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Cholera vaccine use: a snap shot

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

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Cholera vaccine use: a snap shot

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  1. 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

  2. Role of cholera vaccines • control measures not easy to implement • limited spending on water & sanitation new approach needed link environmental management & Oral Cholera Vaccine use Kolkata June 2006

  3. Public Health benefit of cholera vaccines ?target vulnerable groups in high risk areas consider seasonality when usually recommended control measures limited Immunization Averted Cases & deaths

  4. Currently available & WHO pre-qualified vaccine: killed WCrB sub-unit OCV* • 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 *Dukoral

  5. Cholera vaccine use in public health with WHO participation FSM Beira Darfur /Aceh, Indonesia NO vaccine use Uganda 2004 2000 1997 2003/04 2005 1994 Goma, DRC WHO recommendations 2005 WHO recommandations 2002 WHO recommandations 1999 www.who.int/cholera/publications

  6. WHO Recommendations for Cholera Vaccine Use • 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 • WHO meeting on the use of OCV, December 2002 • vaccine use suggested in endemic and epidemic settings • well designed demonstration projects • 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)

  7. 3-step decision making tool to assess the pertinence of OCV use in complex emergencies

  8. Feasibility and Context • Natural disaster: • infrastructure damaged • loss of human resources • limited access • continuous threats • political & economical disruption • complex emergency with • armed conflict • endemic areas with • seasonal outbreaks • access (security, nat disasters)

  9. 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)

  10. challenge (2) target population • considered at risk • accessible • IDPs / living with host families • high mobility • Influence on • numbervaccines needed • vaccine wastage • cost

  11. 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

  12. 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

  13. OCV should be part of a comprehensive, programmatic cholera control programme • OCV to be used when they can make a difference

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