Pioneering use of oral cholera vaccine during outbreak

Using results from a mass vaccination campaign of more than 300,000 people conducted in Guinea last year, MSF and Epicentre show the feasibility of implementing a mass vaccination campaign with oral cholera at the onset of an outbreak, similar to the way reactive vaccination campaigns are conducted when diseases such as measles or meningitis are reported in an area.

Last year, MSF teams in Guinea noticed cases of cholera months ahead of the rainy season. These early cholera cases and other factors, including the lack of a cholera epidemic in Guinea for several years, and the ongoing cholera epidemic in neighboring Sierra Leone, were strong indications to MSF and the Ministry of Health that a major cholera epidemic was imminent.

Starting in April of last year the Guinean Ministry of Health and MSF administered 316,250 doses of vaccine during two vaccination rounds in the coastal districts of Boffa and Forecariah, Guinea over six weeks. All individuals older than 12 months were eligible for vaccination in both rounds. The vaccination campaign was well accepted by the local community and MSF achieved high coverage rates. The two doses vaccine coverage was 75.8% in Boffa and 75.9% in Forecariah, respectively. Almost all people surveyed after the campaign, 98.9 percent, reported that they would be vaccinated again in a future cholera campaign.

Oral cholera vaccine was added to the WHO recommendation for cholera treatment in 2010, but so far has not been commonly used as a public health tool for control of the disease. Concerns about its feasibility, timeliness and acceptability by population, as well as fear of diverting resources from other medical programs have discouraged the use of an oral cholera vaccine.

"With this study, we show that with proper planning and outreach in the communities, it is indeed possible to vaccinate hundreds of thousands of people in a remote area, with a highly mobile population, in a relatively short period of time, against cholera," said Dr. Francisco Luquero, the paper's principal investigator. "However, more evidence is still needed about the feasibility of reactive campaigns in densely populated urban areas. Oral cholera vaccines should not be viewed as a long-term solution for global cholera control. They should be integrated as an additional tool in the global response to cholera outbreaks."