• Adapting to the Global Shortage of Cholera Vaccines: Targeted Single Dose Cholera Vaccine in Response to an Outbreak in South Sudan

      Parker, LA; Rumunu, J; Jamet, C; Kenyi, Y; Lino, RL; Wamala, JF; Mpairwe, AM; Ciglenecki, I; Luquero, FJ; Azman, AS; et al. (Elsevier, 2017-01-18)
      Shortages of vaccines for epidemic diseases, such as cholera, meningitis, and yellow fever, have become common over the past decade, hampering efforts to control outbreaks through mass reactive vaccination campaigns. Additionally, various epidemiological, political, and logistical challenges, which are poorly documented in the literature, often lead to delays in reactive campaigns, ultimately reducing the effect of vaccination. In June 2015, a cholera outbreak occurred in Juba, South Sudan, and because of the global shortage of oral cholera vaccine, authorities were unable to secure sufficient doses to vaccinate the entire at-risk population-approximately 1 million people. In this Personal View, we document the first public health use of a reduced, single-dose regimen of oral cholera vaccine, and show the details of the decision-making process and timeline. We also make recommendations to help improve reactive vaccination campaigns against cholera, and discuss the importance of new and flexible context-specific dose regimens and vaccination strategies.
    • Progress and Challenges in Using Oral Cholera Vaccines to Control Outbreaks: The Médecins Sans Frontières Experience

      Ciglenecki, I; Azman, AS; Jamet, C; Serafini, M; Luquero, FJ; Cabrol, JC (Oxford University Press, 2018-09-14)
      The use of oral cholera vaccine (OCV) has increased since 2011, when Shanchol, the first OCV suitable for large-scale use, became available. Médecins Sans Frontières considers OCVs an essential cholera outbreak control tool and has contributed to generating new evidence on OCV use in outbreaks. We showed that large-scale mass campaigns are feasible during outbreaks, documented high short-term effectiveness and showed that vaccines are likely safe in pregnancy. We found that a single-dose regimen has high short-term effectiveness, making rapid delivery of vaccine during outbreaks easier, especially given the on-going global vaccine shortage. Despite progress, OCV has still not been used widely in some of the largest recent outbreaks and thousands of cholera deaths are reported every year. While working towards improving our tools to protect those most at-risk of cholera, we must strive to use all available effective interventions in efficient ways, including OCV, to prevent avoidable deaths today.
    • Vaccination Against Cholera in Juba - Authors' Reply

      Ciglenecki, I; Azman, AS; Rumunu, J; Cabrol, JC; Luquero, FJ (Elsevier, 2017-05-01)