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Table of Contents
Vol. 7(1), pp. 47-60, 2024
ISSN: 2672-4529
Copyright ©2024, Creative Commons Attribution 4.0 International.
https://gjournals.org/GJBHS
DOI: https://doi.org/10.15580/gjbhs.2024.1.102024146
1Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria.
2Department of Public Health, Maryam Abacha American University of Niger, Maradi, Niger
3Department of Community Medicine, Faculty of Clinical Sciences, Bayelsa Medical University, Yenagoa, Bayelsa State, Nigeria.
4Department of Microbiology, Faculty of Science, Bayelsa Medical University, Yenagoa, Bayelsa State, Nigeria.
5Department of Biological Sciences, College of Natural Sciences, Redeemer’s University, Ede, Nigeria.
6Department of Medical Laboratory Science, Faculty of Health Sciences and Technology, University of Nigeria, Enugu CAMPUS, Enugu State, Nigeria.
7Department of Medical Laboratory Science, Faculty of Basic Medical Sciences, Niger Delta University, Wilberforce Island, Bayelsa State, Nigeria.
Type: Research
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DOI:10.15580/gjbhs.2024.1.102024146
Published: 19/11/2024
Sylvester Chibueze Izah
E-mail: chivestizah@gmail.com
The importance of vaccines in cholera prevention cannot be overstated, particularly in regions where cholera is endemic or where outbreaks are frequent. Cholera, caused by the bacterium Vibrio cholerae, leads to severe diarrhea and dehydration, which can be fatal if not treated promptly. Vaccination serves as a critical public health intervention that protects individuals and contributes to community-wide immunity, thereby reducing the overall incidence of the disease. Studies have shown that achieving a vaccination coverage of 50% can significantly reduce cholera cases, with estimates suggesting that such coverage could avert up to 93% of cases in a single season (Dimitrov et al., 2014). This highlights the potential of vaccines to serve as a frontline defense against cholera outbreaks, especially in vulnerable populations.
The cholera vaccine landscape has evolved significantly, with various formulations developed to enhance efficacy and accessibility. Several types of oral cholera vaccines (OCVs) are available, including killed whole-cell and live attenuated vaccines (El Hayek et al., 2023). Introducing these vaccines has been pivotal in cholera control strategies, particularly in high-risk areas. For instance, using OCVs in mass vaccination campaigns has demonstrated the ability to protect vaccinated individuals and provide indirect protection to unvaccinated community members through herd immunity (Troeger et al., 2014). This indirect protection is crucial in controlling cholera transmission in endemic regions, as it reduces the overall pool of susceptible individuals.
Recent studies have underscored the effectiveness of targeted mass vaccination strategies in cholera prevention. For example, in rural Bangladesh, areas with higher coverage of OCVs experienced lower cholera incidence, even among unvaccinated individuals (Troeger et al., 2014). This phenomenon of herd immunity is essential for controlling outbreaks, as it creates a buffer against the spread of the disease. Furthermore, the cost-effectiveness of mass vaccination campaigns has been demonstrated, with models indicating that achieving a coverage of 60% can significantly reduce cholera incidence within a few years (Mukandavire et al., 2020). This economic aspect is vital for public health planning, especially in resource-limited settings where healthcare budgets are constrained.
In addition to traditional vaccination strategies, innovative approaches are being explored to enhance cholera prevention efforts. For instance, ring vaccination, which involves vaccinating individuals near confirmed cholera cases, has shown promise in controlling outbreaks (Ali et al., 2016). This targeted approach can be efficient in urban settings where cholera transmission is rapid and widespread. Moreover, the flexibility of dosing schedules for OCVs has been investigated, revealing that alternative vaccination schedules can still elicit robust immune responses, thereby increasing the feasibility of vaccination campaigns in various contexts (Kanungo et al., 2015). Such adaptability is crucial in responding to the dynamic nature of cholera outbreaks. The safety and efficacy of cholera vaccines have also been a focus of recent research, particularly concerning vulnerable populations such as pregnant women (El Hayek et al., 2023). Ensuring that vaccines are safe for all demographic groups is essential for widespread acceptance and implementation. Furthermore, developing new-generation cholera vaccines has shown promising efficacy rates exceeding 65%, encouraging future vaccination efforts (Mukandavire et al., 2013). These advancements in vaccine technology are critical for improving public health outcomes in cholera-endemic regions.
Despite the progress in cholera vaccination, challenges still need to be addressed in achieving high coverage rates, particularly in hard-to-reach communities. Studies have indicated that logistical barriers, such as transportation and access to vaccination sites, can hinder effective vaccination campaigns (Scheffold et al., 2012). Addressing these challenges requires innovative strategies, such as mobile vaccination units and community engagement initiatives, to ensure vaccines reach those most at risk. Additionally, public trust in vaccination programmes is essential; campaigns must be designed to educate communities about the benefits of vaccination and address any concerns regarding vaccine safety (Scheffold et al., 2012).
The global response to cholera has also been shaped by initiatives such as the WHO’s Global Cholera Elimination Roadmap, which aims to eliminate cholera by 2030 through a combination of vaccination, improved water, sanitation, and hygiene (WASH) measures, and effective surveillance (Bwire et al., 2022). This comprehensive approach recognizes that vaccination alone cannot eradicate cholera; it must be part of a multifaceted strategy addressing the underlying health determinants. The integration of vaccination with WASH interventions has the potential to create a synergistic effect, further reducing cholera incidence in vulnerable populations.
The paper focuses on the history and development of cholera vaccines, emphasizing the progression from early attempts to modern oral OCVs like Dukoral, Shanchol, and Euvichol. It explores the challenges in vaccine distribution, particularly in low-income regions, and highlights public health strategies, such as targeting vulnerable populations and integrating with WASH programmes. Additionally, it addresses vaccine hesitancy, public perception, and the importance of community engagement in successful vaccine campaigns.
The history of cholera vaccine development is a complex narrative reflecting the evolution of scientific understanding and public health strategies over a century. Cholera has caused numerous pandemics, particularly since the 19th century in the hotspot region. The quest for a vaccine has been driven by the urgent need to control outbreaks and reduce mortality, especially in areas with poor sanitation and limited healthcare infrastructure. This historical journey can be divided into key phases, each marked by significant advancements and challenges (Table 1).
Table 1: Major Milestones in the Development of Cholera Vaccines
The late 19th century marked the beginning of serious attempts to develop a cholera vaccine, coinciding with the establishment of the germ theory of disease. Russian scientist Waldemar Haffkine pioneered this field, creating one of the first cholera vaccines in the 1890s. Haffkine’s vaccine was a killed, injectable formulation derived from heat-killed Vibrio cholerae bacteria. His self-experimentation and subsequent field trials in India during a cholera epidemic demonstrated some efficacy, but the vaccine faced several limitations. Notably, it provided only modest protection, with immunity waning quickly, often within months, and was associated with adverse reactions such as fever and pain at the injection site (Luquero et al., 2014; Ivers et al., 2013). These challenges highlighted the need for more effective and user-friendly vaccination strategies.
Throughout the 20th century, the development of cholera vaccines continued, but progress was slow and fraught with difficulties. The initial focus remained on injectable vaccines, which, while somewhat effective, were hampered by variability in efficacy across different populations and strains of Vibrio cholerae. Field trials revealed that the effectiveness of these vaccines could differ significantly based on local epidemiological conditions (Khuntia et al., 2021; Ilboudo & Gargasson, 2017). Moreover, cholera’s persistence in water sources and its association with inadequate sanitation underscored the necessity for comprehensive public health measures beyond vaccination alone. The realization that vaccines could not single-handedly control cholera outbreaks led to a more integrated approach that combined vaccination with improved sanitation and water quality (Ivers et al., 2015; Martin et al., 2014).
