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Experts urge vaccination to try to control cholera outbreak in Haiti

BMJ 2011; 342 doi: http://dx.doi.org/10.1136/bmj.d23 (Published 05 January 2011) Cite this as: BMJ 2011;342:d23
  1. John Zarocostas
  1. 1Geneva

Experts have called for a pilot project to test whether the cholera vaccine might help to contain Haiti’s ongoing outbreak of the disease. They are also urging the creation of an international stockpile of cholera vaccine for future outbreaks.

Roger Glass, director of the Fogarty International Center for Advanced Study in the Health Sciences at the US National Institutes of Health (NIH) and associate director for international research at the NIH, said, “In the short term we should make use of the limited amount of vaccine we have.

“In the long term we need to make sure we have adequate supplies to respond to cholera in Haiti, in the Americas, and around the world.”

The planned measures foresee 100 000 doses of cholera being made available for shipment and an additional 200 000 doses that could become available in the next three months and up to a million doses in the second half of 2011.

The recommendation, made during a meeting convened at the Pan American Health Organization (PAHO), the regional arm of the World Health Organization, in late December, marks a shift in strategy to one that factors in the vaccine option. Until now PAHO has focused on interventions to prevent and control the spread of cholera in the event of an outbreak, including the distribution of oral rehydration salts and drugs, distribution of clean water, sanitation measures, and extensive awareness campaigns.

At first the vaccine option was not seen as a priority, given the limited availability of supplies of vaccine, its high cost, and the difficult conditions on the ground in Haiti, including a lack of security.

Two doses of oral cholera vaccine, given between one week and six weeks apart, are needed to confer protection against the disease, and the cost ranges from $1.50 (£1; €1.1) to $3 a dose, WHO said.

Jon Andrus, deputy director of PAHO, reported that delegates at the meeting said that the situation in Haiti “clearly demonstrates the need for an international stockpile of cholera vaccine, which would stimulate vaccine production and guarantee vaccine supplies.”

From mid-October to 26 December the cholera epidemic had affected around 150 000 people in Haiti, hospitalising 83 200 and claiming at least 3000 lives.

Dr Andrus said that the availability of a vaccine is “certainly good news” but emphasised that Haiti has more than 10 million people and the neighbouring Dominican Republic has a similar number. “Under no circumstances could there be enough vaccine—over 40 million doses—to vaccinate all the inhabitants of the island of Hispaniola over the next year,” he said.

Ciro de Quandros, executive vice president of the Sabin Institute, which promotes vaccine development, said, “We have asked PAHO/WHO to dialogue with suppliers to see how much more vaccine they can produce and to dialogue with organisations who would be willing to finance the purchase of a vaccine.”

Claire-Lise Chaignat, chief of WHO’s global taskforce on cholera control, said that the agency recommends that where cholera is endemic vaccination should occur in conjunction with other prevention and control strategies. Vaccination should be targeted at high risk areas and high risk groups, she said.

Notes

Cite this as: BMJ 2011;342:d23