Oral Vaccination Campaigns Research Articles

Out-of-Sequence Vaccinations With Measles Vaccine and Diphtheria-Tetanus-Pertussis Vaccine: A Reanalysis of Demographic Surveillance Data From Rural Bangladesh.

Due to delays in vaccinations, diphtheria-tetanus-whole-cell-pertussis (DTP) is often given with or after measles vaccine (MV)-out of sequence. We reanalyzed data from Matlab, Bangladesh, to examine how administration of MV and DTP out-of-sequence was associated with child survival. In sum, 36 650 children born between 1986 and 1999 were followed with registration of vaccinations and survival. Controlling for background factors using Cox proportional hazards models, survival was analyzed between 9 and 24 months of age. We measured the mortality rate ratio (MRR) to compare vaccination groups. Oral polio vaccine (OPV) campaigns, which started in 1995, reduced the mortality rate and reduced the difference between vaccination groups. In the main analysis, we therefore censored for OPV campaigns; there were 151 nonaccident deaths before the OPV campaigns. Compared with MV administered alone (MV-only), DTP administered with or after MV had MRR 2.20 (1.31-3.70), and DTP-only had MRR 1.78 (1.01-3.11). Compared with MV-only, DTP administered with MV had a female-male MRR 0.56 (0.13-2.38), significantly different to DTP administered after MV, which had MRR 14.83 (1.88-117.1), test of interaction P = .011. Compared with having DTP (no MV) as most recent vaccination, MV-only had a nonaccident MRR of 0.56 (0.32-0.99). The negative effects of non-live DTP with or after live MV are not explained merely by selection bias. These observations support a live-vaccine-last policy where DTP should not be given with or after MV.

The projected impact of geographic targeting of oral cholera vaccination in sub-Saharan Africa: A modeling study.

BackgroundCholera causes an estimated 100,000 deaths annually worldwide, with the majority of burden reported in sub-Saharan Africa. In May 2018, the World Health Assembly committed to reducing worldwide cholera deaths by 90% by 2030. Oral cholera vaccine (OCV) plays a key role in reducing the near-term risk of cholera, although global supplies are limited. Characterizing the potential impact and cost-effectiveness of mass OCV deployment strategies is critical for setting expectations and developing cholera control plans that maximize the chances of success.Methods and findingsWe compared the projected impacts of vaccination campaigns across sub-Saharan Africa from 2018 through 2030 when targeting geographically according to historical cholera burden and risk factors. We assessed the number of averted cases, deaths, and disability-adjusted life years and the cost-effectiveness of these campaigns with models that accounted for direct and indirect vaccine effects and population projections over time. Under current vaccine supply projections, an approach optimized to targeting by historical burden is projected to avert 828,971 (95% CI 803,370–859,980) cases (equivalent to 34.0% of projected cases; 95% CI 33.2%–34.8%). An approach that balances logistical feasibility with targeting historical burden is projected to avert 617,424 (95% CI 599,150–643,891) cases. In contrast, approaches optimized for targeting locations with limited access to water and sanitation are projected to avert 273,939 (95% CI 270,319–277,002) and 109,817 (95% CI 103,735–114,110) cases, respectively. We find that the most logistically feasible targeting strategy costs US$1,843 (95% CI 1,328–14,312) per DALY averted during this period and that effective geographic targeting of OCV campaigns can have a greater impact on cost-effectiveness than improvements to vaccine efficacy and moderate increases in coverage. Although our modeling approach does not project annual changes in baseline cholera risk or directly incorporate immunity from natural cholera infection, our estimates of the relative performance of different vaccination strategies should be robust to these factors.ConclusionsOur study suggests that geographic targeting substantially improves the cost-effectiveness and impact of oral cholera vaccination campaigns. Districts with the poorest access to improved water and sanitation are not the same as districts with the greatest historical cholera incidence. While OCV campaigns can improve cholera control in the near term, without rapid progress in developing water and sanitation services or dramatic increases in OCV supply, our results suggest that vaccine use alone is unlikely to allow us to achieve the 2030 goal.

