Use of oral vaccine can complement cholera elimination efforts

Use of oral vaccine can complement cholera elimination efforts on the Island of Hispaniola, experts say

Elimination of cholera transmission on the Island of Hispaniola can be
achieved by increasing and sustaining access to clean drinking water and
adequate sanitation, according to experts of the Pan American Health
Organization’s Technical Advisory Group on Vaccine-Preventable Diseases
(TAG). Reaching the long-term goal will be greatly aided with
complementary short-term actions such as the expanded use of oral
cholera vaccine, the group further noted during a meeting held on August
14, 2012 at PAHO’s Washington, D.C, Headquarters. The meeting of the
Technical Advisory Group is framed in the set of actions that
governments of Haiti and Dominican Republic, PAHO/WHO, and other
agencies and partners have been carrying out the wake of the cholera
outbreak in October 2010. One example of this coordinated action is the
launching last June of the Regional Coalition on Water and Sanitation
for the Elimination of Cholera on the Island of Hispaniola, which helps
governments to harmonize and streamline international assistance and
investments in water and sanitation infrastructure on the island.

Dr. Jon Andrus, Deputy Director of PAHO, opened the meeting by tasking
TAG with the provision of technical recommendations on cholera
vaccination grounded in the best available science. "If the evidence
indicates, especially with the recent experience of demonstration
projects conducted in the field in Haiti, we should not fail to miss
short-term opportunities to save more lives more quickly,"
he stated.
"However, such action must be balanced within the long-term vision of
safe water and sanitation that will ultimately stop cholera transmission
on the island."
After the presentation of scientific evidence and
the results of two demonstration projects, the Technical Advisory Group,
chaired by Dr. Ciro de Quadros, recommended introduction of the oral
cholera vaccine. This recommendation was supported by data presented by
Partners in Health and GIESKO, two nongovernmental health organizations
with a long history of work in Haiti. Acting on PAHO’s suggestion, both
had recently conducted projects which achieved high vaccination coverage
of up to 90% for two doses of the oral cholera vaccine. "These results are highly impressive and really provide a road map for what we can do in the near future," noted
Dr. de Quadros. Given that current global supplies of the vaccine are
limited, TAG experts also recommended prioritizing vaccination in
densely populated urban areas with limited access to sanitation and
drinking water, and in rural areas where access to health services is
most challenging. As manufacturers ramp up production in the near
future, the experts unanimously recommended moving toward universal
vaccination. However, they noted that doing so will require urgent
attention to mobilizing and sustaining the flow of financial resources,
strengthening operational capacity, and insuring that vaccination
efforts are well-integrated into the long-term vision of safe water and
sanitation to stop cholera’s transmission.

The Technical Advisory Group also highlighted the importance of finding
solutions to the global scarcity of the cholera vaccine, as well as the
need to strengthen epidemiological surveillance processes, which are
critical in securing cholera prevention and control. TAG members
additionally stressed the need to conduct research to close current
knowledge gaps on the vaccine. Experts agreed that introduction and
universal access to the cholera vaccine will not manage, in and of
itself, in halting the disease’s transmission on Hispaniola, a goal
which will require major and sustainable improvements in access to safe
drinking water and to sanitation. They emphasized the importance of all
actors maintaining their support and commitment to the integrated
strategy of action for interrupting cholera transmission on Hispaniola.

More than half a million people in Haiti are estimated to have been
infected by cholera between October 2010 and July 2012, and more than
7,400 have lost their lives. The Dominican Republic has reported more
than 25,000 cases and over 400 deaths from cholera. Two oral cholera
vaccines are currently available on the global market; both require the
administration of at least two doses separated by 1–2 weeks and must be
kept under refrigeration during storage and distribution.

Members of PAHO’s Technical Advisory Group for Vaccine-Preventable
Disease include Dr. Ciro de Quadros (Chairperson and Executive Vice-
President of the Sabin Vaccine Institute), Dr. Peter Figueroa
(Rapporteur and Acting Chief Medical Officer at the Ministry of Health
of Jamaica), Dr. Roger Glass (Fogarty International Center, U.S.
National Institutes of Health), Dr. Anne Schuchat (National Center for
immunization and Respiratory Diseases, U.S. Centers for Disease Control
and Prevention), Dr. Jeannette Vega (Center for Epidemiology and Health
Policy, Chile), Dr. Akira Homma (Policy and Strategy Council,
Bio-Manguinhos Institute, Fiocruz, Brazil), Dr. Arlene King (Ministry of
Health and Long-term Care, Canada), Dr. Ramiro Guerrero-Carvajal
(PROESA, Colombia) and Dr. José Ignacio Santos (Department of
Experimental Medicine, National Autonomous University of Mexico).

which celebrates its 110th anniversary this year, is the oldest public
health organization in the world. It works with its member countries to
improve the health and quality of life of the peoples of the Americas.
It also serves as the Regional Office for the Americas of the World
Health Organization. 

PAHO – 16-08-2012