The limitations of injectable vaccines paved the way for developing OCVs, representing a significant advancement in cholera prevention strategies. The transition to oral vaccines was driven by their ease of administration, particularly in resource-limited settings where healthcare infrastructure was lacking. Oral vaccines were designed to stimulate local immunity in the gastrointestinal tract, the primary site of infection for Vibrio cholerae (Martínez-Pino et al., 2013; Islam et al., 2018). The first-generation OCVs developed in the 1960s and 1970s included killed and live-attenuated formulations. While these vaccines demonstrated some protective efficacy, they still required multiple doses and often resulted in short-lived immunity (Ali et al., 2016; Mahalanabis et al., 2008).
The late 20th century saw the emergence of second-generation OCVs, which were more effective and safer than their predecessors. One of the most notable developments was the introduction of Dukoral in 1991, which combined killed whole cells of Vibrio cholerae with a component of cholera toxin. This innovative formulation enhanced the immune response, protecting the patient for up to two years with just two doses (Sayeed et al., 2015; Qadri et al., 2016). The World Health Organization (WHO) recognized the potential of OCVs and began to advocate for their use in cholera-endemic regions, particularly during outbreaks (Kar et al., 2014; Sow et al., 2017). The success of Dukoral set the stage for further advancements in OCV technology. In 2011, Shanchol was introduced as an improved and more affordable OCV. Unlike Dukoral, Shanchol did not require a buffer solution for administration, making it easier to deploy in mass vaccination campaigns. Shanchol is based on killed whole-cell Vibrio cholerae and has been shown to provide long-lasting immunity, with studies indicating protection lasting up to five years (Sarker et al., 2015; Sur et al., 2011). The vaccine has been utilized extensively in cholera-endemic countries and during outbreaks, such as the response to the cholera epidemic in Haiti following the 2010 earthquake (Kar et al., 2014; Ilboudo et al., 2021). The introduction of Shanchol marked a turning point in cholera vaccination efforts, as it allowed for broader access to effective vaccines in vulnerable populations. Euvichol, a variant of Shanchol, was developed to enhance the affordability and accessibility of OCVs further. Packaged in plastic containers instead of glass vials, Euvichol aimed to reduce costs and facilitate distribution in humanitarian crises and outbreak responses (Bekolo et al., 2016; Falkard et al., 2019). The WHO’s establishment of a global stockpile of OCVs has also played a crucial role in ensuring that vaccines are available for rapid deployment in response to cholera outbreaks worldwide (Ivers et al., 2015; Poncin et al., 2017). This proactive approach to cholera vaccination has been instrumental in controlling the disease in various settings and has underscored the importance of vaccination as a public health tool.
Recent studies have demonstrated the effectiveness of OCVs in diverse populations, including those with specific vulnerabilities, such as individuals living with HIV. Research has shown that the immunogenicity of OCVs remains robust even in these populations, further supporting the use of cholera vaccination as a critical intervention (Ali et al., 2017; Charles et al., 2014). The ongoing evaluation of OCVs in various epidemiological contexts provides valuable insights into their effectiveness and safety, reinforcing the need for sustained investment in cholera vaccine research and deployment. Despite the progress made in cholera vaccine development, challenges remain. The need for continuous monitoring of vaccine efficacy, safety, and public acceptance is paramount, particularly in regions where cholera is endemic. Additionally, integrating vaccination campaigns with broader public health initiatives, including water and sanitation infrastructure improvements, is essential to achieve long-term cholera control (Hsiao et al., 2017). The lessons learned from past vaccination campaigns can inform future strategies, ensuring that cholera vaccination remains vital to global health efforts.
Cholera, an acute diarrheal disease caused by the bacterium Vibrio cholerae, remains a significant public health challenge, particularly in regions with inadequate sanitation and clean water access. Developing cholera vaccines has been a crucial strategy in controlling outbreaks and preventing the disease. Three primary OCV are widely used: Dukoral®, Shanchol®, and Euvichol®. Each of these vaccines has unique characteristics regarding their composition, administration, efficacy, and safety profiles (Table 2), which are critical for implementing public health strategies.
Table 2: Overview of Current Cholera Vaccines
Dukoral® is a killed whole-cell oral vaccine that combines an inactivated strain of Vibrio cholerae O1 with a recombinant cholera toxin B subunit (CTB). This vaccine targets classical and El Tor biotypes of V. cholerae O1, providing a protective efficacy of approximately 60-85% for 2-3 years following administration. It is administered in a liquid form with a buffer solution, requiring two doses spaced 1-6 weeks apart and a booster dose every two years for individuals at continued risk. While Dukoral® has a higher initial efficacy compared to other vaccines, its requirement for a buffer solution and shorter duration of protection limits its practicality in mass vaccination campaigns, particularly in resource-limited settings (Peak et al., 2018; Qadri et al., 2018).
In contrast, Shanchol® and Euvichol® are also killed whole-cell oral vaccines, but they contain inactivated strains of both V. cholerae O1 and O139. These vaccines are administered orally without a buffer, simplifying their use in field settings. Both Shanchol® and Euvichol® require two doses, typically spaced two weeks apart, and provide approximately 65% protection for up to five years. The longer duration of immunity and ease of administration make these vaccines more suitable for mass vaccination campaigns, especially in endemic areas where cholera is a persistent threat (Khan et al., 2018; Harris, 2018).
The comparative efficacy of these vaccines highlights the importance of context in their deployment. While Dukoral® may provide higher initial protection, the logistical challenges associated with its administration can hinder its effectiveness in outbreak situations. On the other hand, Shanchol® and Euvichol® are effective in controlling cholera outbreaks in various settings, particularly in urban areas with high population density, where rapid vaccination is essential to curb transmission (Khan et al., 2018; Harris, 2018). Furthermore, the broader strain coverage of Shanchol® and Euvichol® against both V. cholerae O1 and O139 enhances their utility in diverse epidemiological contexts (Khan et al., 2018; Harris, 2018).
Safety profiles of these vaccines are generally favorable, with mild side effects reported across all three formulations. Common adverse effects include gastrointestinal discomfort, nausea, and diarrhea, which are typically transient and self-limiting. Dukoral® may be associated with slightly higher rates of nausea due to its buffer requirement, while Shanchol® and Euvichol® tend to have fewer gastrointestinal side effects, making them more acceptable for mass vaccination campaigns (Khan et al., 2018; Harris, 2018). The overall safety of these vaccines supports their use in vulnerable populations, including children and individuals in high-risk areas (Khan et al., 2018; Harris, 2018).
Implementing cholera vaccination strategies must also consider the socioeconomic context of affected populations. Cholera disproportionately impacts impoverished communities with limited access to healthcare services. Therefore, equitable access to vaccination is crucial for reducing health disparities and improving overall public health outcomes (Khan et al., 2018; Harris, 2018). Vaccination campaigns targeting high-risk populations, such as those living in slums or areas with poor sanitation, can significantly mitigate the burden of cholera and enhance community resilience against outbreaks (Khan et al., 2018; Harris, 2018).
In addition to traditional vaccination strategies, innovative approaches such as the “Mass and Maintain” strategy have been proposed to enhance cholera control efforts. This approach involves mass vaccination campaigns followed by routine vaccination of new population members, such as newborns and migrants. Such strategies are particularly relevant in dynamic urban environments where population mobility is high and the risk of cholera transmission is elevated (Peak et al., 2018; Khan et al., 2018; Harris, 2018). Public health authorities can create a comprehensive approach to cholera prevention by integrating vaccination with improved water and sanitation infrastructure. Despite the availability of effective vaccines, challenges remain in controlling cholera outbreaks. The emergence of non-O1/non-O139 strains of Vibrio cholerae poses a significant threat, as current vaccines do not protect against these serogroups. This limitation underscores the need for ongoing research and development of new vaccines targeting a broader range of Vibro cholerae strains, including those responsible for sporadic cases and outbreaks (Arteaga et al., 2019). The genomic characterization of non-O1/non-O139 strains is essential for understanding their epidemiology and potential impact on public health (Arteaga et al., 2019).