Detection of rabies antibodies in wild boars in north-east Romania by a rabies ELISA test

BackgroundIn the last few decades, Romania has been considered one of the European countries most affected by animal rabies, but a combination of oral rabies vaccination (ORV) campaigns in foxes alongside mandatory vaccination of pets has substantially decreased the number of rabies cases in recent years.The objective of this study was to detect rabies antibodies in wild boar serum and thoracic fluid samples collected during the hunting season after ORV campaigns in north-eastern Romania in order to identify if wild boars are substantial competitors to foxes for ORV baits.ResultsWhen the 312 wild boar samples were tested by ELISA (BioPro ELISA, Czech Republic), 42.31% (132/312) demonstrated rabies antibodies. In order to compare these wild boar results in terms of the percentage of immunisation, fox samples were also included in the study, and in this case only 28.40% (98/345) demonstrated rabies antibodies by ELISA. To check the diagnostic sensitivity and specificity of this ELISA, those samples with a sufficient volume from both species that had tested either negative or positive with an initial ELISA were then tested with the Fluorescent Antibody Virus Neutralisation (FAVN) assay. The overall concordance between the BioPro ELISA and FAVN test was 74.26% (75/101) in wild boar samples and 65.66% (65/99) in fox samples, 140 out of 200 samples being correlated with the two methods, although no significant statistical difference (p = 0.218) between the two species was registered. We found a good agreement by both tests for the ELISA-positive samples (91.30%), however the situation was different for the ELISA-negative samples, where a low agreement was demonstrated (41.18%).ConclusionsThis study reports for the first time the presence of rabies antibodies in wild boar samples collected during the hunting season in Romania after ORV campaigns in rabies endemic areas. It is also the first study to demonstrate that ELISA BioPro can be used on wild boar samples with satisfactory results compared to the FAVN test for this species.

Progress Toward Poliomyelitis Eradication - Nigeria, January 2018-May 2019.

The number of wild poliovirus (WPV) cases in Nigeria decreased from 1,122 in 2006 to six WPV type 1 (WPV1) in 2014 (1). During August 2014-July 2016, no WPV cases were detected; during August-September 2016, four cases were reported in Borno State. An insurgency in northeastern Nigeria had resulted in 468,800 children aged <5 years deprived of health services in Borno by 2016. Military activities in mid-2016 freed isolated families to travel to camps, where the four WPV1 cases were detected. Oral poliovirus vaccine (OPV) campaigns were intensified during August 2016-December 2017; since October 2016, no WPV has been detected (2). Vaccination activities in insurgent-held areas are conducted by security forces; however, 60,000 unvaccinated children remain in unreached settlements. Since 2018, circulating vaccine-derived poliovirus type 2 (cVDPV2) has emerged and spread from Nigeria to Niger and Cameroon; outbreak responses to date have not interrupted transmission. This report describes progress in Nigeria polio eradication activities during January 2018-May 2019 and updates the previous report (2). Interruption of cVDPV2 transmission in Nigeria will need increased efforts to improve campaign quality and include insurgent-held areas. Progress in surveillance and immunization activities will continue to be reviewed, potentially allowing certification of interruption of WPV transmission in Africa in 2020.

Evaluating the costs of cholera illness and cost-effectiveness of a single dose oral vaccination campaign in Lusaka, Zambia.

