Coverage and acceptability of cholera vaccine among high-risk population of urban Dhaka, Bangladesh

Uddin, Md. Jasim; Wahed, Tasnuva; Saha, Nirod Chandra; Kaukab, Sheikh Shah Tanvir; Khan, Iqbal Ansary; Khan, Ashraful Islam; Saha, Amit; Chowdhury, Fahima; Clemens, John D.; Qadri, Firdausi

doi:10.1016/j.vaccine.2014.08.021

Cited by 21 publications

(10 citation statements)

References 16 publications

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“…The site was within one of three study arms (the vaccine and behavior change arm vaccine) in a randomized controlled trial named “Introduction of Cholera Vaccine in Bangladesh (ICVB)” [35, 36]. As part of this arm, study participants received handwashing stations (bright red water bucket with a tap), and soapy water bottles (1.5-l plastic bottles where participants could mix detergent and water to make soapy water for handwashing) [35, 36]. Community health promoters (CHPs) made regular visits to the households to monitor handwashing station usage and deliver promotion messages.…”

Section: Methodsmentioning

confidence: 99%

Behavioral antecedents for handwashing in a low-income urban setting in Bangladesh: an exploratory study

et al. 2017

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BackgroundHealth programs commonly promote handwashing by drawing attention to potential fecal contamination in the environment. The underlying assumption is that the thought of fecal contamination will result in disgust, and motivate people to wash their hands with soap. However, this has not proven sufficient to achieve high rates of handwashing with soap at key times. We argue that handwashing with soap is influenced by broader range of antecedents, many unrelated to fecal contamination, that indicate to people when and where to wash their hands. This exploratory study aimed to identify and characterize this broader range of handwashing antecedents for use in future handwashing promotion efforts.MethodsFirst, an initial list of behavioral antecedents was elicited through unstructured interviews, focus group discussions and observation with residents, from a low-income community in Dhaka, Bangladesh, who were also recipients of a handwashing intervention. Then, photographs representing three categories of behavioral antecedents were taken: activities of daily living, visual or tactile sensations, and handwashing-related hardware and activities. Finally, the research team conducted ranking exercises with a new set of participants, from the same area, to assess the perceived importance of each antecedent illustrated by the photographs. The research team probed about perceptions regarding how and why that particular antecedent, represented by the photograph, influences handwashing behavior.ResultsAfter coming out of the bathroom and dirt (moyla) on hands were the two antecedents that ranked highest. In all the categories, intervention-related antecedents (three key times for handwashing which included handwashing after coming out of the bathroom, after cleaning a child’s anus and before food preparation; intervention provided items that included handwashing station, soapy water bottle, handwashing reminders from posters and community health provider visits) that were being promoted actively in this community were perceived favorably in the qualitative responses, but did not consistently rank higher than non-intervention items. However, many other antecedents were reported to influence when and where people wash their hands: cutting greasy fish, starting a meal, contact with oil and fat stuck to dishes, oil and lice from hair, sweat, unwashed vegetables, reminders from son and daughter or observing others wash hands, and observing the sunset.ConclusionsBeyond well-recognized antecedents related to fecal contact and dirt on hands, we identified a broader set of antecedents not reported in the literature. Adopting a handwashing promotional strategy to highlight existing antecedents that people themselves have identified as important can help inform the content of an intervention that is more relatable and effective in increasing handwashing practices.

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Section: Methodsmentioning

confidence: 99%

Behavioral antecedents for handwashing in a low-income urban setting in Bangladesh: an exploratory study

et al. 2017

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“…A recent large field trial in Kolkata, India, has shown that Shanchol , one of two World Health Organization prequalified OCVs, provides 65% protection over 5 years [5] . Further, successful demonstration campaigns conducted by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) in urban and rural communities show promise for expanding vaccination coverage in Bangladesh [4] , [7] . The expanded use of OCV as a component of cholera control is supported by the recent decision by the World Health Organization to establish a global stockpile of 2 million doses of OCV, and the GAVI Alliance has committed to finance and leverage support for the global stockpile through 2018 [8] , [9] .…”

Section: Introductionmentioning

confidence: 99%

Comparative Effectiveness of Different Strategies of Oral Cholera Vaccination in Bangladesh: A Modeling Study