Furthermore, the role of environmental factors in cholera transmission cannot be overlooked. Vibrio cholerae is a natural inhabitant of aquatic environments, and its presence in water sources can lead to outbreaks, particularly in areas with poor sanitation. Surveillance of water sources for cholera contamination is vital for early detection and response to potential outbreaks (Bwire et al., 2018; Bwire et al., 2018). Integrating environmental monitoring with vaccination efforts can enhance the effectiveness of cholera control strategies and reduce the risk of transmission. The economic implications of cholera vaccination are also noteworthy. Studies have demonstrated that the cost-effectiveness of OCV is favorable, particularly in high-burden settings. By preventing cholera cases and reducing healthcare costs associated with treatment, vaccination can yield significant economic benefits for communities and healthcare systems (Khan et al., 2018; Harris, 2018). Policymakers must consider these economic factors when designing and implementing cholera vaccination programmes to ensure sustainability and maximize public health impact.
The distribution and access to vaccines present significant challenges that can hinder widespread implementation, particularly in low-income regions. These challenges can be categorized into barriers, including public hesitancy, regulatory challenges, and infrastructure limitations (Table 3). Each of these barriers plays a crucial role in determining the success of vaccination programmes globally.
Table 3: Key challenges and suggests potential solutions to improve vaccine distribution and access.
Regulatory Challenges: Variability in approval processes.
Infrastructure Limitations: Inadequate healthcare infrastructure.
Delayed distribution.
Complicated logistics.
Streamlined regulatory processes.
Investment in infrastructure.
Financial Constraints: High costs of vaccines.
Supply Chain Issues: Limited availability, especially in rural areas.
Limited access to vaccines.
It enhanced cold chain logistics.
It strengthened supply chains.
Public hesitancy remains a formidable barrier to vaccine uptake. Misinformation, distrust in healthcare systems, and cultural beliefs contribute to a significant reluctance among populations to receive vaccines. For instance, a study indicated that 35% of respondents cited fear of immunization as a primary impediment, often stemming from concerns about potential adverse effects and the pervasive spread of disinformation within communities (Alkahmous et al., 2023). Addressing this hesitancy requires clear and open communication, evidence-based information, and active rebuttal of myths and misconceptions to build confidence in vaccination (Alkahmous et al., 2023). Furthermore, community engagement and targeted awareness programmes can help mitigate these fears, particularly in regions where cultural beliefs strongly influence health decisions (Shaikh et al., 2018).
Regulatory challenges also complicate vaccine distribution and access. The variability in approval processes across different countries can lead to delays in the availability of vaccines. High-income countries often have streamlined processes that facilitate quicker access to vaccines, while low- and middle-income countries may struggle with bureaucratic hurdles that impede timely distribution (Duan et al., 2021). This disparity affects the speed at which vaccines are made available. It exacerbates global health inequalities, as countries with fewer resources may compete for limited vaccine supplies on the open market (Duan et al., 2021). International cooperation and harmonization of regulatory standards are critical to addressing these disparities and ensuring equitable vaccine access (Morales et al., 2021).
Infrastructure limitations are another significant barrier to effective vaccine distribution. In many low-income regions, inadequate healthcare infrastructure complicates vaccine delivery and administration logistics. A robust healthcare system is essential for successfully implementing vaccination programmes, as it ensures that vaccines can be stored, transported, and administered effectively (Escoffery et al., 2023). In regions where healthcare facilities are lacking, the challenges of reaching populations in need are magnified, leading to significant gaps in vaccination coverage (Nkwenkeu et al., 2020). Strengthening healthcare infrastructure through investment in facilities, training, and resources is crucial for improving vaccine access in underserved areas (Escoffery et al., 2023).
Cold chain logistics present a unique challenge in vaccine distribution, particularly in low-income regions. Many vaccines require strict temperature controls to maintain efficacy, necessitating reliable refrigeration and transportation systems (Forman et al., 2021). In areas without consistent electricity or refrigeration, the risk of vaccine spoilage increases, further complicating efforts to vaccinate populations (Forman et al., 2021). Addressing these cold chain requirements is essential for ensuring that vaccines remain viable from the point of manufacture to administration, particularly in remote or rural areas where infrastructure is often lacking (Forman et al., 2021).
Financial constraints further exacerbate the challenges of vaccine distribution in low-income regions. The high costs associated with vaccine production, distribution, and administration can limit access, particularly in countries with constrained healthcare budgets (Hill & Okugo, 2014). In many cases, the financial burden of vaccination programmes falls disproportionately on low-income populations, who may already face barriers to accessing healthcare services (Hill & Okugo, 2014). Innovative financing mechanisms, such as public-private partnerships and international funding, are necessary to alleviate these financial pressures and ensure that vaccines are accessible to all, regardless of socioeconomic status (Hill & Okugo, 2014).
Supply chain issues also pose significant challenges to vaccine distribution, particularly in rural areas. Limited availability of vaccines can hinder efforts to reach populations in need, as logistical challenges may prevent timely delivery (Yazdani et al., 2021). Moreover, the unavailability of vaccines can lead to unorganized vaccination schedules, further complicating access for families seeking immunization for their children (Izzati et al., 2021). Addressing these supply chain issues requires a coordinated approach that involves improving logistics, enhancing inventory management, and ensuring that vaccines are distributed equitably across regions (Yazdani et al., 2021).
The interplay of these challenges highlights the need for coordinated efforts to improve vaccine distribution systems, particularly in underserved areas. Effective vaccination programmes require the availability of vaccines and the infrastructure, resources, and community engagement necessary to ensure successful implementation (Escoffery et al., 2023). Collaborative approaches that involve governments, healthcare providers, and community organizations can help address these barriers and enhance vaccine uptake (Shaikh et al., 2018).
Implementing public health strategies for vaccination is critical in mitigating the impact of infectious diseases, particularly among high-risk populations and in outbreak hotspots (Table 4). Targeting these groups, such as healthcare workers, the elderly, and individuals with pre-existing health conditions, is essential for maximizing the benefits of vaccination campaigns. Epidemiological data plays a vital role in identifying these high-risk populations and outbreak hotspots, allowing health authorities to prioritize vaccination efforts effectively. For instance, Azman and Lessler (2015) emphasized the importance of reactive vaccination strategies that focus on outbreak hotspots, which can significantly enhance the effectiveness of vaccination campaigns during public health emergencies. Additionally, Dean et al. (2019) highlighted that understanding the direct and indirect effects of vaccination can inform strategies that target susceptible populations, thereby reducing disease transmission and protecting community health.
Table 4: Public health strategies for vaccine implementation
Integration with water, sanitation, and hygiene programmes and surveillance
Integrating vaccination campaigns with WASH programmes can further enhance public health outcomes. Improved sanitation and hygiene practices reduce the transmission of infectious diseases and support the efficacy of vaccines by creating healthier environments for immunization. For example, vaccination and WASH initiatives effectively control cholera outbreaks, as evidenced by studies conducted in various settings (Parker et al., 2017). Furthermore, establishing robust surveillance systems is crucial for monitoring vaccination coverage and tracking outbreaks. This integration allows timely responses to emerging health threats, ensuring sustained community protection (Azman et al., 2012). Faucher et al. (2021) stress the importance of surveillance and note that effective monitoring can facilitate rapid vaccination responses in workplaces and schools during outbreaks.
Targeting high-risk populations and outbreak hotspots is not merely a logistical necessity but a moral imperative in public health. Vulnerable groups often bear the brunt of infectious disease outbreaks, and prioritizing their vaccination can significantly reduce morbidity and mortality rates. For instance, studies have shown that healthcare workers are at an increased risk of exposure to infectious diseases, making their vaccination a priority (Morrison et al., 2020). Similarly, the elderly and individuals with chronic health conditions are more susceptible to severe infection outcomes, underscoring the need for targeted vaccination strategies (Hall et al., 2017). Public health authorities can achieve excellent herd immunity and protect the broader community from outbreaks by focusing on these high-risk populations.
