8 research outputs found
Neighborhood-targeted and case-triggered use of a single dose of oral cholera vaccine in an urban setting: Feasibility and vaccine coverage
<div><p>Introduction</p><p>In June 2015, a cholera outbreak was declared in Juba, South Sudan. In addition to standard outbreak control measures, oral cholera vaccine (OCV) was proposed. As sufficient doses to cover the at-risk population were unavailable, a campaign using half the standard dosing regimen (one-dose) targeted high-risk neighborhoods and groups including neighbors of suspected cases. Here we report the operational details of this first public health use of a single-dose regimen of OCV and illustrate the feasibility of conducting highly targeted vaccination campaigns in an urban area.</p><p>Methodology/Principal findings</p><p>Neighborhoods of the city were prioritized for vaccination based on cumulative attack rates, active transmission and local knowledge of known cholera risk factors. OCV was offered to all persons older than 12 months at 20 fixed sites and to select groups, including neighbors of cholera cases after the main campaign (‘case-triggered’ interventions), through mobile teams. Vaccination coverage was estimated by multi-stage surveys using spatial sampling techniques. 162,377 individuals received a single-dose of OCV in the targeted neighborhoods. In these neighborhoods vaccine coverage was 68.8% (95% Confidence Interval (CI), 64.0–73.7) and was highest among children ages 5–14 years (90.0%, 95% CI 85.7–94.3), with adult men being less likely to be vaccinated than adult women (Relative Risk 0.81, 95% CI: 0.68–0.96). In the case-triggered interventions, each lasting 1–2 days, coverage varied (range: 30–87%) with an average of 51.0% (95% CI 41.7–60.3).</p><p>Conclusions/Significance</p><p>Vaccine supply constraints and the complex realities where cholera outbreaks occur may warrant the use of flexible alternative vaccination strategies, including highly-targeted vaccination campaigns and single-dose regimens. We showed that such campaigns are feasible. Additional work is needed to understand how and when to use different strategies to best protect populations against epidemic cholera.</p></div
Selection of households for inclusion in the neighborhood-targeted vaccine coverage survey.
<p>Selection of households for inclusion in the neighborhood-targeted vaccine coverage survey.</p
Estimated vaccine coverage by age and sex in the neighborhood-targeted campaign.
<p>Red represents women and blue represents men. Lines represent LOESS smoothed estimates of coverage by sex and non-parametric 95% confidence intervals.</p
Overview of vaccination areas in Juba.
<p>Sub-panel on top left illustrates the case-triggered comprehensive targeted intervention (CTI) approach.</p
Population size and vaccine coverage estimates for neighborhood-targeted vaccination campaign.
<p>Population size and vaccine coverage estimates for neighborhood-targeted vaccination campaign.</p
Estimated vaccine coverage by distance to the closest vaccination site in the neighborhood-targeted campaign.
<p>Line represents LOESS smoothed estimates of coverage with non-parametric 95% confidence intervals.</p
Diagnostic performance of direct and enriched RDT, and of culture at National Public Health Laboratory, Juba, and at Institut Pasteur, Paris, using PCR as the reference standard in all (N = 101) or patients without prior antibiotics (N = 80).
<p>Diagnostic performance of direct and enriched RDT, and of culture at National Public Health Laboratory, Juba, and at Institut Pasteur, Paris, using PCR as the reference standard in all (N = 101) or patients without prior antibiotics (N = 80).</p
Results of the enriched RDT and of culture at National Public Health Laboratory, Juba, and at Institut Pasteur, Paris, compared to PCR results.
<p>Results of the enriched RDT and of culture at National Public Health Laboratory, Juba, and at Institut Pasteur, Paris, compared to PCR results.</p