Feasibility and costs of a targeted cholera vaccination campaign in Ethiopia.
Feasibility and costs of a targeted cholera vaccination campaign in Ethiopia.
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DOI：
10.1080/21645515.2018.1460295
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发表时间：
2018
影响因子：
4.8
通讯作者：
Mogasale V
中科院分区：
文献类型：
--
作者：
Teshome S;Desai S;Kim JH;Belay D;Mogasale V
Shanchol™是一种经世卫组织资格预审的口服霍乱疫苗（OCV），已被用于控制亚洲的地方性霍乱，以及其他地方的紧急情况和疫情。尽管开展了几次疫情应对运动，但非洲霍乱流行地区的公共卫生系统尚未使用该疫苗。在这里，我们介绍了埃塞俄比亚霍乱流行环境中大规模疫苗接种运动的经验，其中Shanchol™通过公共卫生系统引入。疫苗接种地点是根据往年报告的霍乱病例选择的。社会动员包括对社区领导人进行宣传、入户访问以及大量分发横幅、海报和传单。此次疫苗接种是在对物流冷链、人力、运输、疫苗供应以及不良事件的监督监测等方面进行了周密的微观规划后实施的。疫苗接种记录在个体接种卡上。疫苗接种后收集并分析疫苗运送成本。由于埃塞俄比亚没有Shanchol™的经验，因此进行了一项桥接试验，以证明疫苗在大规模接种前在当地人群中的安全性和免疫原性。2015年2月和2015年3月，在埃塞俄比亚Shashemenae农村地区的10个选定村庄进行了两轮口服霍乱疫苗接种，每轮为期4天。共有62，161人成为目标。47,137人（76%）接受了第一剂，40,707人（65%）接受了两剂。疫苗接种活动的财务成本估计为每剂2.60美元或每名完全免疫者5.64美元。不包括疫苗采购的疫苗交付成本为每剂0.68美元或每名完全免疫者1.48美元。该研究表明，通过埃塞俄比亚的公共卫生系统进行大规模霍乱疫苗接种是可行的，可以通过现有的卫生系统以负担得起的成本实施，疫苗是社区可以接受的。这项研究的经验教训是有用的部署OCV在其他非洲流行病的环境中通过公共卫生系统，并可能指导未来的免疫政策决定。
Shanchol™, a WHO-prequalified oral cholera vaccine (OCV), has been used to control endemic cholera in Asia, as well as in emergencies and outbreaks elsewhere. The vaccine has not been used by public health systems in cholera-endemic settings of Africa although several outbreak response campaigns have been conducted. Here we present experiences from a mass vaccination campaign in a cholera-endemic setting of Ethiopia in which Shanchol™ was introduced through the public health system. The vaccination site was selected based on cholera cases reported in previous years. Social mobilization involved sensitization of community leaders, household visits, and mass distribution of banners, posters and leaflets. The vaccination was implemented after careful microplanning of logistics and cold chain, manpower, transportation, vaccine supply and supervision and monitoring of adverse events. Vaccine administration was recorded on individual vaccination cards. Vaccine delivery costs were collected and analyzed after vaccination. As there was no experience with Shanchol™ in Ethiopia, a bridging trial was conducted to demonstrate safety and immunogenicity of the vaccine in the local population prior to the mass vaccination. Oral cholera vaccination was conducted in two rounds of four days each in February 2015 and March 2015 in 10 selected villages of Shashemenae rural district of Ethiopia. A total of 62,161 people targeted. 47,137 people (76%) received the first dose, and 40,707 (65%) received two doses. The financial cost of the vaccination campaign was estimated at US $2·60 per dose or US $5·64 per fully immunized person. The cost of vaccine delivery excluding vaccine procurement was $0·68 per dose or $1·48 per fully immunized person. The study demonstrates that mass cholera vaccination administered through the public health system in Ethiopia is feasible, can be implemented through the existing health system at an affordable cost, and the vaccine is acceptable to the community. The lessons from this study are useful for deploying OCV in other African endemic settings through the public health system and may guide future immunization policy decisions.
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