Moreover, the effectiveness of vaccination strategies can be enhanced through community engagement and education. Educating communities about the importance of vaccination and addressing vaccine hesitancy are critical components of successful vaccination campaigns. Research indicates that individual decision-making regarding vaccination can significantly influence outbreak dynamics, suggesting that targeted communication strategies can improve vaccination uptake (Morrison et al., 2020). Additionally, fostering trust in healthcare systems and ensuring equitable access to vaccines is essential for achieving high coverage rates among vulnerable populations (Parpia et al., 2020). This approach aligns with the findings of Parpia et al. (2020), who emphasized the need for comprehensive vaccination programmes that address access and education.
The integration of vaccination with WASH programmes also highlights the interconnectedness of public health strategies. Improved sanitation and hygiene practices can reduce the incidence of diseases that vaccines aim to prevent, thereby enhancing public health outcomes. For instance, cholera vaccination campaigns are more effective when combined with efforts to improve water quality and sanitation (Martin et al., 2014). This holistic approach addresses immediate health threats and contributes to long-term health improvements within communities. As noted by Gachohi et al., targeted interventions in identified hotspots can lead to sustainable disease elimination efforts, particularly when combined with education and community involvement (Gachohi et al., 2022).
Surveillance systems play a pivotal role in the success of vaccination campaigns, enabling health authorities to monitor vaccination coverage and assess the effectiveness of interventions. Effective surveillance can identify gaps in coverage and inform targeted vaccination efforts, particularly in areas with low uptake (Kundrick et al., 2018). For example, spatial clustering data can help identify high-risk areas for outbreaks, allowing for timely vaccination responses (Roskosky et al., 2020). This proactive approach is essential for controlling infectious diseases and preventing widespread outbreaks, as highlighted by the experiences documented in various studies (Merler et al., 2016). Integrating surveillance with vaccination efforts ensures that public health responses are data-driven and responsive to emerging threats. In addition to traditional vaccination strategies, innovative approaches such as reactive vaccination have gained traction recently. Reactive vaccination involves administering vaccines in response to an outbreak, targeting specific populations or areas to contain the spread of disease. This strategy has been successfully implemented in various contexts, including cholera and measles outbreaks, where rapid vaccination efforts have proven effective in controlling transmission (Alberti et al., 2010). The flexibility of reactive vaccination allows health authorities to respond swiftly to changing epidemiological landscapes, ensuring that resources are allocated where they are most needed (Faucher et al., 2022). This adaptability is crucial in evolving public health challenges, particularly in resource-limited settings.
Furthermore, the role of community engagement in vaccination efforts cannot be overstated. Community involvement in planning and implementing vaccination campaigns can enhance trust and increase participation rates. Research has shown that local knowledge and cultural practices can inform vaccination strategies, making them more acceptable to target populations (Njim et al., 2016). By adopting a sense of ownership among community members, public health authorities can improve vaccination uptake and ultimately achieve better health outcomes (Rast et al., 2010). This community-centered approach aligns with the findings of Parpia et al., who emphasize the importance of understanding local dynamics in the context of vaccination campaigns (Parpia et al., 2020).
The challenges associated with vaccine distribution and uptake are compounded by misinformation and vaccine hesitancy. Addressing these challenges requires a multifaceted approach that includes clear communication, education, and community engagement. Studies have demonstrated that misinformation can significantly impact vaccination rates, increasing susceptibility to outbreaks (Morrison et al., 2020). Therefore, public health campaigns must prioritize accurate information dissemination and actively counter misinformation to build public trust in vaccines (Nampanya et al., 2012). This proactive stance is essential for ensuring vaccination efforts are met with community support and participation.
Vaccine hesitancy regarding cholera vaccination is a multifaceted issue that significantly impacts public health outcomes, particularly in regions prone to cholera outbreaks. Vaccine hesitancy is often characterized by a reluctance or refusal to vaccinate despite the availability of vaccination services. This phenomenon can be attributed to various factors, including misinformation, distrust in healthcare systems, cultural beliefs, and fears regarding potential side effects. For instance, Merten et al. (2013) highlighted that local perceptions of cholera and anticipated vaccine acceptance are influenced by knowledge gaps regarding the disease, leading to hesitancy in accepting OCVs. Additionally, cultural beliefs, such as the association of illness with witchcraft or taboos, can further complicate vaccine acceptance. However, Merten et al. (2013) found that these beliefs were not significantly associated with OCV acceptability in their study. Table 5 shows the factors influencing vaccine hesitancy and acceptance.
Table 5: Factors Influencing Vaccine Hesitancy and Acceptance
Distrust in healthcare
Cultural beliefs
Fear of side effects
Socioeconomic factors
Lack of access to healthcare
Negative past experiences
Enhance access to healthcare
Ensure culturally sensitive strategies.
Engage communities in campaign planning and implementation.
Socioeconomic factors also play a crucial role in vaccine hesitancy. Individuals from lower socioeconomic backgrounds may face barriers to accessing healthcare services, which can deter them from seeking vaccination. Sundaram et al. (2015) found that a lack of education was significantly associated with non-acceptance of OCVs, suggesting that educational initiatives are vital for improving vaccine uptake. Furthermore, previous negative experiences with medical interventions can create a lasting distrust in healthcare systems, leading to reluctance to accept vaccines. This distrust is often exacerbated in communities where healthcare infrastructure is weak, as Burnett et al. (2016) noted that the effectiveness of prior health campaigns influenced knowledge and attitudes toward cholera vaccination.
The role of community engagement in addressing vaccine hesitancy cannot be overstated. Effective community engagement strategies can help mitigate concerns and misinformation surrounding cholera vaccines through education and dialogue. For example, Scheffold et al. (2012) emphasized the importance of culturally sensitive approaches in vaccination campaigns, which can enhance community trust and acceptance of OCVs. Engaging local leaders and influencers in the planning and implementing vaccination campaigns can further bolster vaccine acceptance. This is particularly important in regions where traditional beliefs and practices are deeply rooted, as local leaders can serve as trusted sources of information (Scheffold et al., 2012).
Moreover, community participation in vaccination campaigns ensures that strategies are relevant and tailored to the population’s specific needs. Kirpich et al. (2017) demonstrated that community involvement in cholera vaccination efforts in Haiti led to a high acceptance rate, with over 90% of participants receiving both vaccine doses. This highlights the effectiveness of participatory approaches in increasing vaccine uptake. Additionally, the involvement of community members in the planning stages can help identify potential barriers to vaccination and develop targeted interventions to address these challenges (Sundaram et al., 2012).
Educational campaigns are essential for improving public knowledge about cholera and the benefits of vaccination. Studies have shown that increased awareness of cholera transmission pathways and symptoms significantly influences vaccine acceptability (Merten et al., 2013). For instance, in Zanzibar, individuals unaware of cholera’s infectious pathways were less likely to accept the OCV during mass vaccination campaigns (Scheffold et al., 2012). Therefore, comprehensive educational initiatives that inform communities about cholera and the importance of vaccination are crucial for overcoming hesitancy. Furthermore, the timing and delivery of vaccination campaigns can impact public perception and acceptance. For example, the success of cholera vaccination campaigns in Haiti was attributed to the strategic timing of the campaigns, which coincided with periods of heightened cholera risk (Chao et al., 2011). This approach not only maximized vaccine coverage but also reinforced the urgency of vaccination in the minds of community members. Additionally, the use of single-dose OCVs has been proposed as a temporary measure to reduce cholera risk in the short term, which may further enhance community acceptance (Franke et al., 2018).