IntroductionIn 2016, for the very first time, the Ministry of Health in Zambia implemented a reactive outbreak response to control the spread of cholera and vaccinated at-risk populations with a single dose of Shancol—an oral cholera vaccine (OCV). This study aimed to assess the costs of cholera illness and determine the cost-effectiveness of the 2016 vaccination campaign.MethodologyFrom April to June 2017, we conducted a retrospective cost and cost-effectiveness analysis in three peri-urban areas of Lusaka. To estimate costs of illness from a household perspective, a systematic random sample of 189 in-patients confirmed with V. cholera were identified from Cholera Treatment Centre registers and interviewed for out-of-pocket costs. Vaccine delivery and health systems costs were extracted from financial records at the District Health Office and health facilities. The cost of cholera treatment was derived by multiplying the subsidized cost of drugs by the quantity administered to patients during hospitalisation. The cost-effectiveness analysis measured incremental cost-effectiveness ratio—cost per case averted, cost per life saved and cost per DALY averted—for a single dose OCV.ResultsThe mean cost per administered vaccine was US$1.72. Treatment costs per hospitalized episode were US$14.49–US$18.03 for patients ≤15 years old and US$17.66–US$35.16 for older patients. Whereas households incurred costs on non-medical items such as communication, beverages, food and transport during illness, a large proportion of medical costs were borne by the health system. Assuming vaccine effectiveness of 88.9% and 63%, a life expectancy of 62 years and Gross Domestic Product (GDP) per capita of US$1,500, the costs per case averted were estimated US$369–US$532. Costs per life year saved ranged from US$18,515–US$27,976. The total cost per DALY averted was estimated between US$698–US$1,006 for patients ≤15 years old and US$666–US$1,000 for older patients.ConclusionOur study determined that reactive vaccination campaign with a single dose of Shancol for cholera control in densely populated areas of Lusaka was cost-effective.

Vaccine-associated rabies in red fox, Hungary

Rabies vaccine strain was isolated from a red fox (Vulpes vulpes) with signs of neurological disorder during an oral vaccination campaign in 2015, Hungary. The whole genome sequence of the isolated strain shared >99.9% nucleotide sequence identity to the whole genomes of vaccines strains recently used in Hungarian oral vaccination campaigns. The neuroinvasive potential of rabies vaccines that leads to development of clinical manifestations is rarely seen among wild animals; however, the observed residual pathogenicity needs awareness of field experts and requires close monitoring of rabies cases in areas where elimination programs are implemented.

Environmental distribution of certain modified live-virus vaccines with a high safety profile presents a low-risk, high-reward to control zoonotic diseases

Oral vaccines aid immunization of hard to reach animal populations but often contain live-attenuated viruses that pose risks of reversion to virulence or residual pathogenicity. Human risk assessment is crucial prior to vaccine field distribution but there is currently no standardized approach. We mapped exposure pathways by which distribution of oral vaccines may result in inoculation into people and applied a Markov chain to estimate the number of severe adverse events. We simulated three oral rabies vaccination (ORV) campaigns: (1) first generation ORV (SAD-B19) in foxes, (2) SAD-B19 in dogs, and (3) third generation ORV (SPBN GASGAS) in dogs. The risk of SAD-B19-associated human deaths was predicted to be low (0.18 per 10 million baits, 95% CI: 0.08, 0.36) when distributed to foxes, but, consistent with international concern, 19 times greater (3.35 per 10 million baits, 95% CI: 2.83, 3.98) when distributed to dogs. We simulated no deaths from SPBN GAS-GAS. Human deaths during dog campaigns were particularly sensitive to dog bite rate, and during wildlife campaigns to animal consumption rate and human contact rate with unconsumed baits. This model highlights the safety of third generation rabies vaccines and serves as a platform for standardized approaches to inform risk assessments.

A little goes a long way: Weak vaccine transmission facilitates oral vaccination campaigns against zoonotic pathogens.

Zoonotic pathogens such as Ebola and rabies pose a major health risk to humans. One proven approach to minimizing the impact of a pathogen relies on reducing its prevalence within animal reservoir populations using mass vaccination. However, two major challenges remain for vaccination programs that target free-ranging animal populations. First, limited or challenging access to wild hosts, and second, expenses associated with purchasing and distributing the vaccine. Together, these challenges constrain a campaign’s ability to maintain adequate levels of immunity in the host population for an extended period of time. Transmissible vaccines could lessen these constraints, improving our ability to both establish and maintain herd immunity in free-ranging animal populations. Because the extent to which vaccine transmission could augment current wildlife vaccination campaigns is unknown, we develop and parameterize a mathematical model that describes long-term mass vaccination campaigns in the US that target rabies in wildlife. The model is used to investigate the ability of a weakly transmissible vaccine to (1) increase vaccine coverage in campaigns that fail to immunize at levels required for herd immunity, and (2) decrease the expense of campaigns that achieve herd immunity. When parameterized to efforts that target rabies in raccoons using vaccine baits, our model indicates that, with current vaccination efforts, a vaccine that transmits to even one additional host per vaccinated individual could sufficiently augment US efforts to preempt the spread of the rabies virus. Higher levels of transmission are needed, however, when spatial heterogeneities associated with flight-line vaccination are incorporated into the model. In addition to augmenting deficient campaigns, our results show that weak vaccine transmission can reduce the costs of vaccination campaigns that are successful in attaining herd immunity.

