Organization and implementation of an oral cholera vaccination campaign in an endemic urban setting in Dhaka, Bangladesh

Iqbal Ansary Khan,Ashraful Islam Khan,Anisur Rahman,Shah Alam Siddique,Md Taufiqul Islam,Md Amirul Islam Bhuiyan,Atique Iqbal Chowdhury,Nirod Chandra Saha,Prasanta Kumar Biswas,Amit Saha,Fahima Chowdhury,John D Clemens,Firdausi Qadri

doi:10.1080/16549716.2019.1574544

Iqbal Ansary Khan, Ashraful Islam Khan + Show 11 more

Open Access

https://doi.org/10.1080/16549716.2019.1574544

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Abstract

ABSTRACTBangladesh has historically been cholera endemic, with seasonal cholera outbreaks occurring each year. In collaboration with the government of Bangladesh, the Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) initiated operational research to test strategies to reach the high-risk urban population with an affordable oral cholera vaccine (OCV) “ShancholTM” and examine its effectiveness in reducing diarrhea due to cholera. Here we report a sub-analysis focusing on the organization, implementation and effectiveness of different oral cholera vaccine delivery strategies in the endemic urban setting in Bangladesh. We described how the vaccination program was planned, prepared and implemented using different strategies to deliver oral cholera vaccine to a high-risk urban population in Dhaka, Bangladesh based on administrative data and observations made during the program. The objective of this study is to evaluate the organization, implementation and effectiveness of different oral cholera vaccine delivery strategies in the endemic urban setting in Bangladesh. OCV administration by trained local volunteers through outreach sites and mop-up activities yielded high coverage of 82% and 72% of 172,754 targeted individuals for the first and second dose respectively, using national Expanded Program on Immunization (EPI) campaign mechanisms without disrupting routine immunization activities. The cost of delivery was low. Safety and cold chain requirements were adequately managed. The adopted strategies were technically and programmatically feasible. Current evidence on implementation strategies in different settings together with available OCV stockpiles should encourage at-risk countries to use OCV along with other preventive and control measures.

Highlights

Over the last few years, safe and effective use of the oral cholera vaccine (OCV) in emergencies, disasters, and even endemic settings has prompted its use as an adjunct to accepted public health tools to combat cholera [1–9]
About 1,906 pregnant women were not given their respective doses and 46,316 individuals were absent/migrated out during the vaccination program, about one-third (16,601) of whom took one dose but were not available to complete the two dose schedule (Table 2). 18,183 (13%) first-dose recipients did not attend for the second dose
Coverage was satisfactory by using existing Expanded Program on Immunization (EPI) infrastructure without disrupting routine immunization activities

Summary

Introduction

Over the last few years, safe and effective use of the oral cholera vaccine (OCV) in emergencies, disasters, and even endemic settings has prompted its use as an adjunct to accepted public health tools to combat cholera [1–9]. The World Health Organization (WHO) is strongly considering OCV as a control measure for endemic cholera in addition to other established control measures [11–13]. The Global Alliance for Vaccine board recently approved a contribution of 20 million OCV doses over the five years to this stockpile to increase access in outbreak situations and endemic settings. This will enable broader use of the OCV in settings where it can provide a valuable complement to traditional efforts to improve water and sanitation [15,16]

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