The Oral Cholera Vaccine: Meeting Millennium Development Goal Six Lynn Clark Callister, PhD, RN, FAAN
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illennium Development Goal #6 focuses on a reduction of diseases throughout the world including devastating diarrheal illnesses such as cholera. It is estimated that 1.4 billion people were at risk for cholera in 2012, with 90% of cases in low-resource countries in Africa and 10% in southern Asia (Ali et al., 2012). In 2010, there was a severe cholera epidemic in Haiti for the first time in recorded history following the major earthquake that killed more than 200,000 Haitians and disrupted their already fragile water and sanitation infrastructure. Cholera is a diarrheal disease, which has been called “a disease of poverty, linked to poor sanitation and a lack of potable water” (Pape & Rouzier, 2014, p. 2067). Improving hygiene practices and access to clean water are essential for prevention of this life-threatening disease.
to administer of the three. Shanchol was successfully used in Haiti following the 2010 widespread (664,282 cases) outbreak of cholera (Ivers et al., 2013) and in Odisha, India in a mass immunization of 31,552 people living in slums (Kar et al., 2014). Project administrators found that detailed microplanning and social mobilization were essential to success. Costs per fully vaccinated person were minimal at $1.13. Lessons learned in this study may be useful in other settings with vulnerable populations (Kar et al., 2014). Despite positive factors, many questions remain about OCV, including how many doses (1 versus 2) are most efficacious and whether OCV can safely be stored at room temperature and for what length of time (Pape & Rouzier, 2014). Reaching a large amount of people for a second follow-up OVC dose
Improving hygiene practices and access to clean water are essential for prevention of cholera. Oral cholera vaccines may be lifesaving measures for developing countries. Availability of rehydration centers and better education of both the public and healthcare providers are essential to control cholera. The WHO and UNICEF are working together to improve access to clean water and to improve sanitation and hygiene (WASH) in many developing countries, but there is much work to be done. There are currently three oral cholera vaccines (OCV) available, which all demonstrate safety and efficacy lasting up to 5 years. The Shanchol vaccine has been found to be the least expensive and easiest November/December 2014
can be a major challenge (Kar et al., 2014). Storage becomes a significant barrier, especially when transporting the vaccine in subtropical or desert climates. Finally, can OCV be administered to childbearing women and infants since there are no current guidelines for pregnant women and children younger than 1 year of age? Although both WHO and the Global Alliance for Vaccines and Immunization support the use of OCV for cholera epidemics globally and the Gates Foundation generously underwrites costs, there are
ethical questions regarding what priorities will guide the distribution of current stockpiles of OCV. What if there are concurrent epidemics or situations where there are large bodies of refugees living in close quarters or in areas of the world where cholera is endemic? Who decides what needs are most pressing? In the meantime, educational efforts and the promotion of WASH strategies including improved sanitation and personal hygiene with the provision of soap and clean water to vulnerable populations are essential. ✜ Lynn Clark Callister is a Professor Emerita, College of Nursing, Brigham Young University, Provo, UT, and an Editorial Board Member of MCN. She can be reached via e-mail at [email protected] . The author declares no conflict of interest. DOI:10.1097/NMC.0000000000000079 References Ali, M., Lopez, A. L., You, Y. A., Kim, Y. E., Sah, B., Maskery, B., & Clemens, J. (2012). The global burden of cholera. Bulletin of the World Health Organization, 90(3), 209A–281A. doi:10.2471/BLT.11.093427 Ivers, L.C., Teng, J. E., Lascher, J., Raymond, M., Weigel, J., Victor, N., . . ., Farmer, P. E. (2013). Use of oral cholera vaccine in Haiti: A rural demonstration project. American Journal of Tropical Medical Hygiene, 89(4), 617–624. doi:10.4269/ajtmh.13-0183 Kar, S. K., Sah, B., Patnaik, B., Kim, Y. H., Kerketta, A. S., Shin, S., . . ., Wierzba, T. F. (2014). Vaccination with a new, less expensive oral cholera vaccine using public health infrastructure in India: The Odisha Model. PLoS Neglected Tropical Diseases, 8(2), e2629. d o i : 10 . 1 3 7 1 / j o u r n a l . p n t d . 0 0 0 2 6 2 9 . Retrieved from www.plosntds.org/article/ info%3Adoi%2F10.1371%2Fjournal. pntd.0002629 Pape, J. W., & Rouzier, V. (2014). Embracing oral cholera vaccine—Shifting response to cholera. The New England Journal of Medicine, 370(22), 2067–2069. doi:10.1056/ NEJMp1402837 MCN
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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illennium Development Goal #6 focuses on a reduction of diseases throughout the world including devastating diarrheal illnesses such as cholera. It is estimated that 1.4 billion people were at risk for cholera in 2012, with 90% of cases in low-resource countries in Africa and 10% in southern Asia (Ali et al., 2012). In 2010, there was a severe cholera epidemic in Haiti for the first time in recorded history following the major earthquake that killed more than 200,000 Haitians and disrupted their already fragile water and sanitation infrastructure. Cholera is a diarrheal disease, which has been called “a disease of poverty, linked to poor sanitation and a lack of potable water” (Pape & Rouzier, 2014, p. 2067). Improving hygiene practices and access to clean water are essential for prevention of this life-threatening disease.