RACCOON (PROCYON LOTOR) RESPONSE TO ONTARIO RABIES VACCINE BAITS (ONRAB) IN ST. LAWRENCE COUNTY, NEW YORK, USA.

Oral rabies vaccination (ORV) campaigns have been conducted annually in the US over the past two decades to prevent raccoon (Procyon lotor) rabies, which is enzootic along the eastern region of the country from southeastern Canada to Alabama. Because raccoon rabies has been eliminated from neighboring Canadian provinces, continued detection of the variant in the US is of concern due to the potential for infected raccoons to cross the border via the St. Lawrence River. Ontario Rabies Vaccine Baits (ONRAB) containing a live, recombinant human adenovirus expressing the rabies virus glycoprotein have been under experimental use in the US since 2011. We distributed ONRAB in St. Lawrence County, New York, from 2013 to 2015 as part of field trials to evaluate serologic responses in raccoons. Prior to ONRAB distribution, rabies virus neutralizing antibody (RVNA) seroprevalence in raccoons was 45.2% (183 of 405) and increased to 57.7% (165 of 286) after 3 yr of ONRAB baiting. Postbait RVNA seroprevalence increased each year, with a lower response observed in juvenile compared with adult raccoons. The pre-ONRAB seroprevalence detected in 2013 was relatively high and was likely impacted both by elevated rabies activity in the county and the use of ORV with a different vaccine bait for 14 consecutive years prior to our study. Tetracycline biomarker prevalence increased from 1.4% prior to ONRAB baiting to 51.3% from 2013 to 2015, demonstrating bait palatability to raccoons. These data complemented related field trials conducted in West Virginia and the northeastern US.

Epidemiological description of a protracted cholera outbreak in Tonj East and Tonj North counties, former Warrap State, South Sudan, May-Oct 2017

BackgroundOn 18th May 2017, State Ministry of Health of former Warrap State received a report from Tonj East County of an outbreak of acute watery diarrhoea and vomiting in Makuac payam. We conducted this investigation to confirm the causative organism and describe the epidemiology of the outbreak in order to support evidence-based control measures.MethodsWe defined a suspected case as a resident of Tonj East or Tonj North County with sudden onset of acute watery diarrhoea and vomiting between May 1 and October 15, 2017. A probable case was defined as a suspected case with a positive rapid test for Vibrio cholerae; a confirmed case was a probable case with a positive stool culture for V. cholerae. We conducted systematic case finding by visiting health facilities and villages in the affected payams. We reviewed patient records from 1 May 2017 to 15 October 2017, to identify suspected cholera case-patients. We conducted a descriptive epidemiologic study, examining the distribution of the cases. We computed the attack rates by age, sex, and payam of residence. Case fatality rate was calculated as the ratio of the total number of suspected cholera death to the total number of cholera case-patients. We conducted an oral cholera vaccination campaign after the peak of the outbreak to control and prevent the spread to other payams.ResultsWe identified 1451 suspected cholera cases between May and October 2017. Of these, 81% (21/26) had a positive rapid diagnostic test for V. cholerae; out of the 16 rectal swabs transported to the National Public Laboratory, 88% (14/16) were confirmed to be V. cholerae O1 serotype Inaba. The epidemic curve shows continuous common source outbreak with several peaks. The mean age of the case-patients was 24 years (Range: 0.2-75y). The clinical presentations of the case-patients were consistent with cholera. Males had an attack rate of 9.9/10000. The highest attack rate was in ≥30y (14 per 10,000). Among the six payams affected, Makuac had the highest attack rate of 3/100. The case fatality rate (CFR) was 3.0% (44/1451). Paliang and Wunlit had an oral cholera vaccination coverage of ≥100%, while 4 payams had a vaccination coverage of < 90%.ConclusionThis was a continuous common source cholera outbreak caused by V. cholerae 01 sero type Inaba. We recommended strengthening of the surveillance system to improve early detection and effective response.

