cholera vaccine use: a snap shot
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Cholera vaccine use: a snap shot. Training course on CDS in emergencies 13.12.2007 Dr Claire-Lise Chaignat Global Task Force on Cholera Control. Role of cholera vaccines. control measures not easy to implement limited spending on water & sanitation. new approach needed - PowerPoint PPT PresentationTRANSCRIPT
Global Task Force on Cholera Control
Cholera vaccine use: a snap shot
Training course on CDS in emergencies
13.12.2007
Dr Claire-Lise Chaignat Global Task Force on Cholera Control
Global Task Force on Cholera Control
control measures not easy to implement
limited spending on water & sanitation
new approach neededlink environmental management
&Oral Cholera Vaccine use
Kolkata June 2006
Role of cholera vaccines
Global Task Force on Cholera Control
Public Health benefit of cholera vaccines ?
target vulnerable groupsin high risk areas
consider seasonalitywhen usually recommended control measures limited
Immunization
Averted Cases& deaths
Global Task Force on Cholera Control
Currently available & WHO pre-qualified vaccine:
killed WCrB sub-unit OCV*
*Dukoral
• 2 doses in 10 days apart• each dose diluted in
water with buffer• cold chain required• storage capacities needed• high cost• limited availability
Vaccination does not replace, but complement usually recommended control measures
Global Task Force on Cholera Control
1994 Goma, DRC
1997 2000
Uganda
Cholera vaccine use in public health with WHO participation
NO vaccine useFSM Beira Darfur /Aceh, Indonesia
2003/04
WHO recommandations 1999
WHO recommandations 2002WHO recommendations 2005
2004 2005
www.who.int/cholera/publications
Global Task Force on Cholera Control
WHO Recommendations for Cholera Vaccine Use
II. WHO meeting on the use of OCV, December 2002• vaccine use suggested in endemic and epidemic settings
• well designed demonstration projects
I. WHO meeting on use of OCV in emergencies, May 1999• OCV should be considered among tools to prevent cholera
in populations at risk of an outbreak
III. WHO meeting on the use of OCV in complex emergencies, Cairo, December 2005
• relevance of multidisciplinary approach• context of broader public health priorities• 3-step decision making tool developed (to be tested)
Global Task Force on Cholera Control
Decision making tree for OCV use in complex emergencies
Step 1
Step 2
Step 3
Risk of cholera outbreak limited risk OCV use not relevant
Risk exists
Capacity to contain potential outbreakgood coping/response capacities
OCV use not relevant
Feasibility of OCV mass vaccination campaign
Limited capacity
not feasible OCV use not relevant
feasible
Immunization can be considered
Draft 06.03.2006
3-step decision making tool to assess the pertinence of OCV use in complex emergencies
Global Task Force on Cholera Control
Feasibility and Context
• Natural disaster: infrastructure damagedloss of human resourceslimited accesscontinuous threats
• political & economical disruption• complex emergency with armed conflict• endemic areas with seasonal outbreaks• access (security, nat disasters)
Global Task Force on Cholera Control
challenge (1) risk assessment risk perception
• epidemiology endemicity trends over time
• living conditions overcrowding access to water sanitation
• behaviour of community• climatic conditions• context (natural disaster, complex emergency and security issues)
Global Task Force on Cholera Control
challenge (2) target population
• considered at risk• accessible• IDPs / living with host families• high mobility
Influence onnumber vaccines neededvaccine wastage cost
Global Task Force on Cholera Control
Logistics : Volume & Weight of materials required to vaccinate 20 000 people
▪ 40 000 vaccine vials 3.2 m3 (with box)
▪ 40 000 buffer sachets 1.2 m3
▪ 40 000 plastic cups 2.4 m3
▪ 4 000 x 1.5l of water 9 m3
Total weight : 7,100 kg Total volume: 15.8 m3
Global Task Force on Cholera Control
OCVs and unanswered questions
Duration of protection beyond 2 years
role of a booster dose
cost effectiveness
efficacy of OCV in:
children < 2
HIV+
more evidence on herd protection
Global Task Force on Cholera Control
OCV should be part of a comprehensive, programmatic cholera control programme
OCV to be used when they can make a difference