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A Quantitative Systematic Review and Meta-Analysis of the Effectiveness of Oral Cholera Vaccine as a Reactive Measure in Cholera Outbreaks

  • Patricia Schwerdtle (a1) (a2), Coretta-Kings Onekon (a3) and Katrina Recoche (a1)
Abstract
Introduction

The efficacy of oral cholera vaccines (OCVs) in laboratory conditions has been established, and the World Health Organization (WHO; Geneva, Switzerland) has recommended their preventative use in high-risk settings. The WHO recommendation has not been fully operationalized, nor has it been extended to apply to the reactive use of OCVs in real field epidemic conditions due to concerns about potential resource diversion, feasibility, cost, and acceptability. The purpose of this study is to assess and synthesize existing evidence of OCV effectiveness when used reactively in real field conditions.

Methods

A systematic review and meta-analysis was conducted involving studies that investigated vaccine effectiveness when used as a reactive measure; that is, cases had reached epidemic threshold and a cholera epidemic was declared in real field epidemic conditions. OVID Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA), and EMBASE (Elsevier; Amsterdam, Netherlands), along with grey literature, were systematically searched using pre-determined criteria. Two independent reviewers identified studies that met the selection criteria and data were extracted using validated tools. Pooled estimates were obtained using fixed effect models.

Results

Of the 347 articles that met the inclusion criteria, four studies were retrieved for meta-analysis (three were case-control studies and one was a case-cohort study) involving a total of 1,509 participants and comprising 175 cases and 1,334 case controls. The effectiveness of one or two doses of either Shanchol (Shantha Biotechnics; India) or ORC-Vax (Vabiotech; Vietnam) OCVs showed a combined vaccine effectiveness of 75% (95% CI, 61-84).

Conclusion

A positive association was demonstrated between the reactive use of OCVs and protection against cholera. This supported the WHO recommendation to utilize OCVs reactively as an additional measure to the standard cholera epidemic response package.

Schwerdtle P , Onekon CK , Recoche K . A Quantitative Systematic Review and Meta-Analysis of the Effectiveness of Oral Cholera Vaccine as a Reactive Measure in Cholera Outbreaks. Prehosp Disaster Med. 2018;33(1):26.

Copyright
Corresponding author
Correspondence: Patricia Schwerdtle, MPH Monash University Nursing and Midwifery Faculty of Medicine, Nursing, and Health Sciences Melbourne, Victoria, Australia E-mail: patricia.schwerdtle@monash.edu
Footnotes
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Conflicts of interest: none.

Footnotes
References
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1. Verma, R, Khanna, P, Chawla, S. Cholera vaccine: new preventive tool for endemic countries. Hum Vaccin Immunother. 2012;8(5):682-684.
2. Weinberg, GA, Szilagyi, PG. Vaccine epidemiology: efficacy, effectiveness, and the translational research roadmap. J Infect Dis. 2010;201(11):1607-1610.
3. Luquero, FJ, Grout, L, Ciglenecki, I, et al. Use of Vibrio cholerae vaccine in an outbreak in Guinea. N Engl J Med. 2014;370(22):2111-2120.
4. World Health Organization. Cholera vaccines: WHO position paper-recommendations. Vaccine. 2010;28(30):4687-4688.
5. Date, KA, Vicari, A, Hyde, TB, et al. Considerations for oral cholera vaccine use during outbreak after earthquake in Haiti, 2010-2011. Emerging Infectious Diseases. 2011;17(11):2105-2112.
6. Deen, J, Ali, M, Sack, D. Methods to assess the impact of mass oral cholera vaccination campaigns under real field conditions. PLoS ONE. 2014;9(2):e88139.
7. Ciglenecki, I, Sakoba, K, Luquero, FJ, et al. Feasibility of mass vaccination campaign with oral cholera vaccines in response to an outbreak in Guinea. PLoS Med. 2013;10(9):e1001512.
8. Clemens, J, Shin, S, Sur, D, Nair, GB, Holmgren, J. New-generation vaccines against cholera. Nat Rev Gastroenterol Hepatol. 2011;8(12):701-710.
9. Ali, M, Lopez, AL, You, YA, et al. The global burden of cholera. Bull World Health Org. 2012;90(3):209-218A.
10. World Health Organization. Cholera Fact sheet no. 107. 2015. http://www.who.int/mediacentre/factsheets/fs107/en/. Accessed February 17, 2017.
11. World Health Organization. WHO technical working group on creation of an oral cholera vaccine stockpile: meeting report; Geneva, Switzerland: April 26-27, 2012.
12. CDC. Principles of Epidemiology in Public Health practice, Third Edition. An Introduction to Applied Epidemiology and Biostatistics. 2012. http://www.cdc.gov/ophss/csels/dsepd/SS1978/Lesson1/Section1.html. Accessed February 17, 2017.
13. Calain, P, Chaine, JP, Johnson, E, et al. Can oral cholera vaccination play a role in controlling a cholera outbreak? Vaccine. 2004;22(19):2444-2451.
14. Kim, SY, Choi, Y, Mason, PR, Rusakaniko, S, Goldie, SJ. Potential impact of reactive vaccination in controlling cholera outbreaks: an exploratory analysis using a Zimbabwean experience. South African Medical Journal. 2011;101(9):659-664.
15. von Seidlein, L, Jiddawi, M, Grais, RF, Luquero, F, Lucas, M, Deen, J. The value of and challenges for cholera vaccines in Africa. J Infect Dis. 2013;208(Suppl 1):S8-S14.
16. OXFAM. Cholera Outbreak Guidelines. 2014. https://www.unicef.org/cholera_toolkit/Annexes/Supporting_Resources/Annex_6B/OXFAM_Cholera_guidelines.pdf. Accessed February 17, 2017.
17. Ivers, LC, Hilaire, IJ, Teng, JE, et al. Effectiveness of reactive oral cholera vaccination in rural Haiti: a case-control study and bias-indicator analysis. Lancet Glob Health. 2015;3(3):e162-e168.
18. The Joanna Briggs Institute. New JBI levels of evidence. 2014. http://joannabriggs.org/assets/docs/approach/JBI-Levels-of-evidence_2014.pdf. Accessed February 17, 2017.
19. The Joanna Briggs Institute. Joanna Briggs Institute Reviewers’ Manual: 2016 Edition. Adelaide, Australia: The Joanna Briggs Institute; 2016.
20. Buttner, P, Muller, R. Epidemiology. Melbourne, Australia: Oxford Press; 2011.
21. Azman, A, Parker, L, Rumunu, J, et al. The effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort study. Lancet Glob Health. 2016;4(11):e856-e863.
22. Cochrane Community, Review Manager (RevMan). http://community.cochrane.org/editorial-and-publishing-policy-resource/information-technology/review-manager-revman. Accessed February 17, 2017.
23. Borenstein, M. Introduction to Meta-Analysis. Chichester, England: John Wiley and Sons; 2009.
24. Oliviera, SC, Fonseca, CT, Cardoso, FC, Farias, LP, Leite, LC. Recent advances in vaccine research against schistosomiasis in Brazil. Acta Trop. 2008;108(2-3):256-262.
25. Anh, DD, Lopez, AL, Thiem, VD, et al. Use of oral cholera vaccines in an outbreak in Vietnam: a case control study. PLoS Negl Tropl Dis. 2011;5(1):e1006.
26. Taylor, DL, Kahawita, TM, Cairncross, S, Ensink, JHJ. The impact of water, sanitation, and hygiene interventions to control cholera: a systematic review. PLOS One. 2015;10(8):e0135676.
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