Reducing the mortality and morbidity of cholera in Africa; When and how to use the oral cholera vaccine?

CaHReF 2016, Yaoundé Conges hall, 23 – 26 August 2016 , PN 04

Cholera outbreak continues to be a public health problem in resource-limited countries especially in Africa and Asia continents. According to reports from the WHO, Sub-Saharan Africa bears the brunt of the global cholera burden. Cholera control is multi-sectoral and requires a series of complimentary interventions including improving Water Hygiene and Sanitation (WASH), enhancing epidemiological surveillance, cases management, and vaccination using Oral Cholera Vaccine (OCV).

While improving WASH is a key component for development in general and is even more critical during cholera outbreaks, for areas at high risk of cholera and for areas experiencing an outbreak, OCV is life saving and should be used.  OCV is very effective and safe, and until recently, the limited number of doses limited the number of campaigns that could be carried out.  During 2016, the supply of OCV has greatly increased, and OCV should be used in more areas and more situations.  Unfortunately, the availability of OCV is not well known, so it has not been used as much as it should have been used, especially now that it is available in adequate supply. 

The vaccine is available through the global stockpile, but in fact there are two stockpiles which can be accessed.  One is the emergency stockpile which can be accessed very rapidly when an outbreak is detected.  A simple form is completed and the vaccine, if approved can arrive in country within ten days.  The second stockpile is for endemic (hotspot) use, and should be used in areas where there has been a history of cholera outbreaks.  Again a form is sent describing the situation.  In recent campaigns several hundred thousand doses have been provided.

For GAVI eligible countries, the vaccine is provided without cost and GAVI also provides assistance with program costs; thus, there should be more opportunities to use vaccine,in countries at risk of cholera with limited financial resources, such as Cameroon and its neighbors.

Cameroon has experience severe cholera outbreaks in the past, especially in the Far North, North and Littoral Regions.  Some of these have been associated with high case fatality rates.  Fatalities occur more commonly for patients in remote areas who are far from health services; but they could be given vaccine prior to the outbreak.  This should reduce their risk. Many of the outbreaks in the past have been associated with cholera spreading throughout the region including Nigeria and Chad; thus, when cholera outbreaks are reported near the Cameron border, this may be an early warning to vaccinate populations where the disease may spread. 

The increased availability of OCV and the increased financial support through GAVI suggests that more countries should be using the vaccine among people at risk.  Surveillance can provide an early warning of an impending outbreak and can stimulate the application for vaccine from the emergency stockpile.  Surveillance can also identify the hotspots in the country which can lead to the availability of vaccine from the non-emergency stockpile.  The website www.stopcholera.org provides guidance on how to obtain the vaccine.

OCV, cholera, stockpile, vaccine. Hotspot, surveillance