1. Global Task Force on Cholera Control Cholera vaccine use: a snap shot Training course on CDS in emergencies 13.12.2007 Dr Claire-Lise Chaignat Global Task Force on Cholera Control

2. Global Task Force on Cholera Control l control measures not easy to implement l limited spending on water & sanitation new approach needed link environmental management & Oral Cholera Vaccine use Kolkata June 2006 Role of cholera vaccines

3. Global Task Force on Cholera Control Public Health benefit of cholera vaccines ? target vulnerable groups in high risk areas consider seasonality when usually recommended control measures limited Immunization Averted Cases & deaths

4. Global Task Force on Cholera Control Currently available & WHO pre-qualified vaccine: killed WCrB sub-unit OCV* *Dukoral 2 doses in 10 days apart each dose diluted in water with buffer cold chain required storage capacities needed high cost limited availability Vaccination does not replace, but complement usually recommended control measures

5. Global Task Force on Cholera Control 1994 Goma, DRC 1997 2000 Uganda Cholera vaccine use in public health with WHO participation NO vaccine use FSM Beira Darfur /Aceh, Indonesia 2003/04 WHO recommandations 1999 WHO recommandations 2002 WHO recommendations 2005 2004 2005 www.who.int/cholera/publications

6. Global Task Force on Cholera Control WHO Recommendations for Cholera Vaccine Use II.WHO meeting on the use of OCV, December 2002 vaccine use suggested in endemic and epidemic settings well designed demonstration projects I.WHO meeting on use of OCV in emergencies, May 1999 OCV should be considered among tools to prevent cholera in populations at risk of an outbreak III.WHO meeting on the use of OCV in complex emergencies, Cairo, December 2005 relevance of multidisciplinary approach context of broader public health priorities 3-step decision making tool developed (to be tested)

7. Global Task Force on Cholera Control 3-step decision making tool to assess the pertinence of OCV use in complex emergencies

8. Global Task Force on Cholera Control Feasibility and Context Natural disaster: infrastructure damaged loss of human resources limited access continuous threats political & economical disruption complex emergency with armed conflict endemic areas with seasonal outbreaks access (security, nat disasters)

9. Global Task Force on Cholera Control challenge (1) risk assessment risk perception epidemiology endemicity trends over time living conditions overcrowding access to water sanitation behaviour of community climatic conditions context (natural disaster, complex emergency and security issues)

10. Global Task Force on Cholera Control challenge (2) target population considered at risk accessible IDPs / living with host families high mobility Influence on number vaccines needed vaccine wastage cost

11. Global Task Force on Cholera Control Logistics : Volume & Weight of materials required to vaccinate 20 000 people ▪ 40 000 vaccine vials 3.2 m3 (with box) ▪ 40 000 buffer sachets1.2 m3 ▪ 40 000 plastic cups2.4 m3 ▪ 4 000 x 1.5l of water 9 m3 Total weight : 7,100 kg Total volume: 15.8 m3

12. Global Task Force on Cholera Control OCVs and unanswered questions  Duration of protection beyond 2 years  role of a booster dose  cost effectiveness  efficacy of OCV in:  children < 2  HIV+  more evidence on herd protection

13. Global Task Force on Cholera Control l OCV should be part of a comprehensive, programmatic cholera control programme l OCV to be used when they can make a difference