estabelecimento de um sistema de organizacio sanitaria onde participaram para alem do pessoal de saude; elementos da comunidade para apoio ao tratamento domiciliar dos casos. O aspecto mais importante; tendo em conta outras epidemias ocorridas durante o mesmo periodo na Europa e America; foi a participacio activa da populacio em relacio as medidas de tratamento preconizado palas autoridades de saude