Trust in healthcare providers is another critical factor influencing vaccine acceptance. Individuals are more likely to accept vaccinations when they receive recommendations from trusted healthcare professionals. This underscores the need for healthcare providers to be well-informed and equipped to address concerns related to cholera vaccination (Stark et al., 2016). Moreover, establishing strong relationships between healthcare providers and community members can foster an environment of trust, which is essential for encouraging vaccine uptake. Despite the challenges posed by vaccine hesitancy, successful examples of cholera vaccination campaigns have effectively addressed public concerns. For instance, implementing community-based strategies in Uganda demonstrated the feasibility and effectiveness of OCV campaigns in response to cholera outbreaks (Bwire et al., 2020). These campaigns improved vaccine coverage and enhanced community engagement and trust in the healthcare system. Such examples highlight the potential for tailored interventions to overcome barriers to vaccine acceptance.
Vaccines are integral to the prevention and control of cholera, serving as a vital tool in long-term strategies aimed at mitigating the impact of this devastating disease. The current cholera vaccine landscape features a range of formulations, such as Dukoral®, Shanchol®, and Euvichol®, each with distinct advantages and limitations. To enhance vaccination efforts, it is essential to address the multifaceted challenges of vaccine distribution and access, which include public hesitancy, regulatory hurdles, and infrastructure limitations. A comprehensive approach that combines vaccination with improved sanitation practices, environmental monitoring, and equitable healthcare access is crucial for effectively reducing the global burden of cholera.
Emerging vaccine technologies, such as single-dose and thermostable vaccines, present promising prospects for cholera control, particularly in vulnerable populations and outbreak-prone regions. Ongoing research and innovative strategies are necessary to overcome existing barriers to vaccination, while community engagement and education will be vital in building trust and fostering vaccine acceptance. By prioritizing high-risk populations and integrating vaccination efforts with robust public health initiatives, including water, sanitation, and hygiene (WASH) programmes, we can enhance the effectiveness of cholera prevention efforts. The collaboration of public health authorities, communities, and researchers will be paramount in the pursuit of cholera elimination and protecting those most at risk.
Alberti, K. P., King, L. A., Burny, M. E., Ilunga, B. K., & Grais, R. F. (2010). Reactive vaccination as an effective tool for measles outbreak control in measles mortality reduction settings, Democratic Republic of Congo, 2005–2006. International Health, 2(1), 65-68. https://doi.org/10.1016/j.inhe.2009.12.009
Ali, M., Debes, A. K., Luquero, F. J., Kim, D. R., Park, J. Y., Digilio, L., Manna, B., Kanungo, S., Dutta, S., Sur, D., et al. (2016). Potential for controlling cholera using a ring vaccination strategy: Re-analysis of data from a cluster-randomized clinical trial. PLOS Medicine, 13(9), e1002120. https://doi.org/10.1371/journal.pmed.1002120
Ali, M., Nelson, A., Luquero, F. J., Azman, A. S., Debes, A. K., M’bang’ombe, M. M., Seyama, L., Kachale, E., Zuze, K., Malichi, D., et al. (2017). Safety of a killed oral cholera vaccine (Shanchol) in pregnant women in Malawi: An observational cohort study. The Lancet Infectious Diseases, 17(5), 538-544. https://doi.org/10.1016/s1473-3099(16)30523-0
Alkahmous, M. A., Alyahya, A. Z. T., Almansour, A. N., Aldhfeeri, M. T., Alsanari, A. A., & Fagehi, S. E. Y. (2023). Assessment of vaccination rates and barriers in family medicine practices: A cross-sectional study. Middle East Journal of Family Medicine, 21(9), 25-32. https://doi.org/10.5742/mewfm.2023.95256192
Arteaga, M., Velasco, J., Rodriguez, S., Vidal, M., Arellano, C., Silva, F., Carreño, L. J., Vidal, R., & Montero, D. A. (2020). Genomic characterization of the non-O1/non-O139 Vibrio cholerae strain that caused a gastroenteritis outbreak in Santiago, Chile, 2018. Microbial Genomics, 6(3), e000340. https://doi.org/10.1101/835090
Azman, A. S., & Lessler, J. (2015). Reactive vaccination in the presence of disease hotspots. Proceedings of the Royal Society B: Biological Sciences, 282(1798), 20141341. https://doi.org/10.1098/rspb.2014.1341
Azman, A. S., Luquero, F. J., Rodrigues, A., Palma, P. P., Grais, R. F., Banga, C. N., Grenfell, B. T., & Lessler, J. (2012). Urban cholera transmission hotspots and their implications for reactive vaccination: Evidence from Bissau City, Guinea Bissau. PLOS Neglected Tropical Diseases, 6(11), e1901. https://doi.org/10.1371/journal.pntd.0001901
Bekolo, C. E., van Loenhout, J. A. F., Rodriguez-Llanes, J. M., Rumunu, J., Ramadan, O. P., & Guha-Sapir, D. (2016). A retrospective analysis of oral cholera vaccine use, disease severity, and deaths during an outbreak in South Sudan. Bulletin of the World Health Organization, 94(9), 667. https://doi.org/10.2471/blt.15.166892
Burnett, E., Dalipanda, T., Ogaoga, D., Gaiofa, J., Jilini, G., Halpin, A., Dietz, V., Date, K., Mintz, E., Hyde, T., et al. (2016). Knowledge, attitudes, and practices regarding diarrhea and cholera following an oral cholera vaccination campaign in the Solomon Islands. PLOS Neglected Tropical Diseases, 10(8), e0004937. https://doi.org/10.1371/journal.pntd.0004937
Bwire, G., Debes, A. K., Orach, C. G., Kagirita, A., Ram, M., Komakech, H., Voeglein, J. B., Buyinza, A. W., Obala, T., Brooks, W. A., & Sack, D. A. (2018). Environmental surveillance of Vibrio cholerae O1/O139 in Uganda’s five African Great Lakes and other major surface water sources. Frontiers in Microbiology, 9, 1560. https://doi.org/10.3389/fmicb.2018.01560
Bwire, G., Kisakye, A., Amulen, E., Bwanika, J. B., Badebye, J., Aanyu, C., Nakirya, B. D., Okello, A., Okello, S. A., Bukenya, J. N., et al. (2022). Prevention of cholera and COVID-19 pandemics in Uganda: Understanding vaccine coverage survey plus. BMC Infectious Diseases. https://doi.org/10.21203/rs.3.rs-1997127/v1
Bwire, G., Roskosky, M., Ballard, A., Brooks, W. A., Okello, A., Rafael, F., Ampeire, I., Orach, C. G., & Sack, D. A. (2020). Use of surveys to evaluate an integrated oral cholera vaccine campaign in response to a cholera outbreak in Hoima District, Uganda. BMJ Open, 10(12), e038464. https://doi.org/10.1136/bmjopen-2020-038464