Cholera Outbreak in Haiti

Abstract In October 2010, a massive cholera outbreak struck Haiti, and subsequently, thousands of cholera cases have been documented throughout Haiti. After much controversy about its origin, scientific evidence demonstrated its importation from Nepalese United Nations Peacekeepers. Despite national and international efforts to combat this outbreak (such as oral cholera vaccine campaigns), challenges related to funding, water and sanitation infrastructure, and poverty make it difficult to eliminate cholera from Haiti. This article discusses the recent cholera epidemic in Haiti, its origin and spread throughout Haiti, the specific nature and microbiologic characteristics of the pathogen, and ongoing disease management and control efforts. Importantly, this article suggests a future research agenda identifying best strategies for eliminating cholera in Haiti.

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

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.

What's the Harm? A Risk Model to Quantify Human and Animal Adverse Events From Environmentally Distributed Modified Live-Vaccine Viruses

Background: While oral vaccines aid immunization of hard to reach animal populations, the use of live-attenuated viruses in many oral vaccines, including first generation oral rabies vaccines, pose risks of reversion to virulence or residual pathogenicity. While a detailed human risk assessment is crucial prior to field distribution of live-attenuated vaccines, there is currently no standardized approach. Methods: We mapped exposure pathways by which distribution of oral vaccines targeting wildlife or free-roaming dogs may result in mucosal, transdermal, or severe inoculation into people. We applied a continuous-time Markov chain to estimate the number of severe adverse events. We tested the model using three scenarios of oral rabies vaccination (ORV) campaigns: 1) first generation ORV (SAD-B19) in foxes, 2) SAD-B19 in dogs, and 3) third generation ORV (SPBN GASGAS) in dogs. Findings: A low risk of 0·18 (95% CI: 0·08, 0·36) vaccine-associated human deaths per 10 million baits was simulated for campaigns where SAD-B19 was distributed to foxes. However, consistent with international concern, our model predicts that SAD-B19 distributed to dogs could result in 3·35 (95% CI: 2·83, 3·98) vaccine-associated human deaths per 10 million baits. The model simulated no deaths for SPBN GASGAS. Human deaths during dog campaigns was particularly sensitive to dog bite rate, and human deaths during wildlife campaigns was particularly sensitive to animal uptake rate and human contact rate with unconsumed baits. Interpretation: This model highlights the safety of newer live-attenuated rabies vaccines and serves as a platform for standardized approaches to inform risk assessments. Funding Statement: Time for this study was funded through a co-agreement between the Pubic Health Institute and the Centers for Disease Prevention and Control. The funding source had no role in the study design, analysis, preparation of the manuscript, or decision to publish the manuscript. Declaration of Interests: AV is a full time employee of a pharmaceutical company, IDT Biologika GmbH, which manufactures oral rabies vaccine baits. TM from the FriedrichLoeffler-Institute received funding from IDT Biologika GmbH in the frame of a research cooperation for research into mechanisms of oral rabies vaccination and resulting immunity

Control and elimination of rabies in Croatia.

Despite the implementation of control measures (preventive dog vaccination), rabies has become endemic in Croatia, with red foxes being the main reservoir species. Oral rabies vaccination (ORV) campaigns supported by the European Commission have been conducted twice a year since the spring of 2011. The first campaigns were limited to the northern and eastern parts of the country, and from the autumn of 2012, the program was extended to the entire country. The Lysvulpen vaccine containing the SAD Bern strain was used for ORV. Following the vaccination campaigns, the number of rabies cases decreased, and the last positive case was recorded in February 2014. The bait uptake ranged from 24.86% to 84.62% and the immunisation rate from 11.24% to 35.64%.

