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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Herd protection by a bivalent killed whole-cell oral cholera vaccine in the slums of Kolkata, India
Clinical Infectious Diseases, Volume 56, No. 8, Year 2013
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Description
Background. We evaluated the herd protection conferred by an oral cholera vaccine using 2 approaches: cluster design and geographic information system (GIS) design.Methods. Residents living in 3933 dwellings (clusters) in Kolkata, India, were cluster-randomized to receive either cholera vaccine or oral placebo. Nonpregnant residents aged ≥1 year were invited to participate in the trial. Only the first episode of cholera detected for a subject between 14 and 1095 days after a second dose was considered. In the cluster design, indirect protection was assessed by comparing the incidence of cholera among nonparticipants in vaccine clusters vs those in placebo clusters. In the GIS analysis, herd protection was assessed by evaluating association between vaccine coverage among the population residing within 250 m of the household and the occurrence of cholera in that population.Results. Among 107 347 eligible residents, 66 990 received 2 doses of either cholera vaccine or placebo. In the cluster design, the 3-year data showed significant total protection (66% protection, 95% confidence interval [CI], 50%-78%, P <. 01) but no evidence of indirect protection. With the GIS approach, the risk of cholera among placebo recipients was inversely related to neighborhood-level vaccine coverage, and the trend was highly significant (P <. 01). This relationship held in multivariable models that also controlled for potentially confounding demographic variables (hazard ratio, 0.94 [95% CI,. 90-.98]; P <. 01).Conclusions. Indirect protection was evident in analyses using the GIS approach but not the cluster design approach, likely owing to considerable transmission of cholera between clusters, which would vitiate herd protection in the cluster analyses. © 2013 The Author 2013. Published.
Authors & Co-Authors
Ali, Mohammad M.
South Korea, Seoul
Seoul National University
Sur, Deepika
India, Kolkata
National Institute of Cholera and Enteric Diseases India
You, Young-ae
South Korea, Seoul
Seoul National University
Kanungo, Suman
India, Kolkata
National Institute of Cholera and Enteric Diseases India
Sah, Binod K.
South Korea, Seoul
Seoul National University
Manna, Byomkesh
India, Kolkata
National Institute of Cholera and Enteric Diseases India
Puri, Mahesh K.
South Korea, Seoul
Seoul National University
Wierzba, Thomas F.
South Korea, Seoul
Seoul National University
Donner, Allan P.
Canada, London
Western University
Nair, Gopinath Balakrish
India, Kolkata
National Institute of Cholera and Enteric Diseases India
Bhattacharya, Sujit Kumar
India, Kolkata
Society for Applied Studies Kolkata
Deen, Jacqueline L.
Australia, Darwin
Menzies School of Health Research
Lopez, Anna Lena
South Korea, Seoul
Seoul National University
Philippines, Manila
National Institutes of Health, University of the Philippines Manila
Clemens, John David
South Korea, Seoul
Seoul National University
United States, Los Angeles
University of California, Los Angeles
Statistics
Citations: 57
Authors: 14
Affiliations: 7
Identifiers
Doi:
10.1093/cid/cit009
ISSN:
15376591
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Randomised Control Trial
Cross Sectional Study
Cohort Study