Bwire, G., Sack, D. A., Almeida, M., Li, S., Voeglein, J. B., Debes, A. K., Kagirita, A., Buyinza, A. W., Orach, C. G., & Stine, O. C. (2018). Molecular characterization of Vibrio cholerae responsible for cholera epidemics in Uganda by PCR, MLVA, and WGS. PLOS Neglected Tropical Diseases, 12(6), e0006492. https://doi.org/10.1371/journal.pntd.0006492
Chao, D. L., Halloran, M. E., & Longini Jr, I. M. (2011). Vaccination strategies for epidemic cholera in Haiti with implications for the developing world. Proceedings of the National Academy of Sciences, 108(17), 7081-7085. https://doi.org/10.1073/pnas.1102149108
Charles, R. C., Hilaire, I. J., Mayo-Smith, L. M., Teng, J. E., Jerome, J. G., Franke, M. F., Saha, A., Yu, Y., Kováč, P., Calderwood, S. B., et al. (2014). Immunogenicity of a killed bivalent (O1 and O139) whole cell oral cholera vaccine, Shanchol, in Haiti. PLOS Neglected Tropical Diseases, 8(5), e2828. https://doi.org/10.1371/journal.pntd.0002828
Dean, N. E., Gsell, P. S., Brookmeyer, R., De Gruttola, V., Donnelly, C. A., Halloran, M. E., Jasseh, M., Nason, M., Riveros, X., Watson, C. H., & others. (2019). Design of vaccine efficacy trials during public health emergencies. Science Translational Medicine, 11(499). https://doi.org/10.1126/scitranslmed.aat0360
Dimitrov, D. T., Troeger, C., Halloran, M. E., Longini, I. M., & Chao, D. L. (2014). Comparative effectiveness of different strategies of oral cholera vaccination in Bangladesh: A modeling study. PLoS Neglected Tropical Diseases, 8(12), e3343. https://doi.org/10.1371/journal.pntd.0003343
Duan, Y., Shi, J., Wang, Z., Zhou, S., Jin, Y., & Zheng, Z. J. (2021). Disparities in COVID-19 vaccination among low-, middle-, and high-income countries: The mediating role of vaccination policy. Vaccines, 9(8), 905. https://doi.org/10.3390/vaccines9080905
Escoffery, C., Ogutu, E. A., Sakas, Z., Hester, K. A., Ellis, A., Rodriguez, K., Jaishwal, C., Yang, C., Dixit, S., Bose, A., & others. (2023). Drivers of early childhood vaccination success in Nepal, Senegal, and Zambia: A multiple case study analysis using the consolidated framework for implementation research. Implementation Science Communications, 4(1), 109. https://doi.org/10.1101/2023.04.05.23288208
Falkard, B., Charles, R. C., Matias, W. R., Mayo-Smith, L. M., Jerome, J. G., Offord, E. S., Xu, P., Kováč, P., Ryan, E. T., Qadri, F., & others. (2019). Bivalent oral cholera vaccination induces a memory B cell response to the V. cholerae O1-polysaccharide antigen in Haitian adults. PLoS Neglected Tropical Diseases, 13(1), e0007057. https://doi.org/10.1371/journal.pntd.0007057
Faucher, B., Assab, R., Roux, J., Levy-Bruhl, D., Kiem, C. T., Cauchemez, S., Zanetti, L., Colizza, V., Boëlle, P. Y., & Poletto, C. (2021). Reactive vaccination of workplaces and schools against COVID-19. medRxiv. https://doi.org/10.1101/2021.07.26.21261133
Faucher, B., Assab, R., Roux, J., Levy-Bruhl, D., Tran Kiem, C., Cauchemez, S., Zanetti, L., Colizza, V., Boëlle, P. Y., & Poletto, C. (2022). Agent-based modelling of reactive vaccination of workplaces and schools against COVID-19. Nature Communications, 13(1), 1414. https://doi.org/10.1038/s41467-022-29015-y
Forman, R., Shah, S., Jeurissen, P., Jit, M., & Mossialos, E. (2021). COVID-19 vaccine challenges: What have we learned so far and what remains to be done? Health Policy, 125(5), 553–567. https://doi.org/10.1016/j.healthpol.2021.03.013
Franke, M. F., Ternier, R., Jerome, J. G., Matias, W. R., Harris, J. B., & Ivers, L. C. (2018). Long-term effectiveness of one and two doses of a killed, bivalent, whole-cell oral cholera vaccine in Haiti: An extended case-control study. The Lancet Global Health, 6(9), e1028–e1035. https://doi.org/10.1016/S2214-109X(18)30284-5
Gachohi, J., Bett, B., Otieno, F., Mogoa, E., Njoki, P., Muturi, M., Mwatondo, A., Osoro, E., Ngere, I., Dawa, J., & others. (2022). Anthrax hotspot mapping in Kenya support establishing a sustainable two-phase elimination program targeting less than 6% of the country landmass. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-24000-3
Hall, V., Banerjee, E., Kenyon, C., Strain, A., Griffith, J., Como‐Sabetti, K., Heath, J., Bahta, L., Martin, K., McMahon, M., & others. (2017). Measles outbreak — Minnesota April–May 2017. MMWR Morbidity and Mortality Weekly Report, 66(27), 713–717. https://doi.org/10.15585/mmwr.mm6627a1
Harris, J. B. (2018). Cholera: Immunity and prospects in vaccine development. The Journal of Infectious Diseases, 218(Suppl 3), S141–S146. https://doi.org/10.1093/infdis/jiy414
El Hayek, P., Boueri, M., Nasr, L., Aoun, C., Sayad, E., & Jallad, K. (2023). Cholera infection risks and cholera vaccine safety in pregnancy. Infectious Diseases in Obstetrics and Gynecology, 2023, 1–8. https://doi.org/10.1155/2023/4563797
Hill, M., & Okugo, G. (2014). Emergency medicine physician attitudes toward HPV vaccine uptake in an emergency department setting. Human Vaccines & Immunotherapeutics, 10(9), 2551–2556. https://doi.org/10.4161/21645515.2014.970933
Hsiao, A., Desai, S. N., Mogasale, V., Excler, J. L., & Digilio, L. (2017). Lessons learnt from 12 oral cholera vaccine campaigns in resource-poor settings. Bulletin of the World Health Organization, 95(4), 303–312. https://doi.org/10.2471/blt.16.175166
Ilboudo, P. G., & Le Gargasson, J. B. (2017). Delivery cost analysis of a reactive mass cholera vaccination campaign: A case study of Shanchol™ vaccine use in Lake Chilwa, Malawi. BMC Infectious Diseases, 17(1). https://doi.org/10.1186/s12879-017-2885-8
Ilboudo, P. G., Mengel, M. A., Gessner, B. D., Ngwira, B., Cavailler, P., & Le Gargasson, J. B. (2021). Cost-effectiveness of a reactive oral cholera immunization campaign using Shanchol™ in Malawi. Cost Effectiveness and Resource Allocation, 19(1). https://doi.org/10.1186/s12962-021-00270-y
Islam, K., Hossain, M., Kelly, M., Mayo Smith, L. M., Charles, R. C., Bhuiyan, T. R., Kováč, P., Xu, P., LaRocque, R. C., Calderwood, S. B., & Others. (2018). Anti-O-specific polysaccharide (OSP) immune responses following vaccination with oral cholera vaccine CVD 103-HgR correlate with protection against cholera after infection with wild-type Vibrio cholerae O1 El Tor Inaba in North American volunteers. PLoS Neglected Tropical Diseases, 12(4), e0006376. https://doi.org/10.1371/journal.pntd.0006376
Ivers, L., Charles, R., Hilaire, I., Mayo-Smith, L., Teng, J., Jerome, J., & Harris, J. (2015). Immunogenicity of the bivalent oral cholera vaccine Shanchol in Haitian adults with HIV infection. The Journal of Infectious Diseases, 212(5), 779-783. https://doi.org/10.1093/infdis/jiv108
Ivers, L. C., Hilaire, I. J., Teng, J. E., Almazor, C. P., Jerome, J. G., Ternier, R., Boncy, J., Buteau, J., Murray, M. B., Harris, J. B., & Franke, M. F. (2015). Effectiveness of reactive oral cholera vaccination in rural Haiti: A case-control study and bias-indicator analysis. The Lancet Global Health, 3(3), e162-e168. https://doi.org/10.1016/s2214-109x(14)70368-7
