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

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

Response to cholera outbreak; Kasese District Uganda

Kasese district in Western Uganda was hit by cholera outbreak from October 1991 to December 1992. The cumulative total of admitted cases was 1685. Deaths were 105. This excludes cases in OPD and temporary treatment centres. At the moment a neighboring district of Bundibugyo has a cholera outbreak. Thirty one (31) countries in Africa are reporting cases of Cholera to WHO. This was a multilateral mode of transmission implicating contaminated river water supplies; travel to endemic areas and food borne transmission. The risk factors were unsafe river water (RR 2.55); travel to a naighboring country with endemic cholera within 2 weeks before onset of signs symptoms (RR2) compared to controls. A steady diet of fish and Bundu (local staple of cassava bread) had a higher risk than controls (RR 1.8). Drinking boiled water protected against Cholera infection (RR 0.4). Laboratory studies demonstrated that V. cholera 01 EL TOR biotype Ogawa serotype was the responsible organism. The response and management of the epidemic centred around appropriate organisation at National; District; Subcounty (S/C); communities and health units. The organisation included proper case management; health education; personal and domestic hygiene; surveillance and notification. National and district task forces with clear terms of reference were formed. A task force was also put in place at sub-county and community (RC1) level. There was collaboration with multilateral agencies namely UNICEF et WHO Training of Health Workers in Cholera Case management was organised. Support supervisors at district level was emphasised. health messages on Cholera were formulated into local languages. Communities were sensitized about cholera and its control measures in order to enlist community participation and involvement. This paper describes details of responses at various levels in order to achieve a quickened control of the epidemic in the district