Cholera

Joint WHO/UNICEF statement for cholera vaccine use in tsunami-affected areas


Issues to be considered for vaccine use

Population at risk
  • Displaced population living in settlements /camps
  • With limited access to safe water and proper sanitation
  • Location endemic for cholera or past cholera outbreaks
  • Outbreak risk according to seasonality of past data
  • With limited health infrastructure
  • Community leaders ensuring involvement of community
  • Access to the population at risk possible (individuals >2 years of age)
  • Access to same population possible over 3-4 weeks (for the two-dose vaccine)
Surveillance
  • Data on occurrence of cholera over time
  • Predominant strain V. cholerae O1
Vaccine
  • Choice of vaccine will depend on the occurrence of cholera2
  • Timing of vaccination either pre-emptive (environmental management in the population not satisfactory and outbreak expected in the near future) or reactive (at the early stages of an outbreak to limit its spread).
  • Sufficient doses available for total population at risk in given area
  • Vaccine prequalified by WHO (in case no adequate prequalified vaccine is available or supply is insufficient, special case-by-case decision will be taken)
Logistics
  • Cold chain facility and storage capacity available
  • Safe water and cups for vaccine distribution available
Human resources
  • Health care staff (e.g. Ministry of Health, nongovernmental organization,...)
  • Expanded Program on Immunization (EPI)/polio vaccination teams
  • Community
Prevention
  • Capacity to implement health education during campaign
  • Environmental management activities should continue
Political commitment
  • Agreement to import/licence vaccine from manufacturing country
  • Support and commitment from national/regional and local levels
  • Support and commitment from community leaders and other groups

2The two-dose OCV cannot be used once an outbreak has started, while the use of the single-dose OCV is possible

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