Cholera Vaccination in Urban Haiti

Abstract

Successful and sustained efforts have been made to curtail the major cholera epidemic that occurred in Haiti in 2010 with the promotion of hygiene and sanitation measures, training of health personnel and establishment of treatment centers nationwide. Oral cholera vaccine (OCV) was introduced by the Haitian Ministry of Health as a pilot project in urban and rural areas. This paper reports the successful OCV pilot project led by GHESKIO Centers in the urban slums of Port-au-Prince where 52,357 persons received dose 1 and 90.8% received dose 2; estimated coverage of the at-risk community was 75%. This pilot study demonstrated the effort, community mobilization, and organizational capacity necessary to achieve these results in a challenging setting. The OCV intervention paved the way for the recent launching of a national cholera vaccination program integrated in a long-term ambitious and comprehensive plan to address Haiti's critical need in water security and sanitation.

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.…”

“…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.…”

Importance of Cholera and Other Etiologies of Acute Diarrhea in Post-Earthquake Port-au-Prince, Haiti

“…In the wake of the cholera epidemic, GHESKIO joined the MSPP country response to this major health emergency, strengthened its community efforts, and led a highly successful pilot vaccine campaign by using Shanchol in a multipronged effort to control the cholera epidemic in these most vulnerable communities. [13][14][15] The main objective of this study was to determine the contribution of cholera to cases of acute diarrheal illness in an urban setting during the dry and rainy season and to compare the causes of acute diarrhea among individuals who presented to the GHESKIO-cholera treatment center (CTC) versus those who presented to the community oral rehydration points (ORPs). As a secondary objective, we surveyed other etiologic agents responsible for acute diarrheal illness using the xTAG GPP polymerase chain reaction (PCR).…”