Ivers, L. C., Teng, J. E., Lascher, J., Raymond, M., Weigel, J., Victor, N., Jerome, J. G., Hilaire, I. J., Almazor, C. P., & Ternier, R. (2013). Use of oral cholera vaccine in Haiti: A rural demonstration project. American Journal of Tropical Medicine and Hygiene, 89(4), 617-624. https://doi.org/10.4269/ajtmh.13-0183
Izzati, A. N., Indarwati, R., Makhfudli, M., Utomo, B., Has, E. M. M., Arief, Y. S., & Arifin, H. (2021). Pro- and anti-vaccination among mothers in deciding children’s immunization: A qualitative study. Open Access Macedonian Journal of Medical Sciences, 9(B), 385-391. https://doi.org/10.3889/oamjms.2021.6113
Kanungo, S., Desai, S. N., Nandy, R. K., Bhattacharya, M. K., Kim, D. R., Sinha, A., Mahapatra, T., Yang, J. S., Lopez, A. L., Manna, B., & Others. (2015). Flexibility of oral cholera vaccine dosing—a randomized controlled trial measuring immune responses following alternative vaccination schedules in a cholera hyper-endemic zone. PLoS Neglected Tropical Diseases, 9(3), e0003574. https://doi.org/10.1371/journal.pntd.0003574
Kar, S. K., Pach, A., Sah, B., Kerketta, A. S., Patnaik, B., Mogasale, V., Kim, Y. H., Rath, S. B., Shin, S., Khuntia, H. K., & Others. (2014). Uptake during an oral cholera vaccine pilot demonstration program, Odisha, India. Human Vaccines & Immunotherapeutics, 10(10), 2834-2842. https://doi.org/10.4161/21645515.2014.971655
Kar, S. K., Sah, B., Patnaik, B., Kim, Y. H., Kerketta, A. S., Shin, S., Rath, S. B., Ali, M., Mogasale, V., Khuntia, H. K., & Others. (2014). Mass vaccination with a new, less expensive oral cholera vaccine using public health infrastructure in India: The Odisha model. PLoS Neglected Tropical Diseases, 8(2), e2629. https://doi.org/10.1371/journal.pntd.0002629
Khan, A. I., Levin, A., Chao, D. L., DeRoeck, D., Dimitrov, D. T., Khan, J. A., Islam, M. S., Ali, M., Islam, M. T., Sarker, A. R., & Others. (2018). The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh: A disease modeling and economic analysis. PLoS Neglected Tropical Diseases, 12(10), e0006652. https://doi.org/10.1371/journal.pntd.0006652
Khuntia, H. K., Ramamurthy, T., Bal, M., Pati, S., & Ranjit, M. (2021). Decades of cholera in Odisha, India (1993–2015): Lessons learned and the ways forward. Epidemiology and Infection, 149. https://doi.org/10.1017/s0950268821001266
Kirpich, A., Weppelmann, T. A., Yang, Y., Morris, J. G., Jr., & Longini, I. M., Jr. (2017). Controlling cholera in the Ouest Department of Haiti using oral vaccines. PLoS Neglected Tropical Diseases, 11(4), e0005482. https://doi.org/10.1371/journal.pntd.0005482
Kundrick, A., Huang, Z., Carran, S., Kagoli, M., Grais, R. F., Hurtado, N., & Ferrari, M. (2018). Sub-national variation in measles vaccine coverage and outbreak risk: A case study from a 2010 outbreak in Malawi. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-5628-x
Luquero, F. J., Grout, L., Ciglenecki, I., Sakoba, K., Traore, B., Heile, M., Diallo, A. A., Itama, C., Page, A. L., Quilici, M. L., & Others. (2014). Use of Vibrio cholerae vaccine in an outbreak in Guinea. New England Journal of Medicine, 370(22), 2111-2120. https://doi.org/10.1056/nejmoa1312680
Mahalanabis, D., Lopez, A. L., Sur, D., Deen, J., Manna, B., Kanungo, S., Von Seidlein, L., Carbis, R., Han, S. H., Shin, S. H., & Others. (2008). A randomized, placebo-controlled trial of the bivalent killed, whole-cell, oral cholera vaccine in adults and children in a cholera endemic area in Kolkata, India. PLoS One, 3(6), e2323. https://doi.org/10.1371/journal.pone.0002323
Martin, S., Lopez, A. L., Bellos, A., Deen, J., Ali, M., Alberti, K., Anh, D. D., Costa, A., Grais, R. F., Legros, D., & Others. (2014). Post-licensure deployment of oral cholera vaccines: A systematic review. Bulletin of the World Health Organization, 92(12), 881-893. https://doi.org/10.2471/blt.14.139949
Martinez-Pino, I., Luquero, F. J., Sakoba, K., Sylla, S., Haile, M., Grais, R. F., Ciglenecki, I., Quilici, M. L., & Page, A. L. (2013). Use of a cholera rapid diagnostic test during a mass vaccination campaign in response to an epidemic in Guinea, 2012. PLoS Neglected Tropical Diseases, 7(8), e2366. https://doi.org/10.1371/journal.pntd.0002366
Merler, S., Ajelli, M., Fumanelli, L., Parlamento, S., Pastore y Piontti, A., Dean, N. E., Putoto, G., Carraro, D., Longini, I. M., Jr., Halloran, M. E., & Vespignani, A. (2016). Containing Ebola at the source with ring vaccination. PLoS Neglected Tropical Diseases, 10(11), e0005093. https://doi.org/10.1371/journal.pntd.0005093
Merten, S., Schaetti, C., Manianga, C., Lapika, B., Chaignat, C. L., Hutubessy, R., & Weiss, M. G. (2013). Local perceptions of cholera and anticipated vaccine acceptance in Katanga Province, Democratic Republic of Congo. BMC Public Health, 13(1). https://doi.org/10.1186/1471-2458-13-60
Morales, K. F., Brown, D. W., Dumolard, L., Steulet, C., Vilajeliu, A., Alvarez, A. M. R., Moen, A., Friede, M., & Lambach, P. (2021). Seasonal influenza vaccination policies in the 194 WHO member states: The evolution of global influenza pandemic preparedness and the challenge of sustaining equitable vaccine access. Vaccine X, 8, 100097. https://doi.org/10.1016/j.jvacx.2021.100097
Morrison, M., Castro, L. A., & Meyers, L. A. (2020). Conscientious vaccination exemptions in kindergarten to eighth-grade children across Texas schools from 2012 to 2018: A regression analysis. PLOS Medicine, 17(3), e1003049. https://doi.org/10.1371/journal.pmed.1003049
Mukandavire, Z., Manangazira, P., Nyabadza, F., Cuadros, D. F., Musuka, G., & Morris Jr, J. G. (2020). Stemming cholera tides in Zimbabwe through mass vaccination. International Journal of Infectious Diseases, 96, 222-227. https://doi.org/10.1016/j.ijid.2020.03.077
Mukandavire, Z., Smith, D. L., & Morris Jr, J. G. (2013). Cholera in Haiti: Reproductive numbers and vaccination coverage estimates. Scientific Reports, 3(1). https://doi.org/10.1038/srep00997
Nampanya, S., Richards, J., Khounsy, S., Inthavong, P., Yang, M., Rast, L., & Windsor, P. A. (2012). Investigation of foot and mouth disease hotspots in northern Lao PDR. Transboundary and Emerging Diseases, 60(4), 315-329. https://doi.org/10.1111/j.1865-1682.2012.01350.x
Njim, T., Agyingi, K., Aminde, L. N., & Atunji, E. F. (2016). Trend in mortality from a recent measles outbreak in Cameroon: A retrospective analysis of 223 measles cases in the Benakuma health district. Pan African Medical Journal, 23. https://doi.org/10.11604/pamj.2016.23.135.8630
Nkwenkeu, S. F., Jalloh, M. F., Walldorf, J. A., Zoma, R. L., Tarbangdo, F., Fall, S., Hien, S., Combassere, R., Ky, C., Kambou, L., et al. (2020). Health workers’ perceptions and challenges in implementing meningococcal serogroup A conjugate vaccine in the routine childhood immunization schedule in Burkina Faso. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-8347-z
