Considerations for Oral Cholera Vaccine Use during Outbreak after Earthquake in Haiti, 2010−2011

Kashmira Date,Brenton Burkholder,M Carolina Danovaro-Holliday,Ariel Henry,Joseph Abrams,Thierry Roels,Terri Hyde,Vance Dietz,Andrea Vicari,Jon Andrus,Eric Mintz,Jordan Tappero,Cuauhtemoc Ruiz-Matus

doi:10.3201/eid1711.110822

Abstract

Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and preemptively during outbreaks and complex emergencies. However, experience and guidelines for reactive use after an outbreak has started are limited. In 2010, after over a century without epidemic cholera, an outbreak was reported in Haiti after an earthquake. As intensive nonvaccine cholera control measures were initiated, the feasibility of OCV use was considered. We reviewed OCV characteristics and recommendations for their use and assessed global vaccine availability and capacity to implement a vaccination campaign. Real-time modeling was conducted to estimate vaccine impact. Ultimately, cholera vaccination was not implemented because of limited vaccine availability, complex logistical and operational challenges of a multidose regimen, and obstacles to conducting a campaign in a setting with population displacement and civil unrest. Use of OCVs is an option for cholera control; guidelines for their appropriate use in epidemic and emergency settings are urgently needed.

Highlights

If you have some statistical information from previous years or weeks verify if the actual increase of cases is unusual over the same period of time
It is important to differentiate between shigella or cholera in order to improve case management and to estimate needed supplies
Nasogastric tubes can be used for rehydration when Oral Rehydration Salt (ORS) solution increases vomiting and nausea or when the patient cannot drink

Summary

Is this the beginning of an outbreak?

You might be facing an outbreak very soon if you have seen an unusual number of acute diarrhoeal cases this week and the patients have the following points in common:. If you have some statistical information from previous years or weeks verify if the actual increase of cases is unusual over the same period of time

Is the patient suffering from cholera or shigella?

Rehydrate depending on severity

Give antibiotics if needed