to administer of the three. Shanchol was successfully used in Haiti following the 2010 widespread (664,282 cases) outbreak of cholera (Ivers et al., 2013) and in Odisha, India in a mass immunization of 31,552 people living in slums (Kar et al., 2014). Project administrators found that detailed microplanning and social mobilization were essential to success. Costs per fully vaccinated person were minimal at $1.13. Lessons learned in this study may be useful in other settings with vulnerable populations (Kar et al., 2014). Despite positive factors, many questions remain about OCV, including how many doses (1 versus 2) are most efficacious and whether OCV can safely be stored at room temperature and for what length of time (Pape & Rouzier, 2014). Reaching a large amount of people for a second follow-up OVC dose
Improving hygiene practices and access to clean water are essential for prevention of cholera. Oral cholera vaccines may be lifesaving measures for developing countries. Availability of rehydration centers and better education of both the public and healthcare providers are essential to control cholera. The WHO and UNICEF are working together to improve access to clean water and to improve sanitation and hygiene (WASH) in many developing countries, but there is much work to be done. There are currently three oral cholera vaccines (OCV) available, which all demonstrate safety and efficacy lasting up to 5 years. The Shanchol vaccine has been found to be the least expensive and easiest November/December 2014
can be a major challenge (Kar et al., 2014). Storage becomes a significant barrier, especially when transporting the vaccine in subtropical or desert climates. Finally, can OCV be administered to childbearing women and infants since there are no current guidelines for pregnant women and children younger than 1 year of age? Although both WHO and the Global Alliance for Vaccines and Immunization support the use of OCV for cholera epidemics globally and the Gates Foundation generously underwrites costs, there are
ethical questions regarding what priorities will guide the distribution of current stockpiles of OCV. What if there are concurrent epidemics or situations where there are large bodies of refugees living in close quarters or in areas of the world where cholera is endemic? Who decides what needs are most pressing? In the meantime, educational efforts and the promotion of WASH strategies including improved sanitation and personal hygiene with the provision of soap and clean water to vulnerable populations are essential. ✜ Lynn Clark Callister is a Professor Emerita, College of Nursing, Brigham Young University, Provo, UT, and an Editorial Board Member of MCN. She can be reached via e-mail at [email protected] . The author declares no conflict of interest. DOI:10.1097/NMC.0000000000000079 References Ali, M., Lopez, A. L., You, Y. A., Kim, Y. E., Sah, B., Maskery, B., & Clemens, J. (2012). The global burden of cholera. Bulletin of the World Health Organization, 90(3), 209A–281A. doi:10.2471/BLT.11.093427 Ivers, L.C., Teng, J. E., Lascher, J., Raymond, M., Weigel, J., Victor, N., . . ., Farmer, P. E. (2013). Use of oral cholera vaccine in Haiti: A rural demonstration project. American Journal of Tropical Medical Hygiene, 89(4), 617–624. doi:10.4269/ajtmh.13-0183 Kar, S. K., Sah, B., Patnaik, B., Kim, Y. H., Kerketta, A. S., Shin, S., . . ., Wierzba, T. F. (2014). Vaccination with a new, less expensive oral cholera vaccine using public health infrastructure in India: The Odisha Model. PLoS Neglected Tropical Diseases, 8(2), e2629. d o i : 10 . 1 3 7 1 / j o u r n a l . p n t d . 0 0 0 2 6 2 9 . Retrieved from www.plosntds.org/article/ info%3Adoi%2F10.1371%2Fjournal. pntd.0002629 Pape, J. W., & Rouzier, V. (2014). Embracing oral cholera vaccine—Shifting response to cholera. The New England Journal of Medicine, 370(22), 2067–2069. doi:10.1056/ NEJMp1402837 MCN
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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