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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effectiveness of mass oral cholera vaccination in Beira, Mozambique
New England Journal of Medicine, Volume 352, No. 8, Year 2005
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Description
BACKGROUND: New-generation, orally administered cholera vaccines offer the promise of improved control of cholera in sub-Saharan Africa. However, the high prevalence of human immunodeficiency virus (HIV) infection in many cholera-affected African populations has raised doubts about the level of protection possible with vaccination. We evaluated a mass immunization program with recombinant cholera-toxin B subunit, killed whole-cell (rBS-WC) oral cholera vaccine in Beira, Mozambique, a city where the seroprevalence of HIV is 20 to 30 percent. METHODS: From December 2003 to January 2004, we undertook mass immunization of nonpregnant persons at least two years of age, using a two-dose regimen of rBS-WC vaccine in Esturro, Beira (population 21,818). We then assessed vaccine protection in a case-control study during an outbreak of El Tor Ogawa cholera in Beira between January and May 2004. To estimate the level of vaccine protection, antecedent rates of vaccination were compared between persons with culture-confirmed cholera severe enough to have prompted them to seek treatment and age- and sex-matched neighborhood controls without treated diarrhea. RESULTS: We assessed the effectiveness of the vaccine in 43 persons with cholera and 172 controls. Receipt of one or more doses of rbS-WC vaccine was associated with 78 percent protection (95 percent confidence interval, 39 to 92 percent; P=0.004). The vaccine was equally effective in children younger than five years of age and in older persons. A concurrently conducted case-control study designed to detect bias compared persons with treated, noncholeraic diarrhea and controls without diarrhea in the same population and found no protection associated with receipt of the rBS-WC vaccine. CONCLUSIONS: The rBS-WC vaccine was highly effective against clinically significant cholera in an urban sub-Saharan African population with a high prevalence of HIV infection. Copyright © 2005 Massachusetts Medical Society.
Authors & Co-Authors
Lucas, Marcelino E.S.
Mozambique, Maputo
Ministry of Health Mozambique
Deen, Jacqueline L.
South Korea, Seoul
International Vaccine Institute, Seoul
Von-Seidlein, Lorenz
South Korea, Seoul
International Vaccine Institute, Seoul
Wang, Xuanyi
South Korea, Seoul
International Vaccine Institute, Seoul
Ampuero, Julia
France, Paris
Epicentre
Puri, Mahesh K.
South Korea, Seoul
International Vaccine Institute, Seoul
Ali, Mohammad M.
South Korea, Seoul
International Vaccine Institute, Seoul
Ansaruzzaman, Mohammed
Bangladesh, Dhaka
Icddr, b Centre for Health and Population Research
Amos, Juvenaldo
Mozambique, Maputo
Ministry of Health Mozambique
Macuamule, Arminda
Mozambique, Maputo
Ministry of Health Mozambique
Cavailler, Philippe
France, Paris
Epicentre
Guérin, Philippe Jean Jean
France, Paris
Epicentre
Mahoudeau, Claude
Switzerland, Geneva
Medecins Sans Frontieres
Kahozi-Sangwa, Pierre
Switzerland, Geneva
Organisation Mondiale de la Santé
Chaignat, Claire Lise
Unknown Affiliation
Barreto, Avertino T.L.
Mozambique, Maputo
Ministry of Health Mozambique
Songane, Francisco Ferreira
Mozambique, Maputo
Ministry of Health Mozambique
Clemens, John David
South Korea, Seoul
International Vaccine Institute, Seoul
Statistics
Citations: 261
Authors: 18
Affiliations: 6
Identifiers
Doi:
10.1056/NEJMoa043323
ISSN:
00284793
Research Areas
Health System And Policy
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Case-Control Study
Study Locations
Mozambique