Rabies control in Europe: an overview of past, current and future strategies.

Europe's step-by-step approach to tackling canine and wildlife-mediated rabies has proven that the disease can be controlled and eliminated at the animal source. A decade of development work and support by the European Union has resulted in a successful oral rabies vaccination campaign for foxes and raccoon dogs, and provided the blueprint for eliminating wildlife-mediated rabies. In this paper, the authors examine the historical stages of animal rabies control and its eventual elimination in parts of Europe, particularly Western Europe. In addition, they consider current control measures and predict future challenges, many of which are faced by the vast and sparsely populated, rabies-endemic areas of Eastern Europe.

La batalla de Madrid por las vacunas antipoliomielitis (1963): ciencia, ideología y poder en la primera campaña de inmunización masiva en España

Between 1958 and 1963, Spain witnessed the highest ever incidence of poliomyelitis (2000 cases and 200 deaths per year). Although Salk's inactivated vaccine had arrived in Spain in 1957, the government took no decisive action to administer it to the entire population at risk. Neither was Sabin's attenuated vaccine administered, available in Europe from 1960. While other countries adopted one or the other, in Spain rivalry arose over the two vaccines, with mixed results. The Salk vaccine was administered to a small percentage of the population at risk through the Compulsory Sickness Insurance scheme (Spanish initials: SOE), while at the same time a research team at the National School of Health led by Florencio Pérez Gallardo (1917-2006) carried out a model epidemiological study that demonstrated the superiority of the Sabin vaccine. In 1963, the SOE launched a national campaign with the Salk vaccine promoted by the paediatrician Juan Bosch Marín (1902-1995), a representative of the most conservative structure of the Franco regime. The dispute over which vaccine was best reached its peak in early 1963 at various scientific conferences in Madrid. Bosch Marín's group argued in favour of his campaign and the Salk vaccine, while Pérez Gallardo did the same for the oral vaccine, achieving a substantial impact by inviting Sabin himself to speak. By the end of the year, following a pilot study, the first mass oral vaccination campaign against polio was introduced in Spain.

Lessons from integration of mass nutrition screening during combined BOPV/IPV campaign in armed conflict settings, Borno State, Nigeria

Background: The Boko Haram insurgency has led to severe humanitarian crisis with high levels of malnutrition and polio outbreak in Borno state, Nigeria. In response, outbreak campaigns were conducted that provided an opportunity to integrate nutrition screening during the combined bivalent oral and inactivated polio vaccination (bOPV/IPV) campaign. Methods : This was a cross-sectional study that measured nutrition status of children using a mid-upper arm circumference (MUAC) measurement tape during bOPV/IPV campaign in 4 of the 24 local government areas (LGAs). Data were collected using tally sheets and mobile ODK Collector and bivariate analysis using logistic regression done. Results : Over 1.66 million and 1.47 million children received bOPV and IPV vaccines respectively in 24 LGAs. The coverage of bOPV and IPV in integrated and non-integrated LGAs were above 90% with no statistical difference (OR:0.85; 95%CI: 0.55-1.29; p=0.42). Only 48.5% (351795/725509) of targeted children were screened for malnutrition, of those 3.7% (13050/351795) had severe acute malnutrition (SAM). Less than 47.5% of children with SAM were successfully referred and enrolled in the treatment facilities. Conclusion : Coverage of bOPV and IPV were similar in both integrated and non-integrated LGAs indicating that integrating nutrition screening in polio campaigns is feasible with minimal negative effects. As children with SAM have lower serological protection against polio, provides a strong rationale for inclusion of nutrition interventions in global polio eradication efforts. There are critical lessons that were identified including joint planning, well-defined optimal partnership including military collaborations, and a need for joint monitoring.

Near real-time forecasting for cholera decision making in Haiti after Hurricane Matthew.

