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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Effectiveness of an oral cholera vaccine in Zanzibar: Findings from a mass vaccination campaign and observational cohort study
The Lancet Infectious Diseases, Volume 12, No. 11, Year 2012
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Description
Background: Zanzibar, in east Africa, has been severely and repeatedly affected by cholera since 1978. We assessed the effectiveness of oral cholera vaccination in high-risk populations in the archipelago to estimate the indirect (herd) protection conferred by the vaccine and direct vaccine effectiveness. Methods: We offered two doses of a killed whole-cell B-subunit cholera vaccine to individuals aged 2 years and older in six rural and urban sites. To estimate vaccine direct protection, we compared the incidence of cholera between recipients and non-recipients using generalised estimating equations with the log link function while controlling for potential confounding variables. To estimate indirect effects, we used a geographic information systems approach and assessed the association between neighbourhood-level vaccine coverage and the risk for cholera in the non-vaccinated residents of that neighbourhood, after controlling for potential confounding variables. This study is registered with . ClinicalTrials.gov, number . NCT00709410. Findings: Of 48 178 individuals eligible to receive the vaccine, 23 921 (50%) received two doses. Between February, 2009, and May, 2010, there was an outbreak of cholera, enabling us to assess vaccine effectiveness. The vaccine conferred 79% (95% CI 47-92) direct protection against cholera in participants who received two doses. Indirect (herd) protection was shown by a decrease in the risk for cholera of non-vaccinated residents within a household's neighbourhood as the vaccine coverage in that neighbourhood increased. Interpretation: Our findings suggest that the oral cholera vaccine offers both direct and indirect (herd) protection in a sub-Saharan African setting. Mass oral cholera immunisation campaigns have the potential to provide not only protection for vaccinated individuals but also for the unvaccinated members of the community and should be strongly considered for wider use. Because this is an internationally-licensed vaccine, we could not undertake a randomised placebo-controlled trial, but the absence of vaccine effectiveness against non-cholera diarrhoea indicates that the noted protection against cholera could not be explained by bias. Funding: Bill & Melinda Gates Foundation, Swedish International Development Cooperation Agency, and the South Korean Government. © 2012 Elsevier Ltd.
Authors & Co-Authors
Khatib, Ahmed M.
Tanzania, Dar es Salaam
Ministry of Health and Social Welfare Dar es Salaam
Ali, Mohammad M.
South Korea, Seoul
International Vaccine Institute, Seoul
Von-Seidlein, Lorenz
Australia, Darwin
Menzies School of Health Research
Kim, Deokryun
South Korea, Seoul
International Vaccine Institute, Seoul
Hashim, Ramadhan
South Korea, Seoul
International Vaccine Institute, Seoul
Reyburn, Rita C.
South Korea, Seoul
International Vaccine Institute, Seoul
Ley, Benedikt B.
South Korea, Seoul
International Vaccine Institute, Seoul
Thriemer, Kamala L.
South Korea, Seoul
International Vaccine Institute, Seoul
Enwere, Godwin C.
Switzerland, Geneva
Organisation Mondiale de la Santé
Hutubessy, Raymond Christiaan W.
Switzerland, Geneva
Organisation Mondiale de la Santé
Aguado, Maria Teresa
Switzerland, Geneva
Organisation Mondiale de la Santé
Kiény, Marie Paule
Switzerland, Geneva
Organisation Mondiale de la Santé
Lopez, Anna Lena
South Korea, Seoul
International Vaccine Institute, Seoul
Wierzba, Thomas F.
South Korea, Seoul
International Vaccine Institute, Seoul
Ali, Said Mohammed
Tanzania, Mkokotoni, Zanzibar
Public Health Laboratory
Saleh, Abdul A.
Tanzania, Dar es Salaam
Ministry of Health and Social Welfare Dar es Salaam
Mukhopadhyay, Asish Kumar
India, Kolkata
National Institute of Cholera and Enteric Diseases India
Clemens, John David
South Korea, Seoul
International Vaccine Institute, Seoul
Jiddawi, Mohamed Saleh
Tanzania, Dar es Salaam
Ministry of Health and Social Welfare Dar es Salaam
Deen, Jacqueline L.
South Korea, Seoul
International Vaccine Institute, Seoul
Australia, Darwin
Menzies School of Health Research
Statistics
Citations: 117
Authors: 20
Affiliations: 6
Identifiers
Doi:
10.1016/S1473-3099(12)70196-2
ISSN:
14733099
e-ISSN:
14744457
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Multi-countries