Controlling cholera in the Ouest Department of Haiti using oral vaccines.
Controlling cholera in the Ouest Department of Haiti using oral vaccines.
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DOI：
10.1371/journal.pntd.0005482
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发表时间：
2017-04
影响因子：
3.8
通讯作者：
Longini IM Jr
中科院分区：
文献类型：
--
作者：
Kirpich A;Weppelmann TA;Yang Y;Morris JG Jr;Longini IM Jr
2010年海地爆发霍乱后，启动了一项计划，大规模改善卫生和饮用水基础设施，以便到2023年在伊斯帕尼奥拉岛消除霍乱。6年5亿美元之后，几乎没有证据表明已经实施了任何实质性的改善;越来越多的证据表明霍乱已经成为地方病。因此，现在是时候探索在海地使用口服霍乱疫苗（OCV）控制霍乱的战略了。大规模管理OCV对霍乱传播的潜在影响进行了评估，使用动态隔室模型拟合海地西部省的霍乱发病率数据。结果表明，如果在最初爆发五周后开始，使用有效率为60%的OCV进行干预，到2012年8月就可以消除霍乱传播。通过考虑疫苗效力、疫苗接种率和保护性免疫持续时间的不同组合，对2017年1月1日开始的OCV干预措施到2023年消除霍乱传播的能力进行了一系列分析。由于疫苗接种的平均等待时间为50周，疫苗诱导免疫的平均持续时间为3年，所有使用疫苗效力至少为60%的OCV的活动都成功地在2023年之前消除了霍乱传播。这项研究的结果表明，即使有一个相对广泛的疫苗效力，管理率，和保护性免疫的持续时间，未来的流行病可以控制在一个相对较低的成本使用大规模管理的OCV在海地。在2010年向加勒比海国家海地引入致炎性霍乱弧菌O 1后，该国经历了近代历史上最大的全国霍乱疫情。在国际社会的帮助下，承诺提供5亿多美元，用于大规模改善饮用水和卫生基础设施，目标是到2023年消除霍乱传播。六年后，霍乱的传播仍在继续，几乎没有证据表明已经取得了任何此类改善。在这项研究中，口服霍乱疫苗（OCV）的使用，以减少最初的疫情传播和消除未来的传播进行了调查，使用一种新的数学建模框架。关键参数，包括疫苗的效力，疫苗接种率，和保护性免疫的持续时间进行了评估，以提供指导方针，在海地的国家霍乱疫苗计划的管理。如果疫苗至少有60%的有效性，所有大规模疫苗接种计划的模拟都成功地在2023年之前消除了霍乱，大多数情况下仅在几年内。研究结果不仅支持使用OCV来消除海地霍乱的传播，而且还表明应该动员OCV来通过积极的疫苗管理活动来平息其他国家未来的疫情。
Following the 2010 cholera outbreak in Haiti, a plan was initiated to provide massive improvements to the sanitation and drinking water infrastructure in order to eliminate cholera from the island of Hispaniola by 2023. Six years and a half billion dollars later, there is little evidence that any substantial improvements have been implemented; with increasing evidence that cholera has become endemic. Thus, it is time to explore strategies to control cholera in Haiti using oral cholera vaccines (OCVs). The potential effects of mass administration of OCVs on cholera transmission were assessed using dynamic compartment models fit to cholera incidence data from the Ouest Department of Haiti. The results indicated that interventions using an OCV that was 60% effective could have eliminated cholera transmission by August 2012 if started five weeks after the initial outbreak. A range of analyses on the ability of OCV interventions started January 1, 2017 to eliminate cholera transmission by 2023 were performed by considering different combinations of vaccine efficacies, vaccine administration rates, and durations of protective immunity. With an average of 50 weeks for the waiting time to vaccination and an average duration of three years for the vaccine-induced immunity, all campaigns that used an OCV with a vaccine efficacy of at least 60% successfully eliminated cholera transmission by 2023. The results of this study suggest that even with a relatively wide range of vaccine efficacies, administration rates, and durations of protective immunity, future epidemics could be controlled at a relatively low cost using mass administration of OCVs in Haiti. After the introduction of toxigenic Vibrio cholerae O1 to the Caribbean nation of Haiti in 2010, the country experienced the largest national cholera outbreak in recent history. With the help of the international community, over $500,000,000 USD was pledged to finance massive improvements in drinking water and sanitation infrastructure with the goal of eliminating cholera transmission by 2023. Over six years later, cholera transmission continues, with little evidence that any such improvements have been made. In this study, the use of oral cholera vaccines (OCVs) to reduce the spread of the initial outbreak and to eliminate future transmission was investigated using a novel mathematical modeling framework. Critical parameters including vaccine efficacy, vaccine administration rates, and duration of protective immunity were evaluated to provide guidelines for the administration of a National Cholera Vaccine Program in Haiti. Provided the vaccines are at least 60% effective, all simulations of mass vaccination programs successfully eliminated cholera by 2023, most within a time frame of only a few years. Not only do the findings support the use of OCVs to eradicate transmission of cholera in Haiti, they indicate that OCVs should be mobilized to quash future outbreaks in other countries using active vaccine administration campaigns.