Parker, L. A., Rumunu, J., Jamet, C., Kenyi, Y., Lino, R. L., Wamala, J. F., Mpairwe, A. M., Muller, V., Llosa, A. E., Uzzeni, F., et al. (2017). Neighborhood-targeted and case-triggered use of a single dose of oral cholera vaccine in an urban setting: Feasibility and vaccine coverage. PLOS Neglected Tropical Diseases, 11(6), e0005652. https://doi.org/10.1371/journal.pntd.0005652
Parpia, A. S., Skrip, L. A., Nsoesie, E. O., Ngwa, M. C., Abah, A. S. A., Galvani, A. P., & Ndeffo-Mbah, M. L. (2020). Spatio-temporal dynamics of measles outbreaks in Cameroon. Annals of Epidemiology, 42, 64-72.e3. https://doi.org/10.1016/j.annepidem.2019.10.007
Peak, C. M., Reilly, A. L., Azman, A. S., & Buckee, C. O. (2018). Prolonging herd immunity to cholera via vaccination: Accounting for human mobility and waning vaccine effects. PLOS Neglected Tropical Diseases, 12(2), e0006257. https://doi.org/10.1371/journal.pntd.0006257
Poncin, M., Zulu, G., Voute, C., Ferreras, E., Muleya, C. M., Malama, K., Pezzoli, L., Mufunda, J., Robert, H., Uzzeni, F., et al. (2017). Implementation research: Reactive mass vaccination with single-dose oral cholera vaccine, Zambia. Bulletin of the World Health Organization, 96(2), 86-93. https://doi.org/10.2471/blt.16.189241
Qadri, F., Ali, M., Lynch, J., Chowdhury, F., Khan, A. I., Wierzba, T. F., Excler, J. L., Saha, A., Islam, M. T., Begum, Y. A., et al. (2018). Efficacy of a single-dose regimen of inactivated whole-cell oral cholera vaccine: Results from 2 years of follow-up of a randomized trial. The Lancet Infectious Diseases, 18(6), 666-674. https://doi.org/10.1016/s1473-3099(18)30108-7
Qadri, F., Wierzba, T. F., Ali, M., Chowdhury, F., Khan, A. I., Saha, A., Khan, I. A., Asaduzzaman, M., Akter, A., Khan, A., et al. (2016). Efficacy of a single-dose, inactivated oral cholera vaccine in Bangladesh. New England Journal of Medicine, 374(18), 1723-1732. https://doi.org/10.1056/nejmoa1510330
Rast, L., Windsor, P. A., & Khounsy, S. (2010). Limiting the impacts of foot and mouth disease in large ruminants in northern Lao People’s Democratic Republic by vaccination: A case study. Transboundary and Emerging Diseases, 57(3), 147-153. https://doi.org/10.1111/j.1865-1682.2010.01099.x
Roskosky, M., Ali, M., Upreti, S. R., & Sack, D. (2020). Spatial clustering of cholera cases in the Kathmandu Valley: Implications for a ring vaccination strategy. International Health, 13(2), 170-177. https://doi.org/10.1093/inthealth/ihaa042
Sarker, A. R., Islam, Z., Khan, I. A., Saha, A., Chowdhury, F., Khan, A. I., Cravioto, A., Clemens, J. D., Qadri, F., & Khan, J. A. (2015). Estimating the cost of cholera-vaccine delivery from the societal point of view: A case of introduction of cholera vaccine in Bangladesh. Vaccine, 33(38), 4916-4921. https://doi.org/10.1016/j.vaccine.2015.07.042
Sayeed, M. A., Bufano, M. K., Xu, P., Eckhoff, G., Charles, R. C., Alam, M. M., Sultana, T., Rashu, M. R., Berger, A., Gonzalez-Escobedo, G., et al. (2015). A cholera conjugate vaccine containing O-specific polysaccharide (OSP) of V. cholerae O1 Inaba and recombinant fragment of tetanus toxin heavy chain (OSP: rTTHc) induces serum, memory and lamina proprial responses against OSP and is protective in mice. PLOS Neglected Tropical Diseases, 9(7), e0003881. https://doi.org/10.1371/journal.pntd.0003881
Schaetti, C., Ali, S. M., Chaignat, C. L., Khatib, A. M., Hutubessy, R., & Weiss, M. G. (2012). Improving community coverage of oral cholera mass vaccination campaigns: Lessons learned in Zanzibar. PLOS ONE, 7(7), e41527. https://doi.org/10.1371/journal.pone.0041527
Schaetti, C., Ali, S. M., Hutubessy, R., Khatib, A. M., Chaignat, C. L., & Weiss, M. G. (2012). Social and cultural determinants of oral cholera vaccine uptake in Zanzibar. Human Vaccines & Immunotherapeutics, 8(9), 1223–1229. https://doi.org/10.4161/hv.20901
Shaikh, B. T., Haq, Z. U., Tran, N., & Hafeez, A. (2018). Health system barriers and levers in implementation of the expanded program on immunization (EPI) in Pakistan: An evidence-informed situation analysis. Public Health Reviews, 39(1), 1–9. https://doi.org/10.1186/s40985-018-0103-x
Sow, S. O., Tapia, M. D., Chen, W. H., Haidara, F. C., Kotloff, K. L., Pasetti, M. F., Blackwelder, W. C., Traoré, A., Tamboura, B., Doumbia, M., et al. (2017). Randomized, placebo-controlled, double-blind phase 2 trial comparing the reactogenicity and immunogenicity of a single standard dose to those of a high dose of CVD 103-HgR live attenuated oral cholera vaccine, with Shanchol inactivated oral vaccine as an open-label immunologic comparator. Clinical and Vaccine Immunology, 24(12). https://doi.org/10.1128/cvi.00265-17
Stark, L. M., Power, M. L., Turrentine, M., Samelson, R., Siddiqui, M. M., Paglia, M. J., Strassberg, E. R., Kelly, E., Murtough, K. L., & Schulkin, J. (2016). Influenza vaccination among pregnant women: Patient beliefs and medical provider practices. Infectious Diseases in Obstetrics and Gynecology, 2016, 1–8. https://doi.org/10.1155/2016/3281975
Sundaram, N., Schaetti, C., Chaignat, C. L., Hutubessy, R., Nyambedha, E. O., Mbonga, L. A., & Weiss, M. G. (2012). Socio-cultural determinants of anticipated acceptance of an oral cholera vaccine in Western Kenya. Epidemiology and Infection, 141(3), 639–650. https://doi.org/10.1017/s0950268812000829
Sur, D., Kanungo, S., Sah, B., Manna, B., Ali, M., Paisley, A. M., Niyogi, S. K., Park, J. K., Sarkar, B., Puri, M. K., et al. (2011). Efficacy of a low-cost, inactivated whole-cell oral cholera vaccine: Results from 3 years of follow-up of a randomized, controlled trial. PLOS Neglected Tropical Diseases, 5(10), e1289. https://doi.org/10.1371/journal.pntd.0001289
Troeger, C., Sack, D. A., & Chao, D. L. (2014). Evaluation of targeted mass cholera vaccination strategies in Bangladesh: A demonstration of a new cost-effectiveness calculator. American Journal of Tropical Medicine and Hygiene, 91(6), 1181–1189. https://doi.org/10.4269/ajtmh.14-0159
Yazdani, A. T., Muhammad, A., Nisar, M. I., Khan, U., & Shafiq, Y. (2021). Unveiling and addressing implementation barriers to routine immunization in the peri-urban slums of Karachi, Pakistan: A mixed-methods study. Health Research Policy and Systems, 19(1), 1–9. https://doi.org/10.21203/rs.3.rs-204016/v1
Etim, NG; Joshua, G; Izah, SC; Alaka, OO; Udensi, CI; Etim, EN (2024). Cholera Vaccine Development: Progress, Efficacy, and Public Health Strategies. Greener Journal of Biomedical and Health Sciences, 7(1), 47-60, https://doi.org/10.15580/gjbhs.2024.1.102024146.
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