Dimitrov

Troeger

Halloran³

et al. 2014

PLoS Negl Trop Dis

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BackgroundKilled, oral cholera vaccines have proven safe and effective, and several large-scale mass cholera vaccination efforts have demonstrated the feasibility of widespread deployment. This study uses a mathematical model of cholera transmission in Bangladesh to examine the effectiveness of potential vaccination strategies.Methods & FindingsWe developed an age-structured mathematical model of cholera transmission and calibrated it to reproduce the dynamics of cholera in Matlab, Bangladesh. We used the model to predict the effectiveness of different cholera vaccination strategies over a period of 20 years. We explored vaccination programs that targeted one of three increasingly focused age groups (the entire vaccine-eligible population of age one year and older, children of ages 1 to 14 years, or preschoolers of ages 1 to 4 years) and that could occur either as campaigns recurring every five years or as continuous ongoing vaccination efforts. Our modeling results suggest that vaccinating 70% of the population would avert 90% of cholera cases in the first year but that campaign and continuous vaccination strategies differ in effectiveness over 20 years. Maintaining 70% coverage of the population would be sufficient to prevent sustained transmission of endemic cholera in Matlab, while vaccinating periodically every five years is less effective. Selectively vaccinating children 1–14 years old would prevent the most cholera cases per vaccine administered in both campaign and continuous strategies.ConclusionsWe conclude that continuous mass vaccination would be more effective against endemic cholera than periodic campaigns. Vaccinating children averts more cases per dose than vaccinating all age groups, although vaccinating only children is unlikely to control endemic cholera in Bangladesh. Careful consideration must be made before generalizing these results to other regions.

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“…We conducted a review of published literature on post-OCV campaign vaccination coverage surveys and identified seven studies related to 24 two-dose campaigns conducted globally from 2003 through 2016 (Table S1) [15][16][17][18][19][20][21][22][23]. For each of the seven studies, we resampled two-dose (the standard vaccine regimen) coverage estimates 5000 times from a Gaussian distribution with a mean equal to the estimated coverage at the campaign site and the variance derived from the associated 95% confidence intervals; for studies with multiple locations, we first drew a single location randomly and then sampled from a Gaussian distribution of coverage estimates for that location.…”

Section: Campaign Coveragementioning

confidence: 99%

“…On the upper end, we assumed that individuals not directly protected by vaccine residing in grid cells with 30%, 50%, and 70% vaccination coverage experienced a respective 66%, 88%, and 97% reduction in cholera risk relative to a no vaccination scenario, according to a logistic model fit to published estimates ( Figure S4) (Longini et al 2007). Sensitivity parameters for vaccination coverage were taken from the 10th and 90th percentile resampled distribution of published coverage survey estimates from previous OCV campaigns ( Figure S1, Table S1) [15][16][17][18][19][20][21][22][23]. Sensitivity parameters for vaccine supply had, after 2019, either no growth or linear growth to 95 million doses in 2030; upper limit vaccine supplies may be achieved if new…”

Section: Sensitivity Analyses For Model Parametersmentioning

confidence: 99%

The impact of geographic targeting of oral cholera vaccination in sub-Saharan Africa: a modeling study

Lee

Azman

Kaminsky

et al. 2019

Preprint

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Background:In May 2018, the World Health Assembly committed to reducing worldwide cholera deaths by 90% by 2030. Oral cholera vaccine (OCV) plays a key role in reducing the near-term risk of cholera, although global supplies are limited. Characterizing the potential impact and cost-effectiveness of mass OCV deployment strategies is critical for setting expectations and developing cholera control plans that maximize chances of success. Methods and Findings:We compared the projected impacts of vaccination campaigns across sub-Saharan Africa from 2018 through 2030 when targeting geographically according to historical cholera burden and risk factors. We assessed the number of averted cases, deaths, disability-adjusted life-years, and cost-effectiveness with models that account for direct and indirect vaccine effects and population projections over time. Under current vaccine supply projections, an approach optimized to targeting by historical burden is projected to avert 828,971 (95% CI: 803,370-859,980) cases (equivalent to 34.0% of projected cases; 95% CI: 33.2-34.8). An approach that balances logistical feasibility with targeting historical burden is projected to avert 617,424 (95% CI: 599,150-643,891) cases. In contrast, approaches optimized for targeting locations with limited access to water and sanitation are projected to avert 273,939 (95% CI: 270,319-277,002) and 109,817 (95% CI: 103,735-114,110) cases, respectively. We find that the most logistically feasible targeting strategy costs $1,843 (95% CI: 1,328-14,312) per DALY averted during this period and that effective geographic targeting of OCV campaigns can have a greater impact on cost-effectiveness than improvements to vaccine efficacy and moderate increases in coverage. Although our modeling approach did not project annual changes in baseline cholera risk or incorporate immunity from natural cholera infection, our estimates of the relative performance of different vaccination strategies should be robust to these factors. Conclusions:Our study suggests that geographic targeting is critical to the cost-effectiveness and impact of oral cholera vaccination campaigns. Districts with the poorest access to improved water and sanitation are not the same as districts with the greatest historical cholera incidence. While OCV campaigns can improve cholera control in the near-term, without rapid progress in developing water and sanitation services, our results suggest that vaccine use alone are unlikely to allow us to achieve the 2030 goals.

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Coverage and acceptability of cholera vaccine among high-risk population of urban Dhaka, Bangladesh

Cited by 21 publications

References 16 publications

Behavioral antecedents for handwashing in a low-income urban setting in Bangladesh: an exploratory study

Behavioral antecedents for handwashing in a low-income urban setting in Bangladesh: an exploratory study

Comparative Effectiveness of Different Strategies of Oral Cholera Vaccination in Bangladesh: A Modeling Study

The impact of geographic targeting of oral cholera vaccination in sub-Saharan Africa: a modeling study

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