Computational models of cholera transmission can provide objective insights into the course of an ongoing epidemic and aid decision making on allocation of health care resources. However, models are typically designed, calibrated and interpreted post-hoc. Here, we report the efforts of a team from academia, field research and humanitarian organizations to model in near real-time the Haitian cholera outbreak after Hurricane Matthew in October 2016, to assess risk and to quantitatively estimate the efficacy of a then ongoing vaccination campaign. A rainfall-driven, spatially-explicit meta-community model of cholera transmission was coupled to a data assimilation scheme for computing short-term projections of the epidemic in near real-time. The model was used to forecast cholera incidence for the months after the passage of the hurricane (October-December 2016) and to predict the impact of a planned oral cholera vaccination campaign. Our first projection, from October 29 to December 31, predicted the highest incidence in the departments of Grande Anse and Sud, accounting for about 45% of the total cases in Haiti. The projection included a second peak in cholera incidence in early December largely driven by heavy rainfall forecasts, confirming the urgency for rapid intervention. A second projection (from November 12 to December 31) used updated rainfall forecasts to estimate that 835 cases would be averted by vaccinations in Grande Anse (90% Prediction Interval [PI] 476-1284) and 995 in Sud (90% PI 508-2043). The experience gained by this modeling effort shows that state-of-the-art computational modeling and data-assimilation methods can produce informative near real-time projections of cholera incidence. Collaboration among modelers and field epidemiologists is indispensable to gain fast access to field data and to translate model results into operational recommendations for emergency management during an outbreak. Future efforts should thus draw together multi-disciplinary teams to ensure model outputs are appropriately based, interpreted and communicated.

First four Oral Rabies Vaccination campaigns of the red foxes in Greece: Evaluating factors and assessment

Following the last animal rabies outbreak in Greece in 2012, Oral Rabies Vaccination (ORV) campaigns of red foxes (Vulpes vulpes) were conducted in order to halt the spread of the disease, as widely and effectively have also been implemented in other countries. The present study aims to report the main outcomes following the first Greek ORV campaigns during autumn 2013, 2014, 2015 and spring 2016, to assess their effectiveness and to investigate factors potentially related to their success. Blood samples, mandible bones and teeth, derived by 452 foxes, were tested for rabies antibody titration, animal age determination and tetracycline (TTC) detection. The laboratory results obtained were statistically analyzed. High seroprevalence and TTC detection rates were obtained following the autumn campaigns studied, while these rates were significantly reduced following the spring campaign. The year or the season of the vaccination campaign, the estimated age group of the animal and the geographical Regional Unit (RU), where the animal was hunted, were identified as important factors. On the contrary, no significance could be ascertained for TTC detection based on exclusively previous uptake, use of filter paper, blood sample type and quality, as well as sex of animal. Based on the monitoring results achieved, the first ORV campaigns conducted in the country can be generally considered to be satisfactory. No positives cases were detected since May 2014. Seasonal, geographical parameters and factors related to fox ecology may interfere with monitoring results and should be always considered when planning future ORV programs.

Cost Evaluation of a Government-Conducted Oral Cholera Vaccination Campaign-Haiti, 2013.

.The devastating 2010 cholera epidemic in Haiti prompted the government to introduce oral cholera vaccine (OCV) in two high-risk areas of Haiti. We evaluated the direct costs associated with the government’s first vaccine campaign implemented in August–September 2013. We analyzed data for major cost categories and assessed the efficiency of available campaign resources to vaccinate the target population. For a target population of 107,906 persons, campaign costs totaled $624,000 and 215,295 OCV doses were dispensed. The total vaccine and operational cost was $2.90 per dose; vaccine alone cost $1.85 per dose, vaccine delivery and administration $0.70 per dose, and vaccine storage and transport $0.35 per dose. Resources were greater than needed—our analyses suggested that approximately 2.5–6 times as many persons could have been vaccinated during this campaign without increasing the resources allocated for vaccine delivery and administration. These results can inform future OCV campaigns in Haiti.