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[Response capacity and challenges of the Cuban health system against communicable diseasesCapacidade de resposta e desafios do sistema de saúde cubano contra doenças transmissíveis].

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[Response capacity and challenges of the Cuban health system against communicable diseasesCapacidade de resposta e desafios do sistema de saúde cubano contra doenças transmissíveis].

Rev Panam Salud Publica. 2018;42:e30

Authors: Corcho DV, Valle IR, Gutiérrez SB, Castillo RR, Ávila LJP, Berrio LA, Cabrera PL, Parra SP, García FAD

Abstract
This article presents distinctive and essential features in the transformations of the Cuban health system that have allowed the eradication and reduction of the incidence rates of some communicable diseases at levels lower than 0.1 per 100 000 inhabitants. The results obtained are a consequence of the importance given to the prevention and control, as well as to the risks and potential damages, of these diseases. The structure and functioning of the hygiene and epidemiology subsystem and its interrelations with the rest of the system, based on the different models of service provision, have been permanent integration scenarios for decision making. Diseases such as poliomyelitis, malaria, diphtheria, whooping cough, rubella, mumps, post-mumps meningitis, measles, yellow fever, cholera, severe forms of tuberculosis, human rabies transmitted by canines, leishmaniasis, Chagas disease, vertical transmission of HIV, congenital syphilis and clinical forms such as neonatal tetanus and congenital rubella syndrome were eliminated. Some communicable diseases are analyzed in more detail and, in particular, the social response developed against tuberculosis, leprosy, AIDS and vector-borne diseases. However, the current health context presents challenges for the sustainability of the achievements made in the country. Assuring the maintenance of universal coverage with access of the Cuban population to health services will always be a principle of Cuban public health.

PMID: 31093059 [PubMed]

Development of a loop-mediated isothermal amplification assay for Vibrio cholerae O1 and O139.

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Development of a loop-mediated isothermal amplification assay for Vibrio cholerae O1 and O139.

Mol Cell Probes. 2019 May 10;:

Authors: Izumiya H, Morita M, Arakawa E, Ngo TC, Nguyen HT, Nguyen DT, Ohnishi M

Abstract
A loop-mediated isothermal amplification assay was developed. It was designed for recognizing Vibrio cholerae O1/O139, where atpA, rfbN, and wfbR genes were adopted. The assay specifically detected the target with sensitivities of 5-67 copies per reaction in 1 h. The assay will aid rapid detection of the cholera bacterium.

PMID: 31082474 [PubMed - as supplied by publisher]

Yemen needs a concrete plan-now.

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Yemen needs a concrete plan-now.

Lancet Glob Health. 2019 01;7(1):e1

Authors: The Lancet Global Health

PMID: 30528294 [PubMed - indexed for MEDLINE]

A systematic review and meta-analysis on the epidemiology of antibiotic resistance of Vibrio cholerae in Iran.

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A systematic review and meta-analysis on the epidemiology of antibiotic resistance of Vibrio cholerae in Iran.

Ann Ig. 2019 May-Jun;31(3):279-290

Authors: Yousefi A, Vaez H, Sahebkar A, Khademi F

Abstract
BACKGROUND: Cholera, an acute diarrheal disease caused by Vibrio cholerae (V. cholerae), is an endemic disease and a major public health problem in Iran. Antibiotic therapy can decrease duration of the disease, transmission of infection and contamination of the environment. Considering different pattern of V. cholerae antibiotic resistance around the world, the aim of the current systematic review and meta-analysis was to evaluate the prevalence of antibiotic resistance of V. cholerae in Iran.
METHODS: A systematic review of the literature was performed using related keywords in the electronic national and international databases including SID, Irandoc, Iran Medex and Magiran as well as PubMed, Scopus, Google Scholar and ISI web of knowledge. Up to July 31, 2018, 27 eligible papers were included in our meta-analysis based on the defined inclusion criteria.
RESULTS: V. cholerae O1 was the most prevalent strain isolated in Iran and exhibited a high resistance rate against numerous antibiotics including chloramphenicol (33.6%), oxytetracycline (40.2%), trimethoprim/sulphamethoxazole (86%), tetracycline (34.5%), furazolidone (69.8%), streptomycin (93.8%), polymyxin (80.7%), ampicillin (32.1%), nalidixic acid (88.9%), kanamycin (29%) and amoxicillin (30.5%).
CONCLUSIONS: According to the meta-analysis results, antibiotic therapy with ciprofloxacin, doxycycline, erythromycin, gentamicin, azithromycin, cefixime and cefepime could be effective for the treatment of severe cases of cholera in Iran.

PMID: 31069372 [PubMed - in process]

Post-monsoon waterlogging-associated upsurge of cholera cases in and around Kolkata metropolis, 2015.

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Post-monsoon waterlogging-associated upsurge of cholera cases in and around Kolkata metropolis, 2015.

Epidemiol Infect. 2019 Jan;147:e167

Authors: Mukhopadhyay AK, Deb AK, Chowdhury G, Debnath F, Samanta P, Saha RN, Manna B, Bhattacharya MK, Datta D, Okamoto K, Bhadra UK, Dutta S

Abstract
The Infectious Diseases and Beliaghata General Hospital, Kolkata, India witnessed a sudden increase in admissions of diarrhoea cases during the first 2 weeks of August 2015 following heavy rainfall. This prompted us to investigate the event. Cases were recruited through hospital-based surveillance along with the collection of socio-demographic characteristics and clinical profile using a structured questionnaire. Stool specimens were tested at bacteriological laboratory of the National Institute of Cholera and Enteric Diseases (NICED), Kolkata. Admission of 3003 diarrhoea cases, clearly indicated occurrence of outbreak in Kolkata municipal area as it was more than two standard deviation of the mean number (911; s.d. = 111) of diarrhoea admissions during the same period in previous 7 years. Out of 164 recruited cases, 25% were under-5 children. Organisms were isolated from 80 (49%) stool specimens. Vibrio cholerae O1 was isolated from 50 patients. Twenty-eight patients had this organism as the sole pathogen. Among 14 infants, five had cholera. All V. cholerae O1 isolates were resistant to nalidixic acid, followed by co-trimoxazole (96%), streptomycin (92%), but sensitive to fluroquinolones. We confirmed the occurrence of a cholera outbreak in Kolkata during August 2015 due to V. cholerae O1 infection, where infants were affected.

PMID: 31063116 [PubMed - in process]

Reduction in cholera deaths targeted for 2030.

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Reduction in cholera deaths targeted for 2030.

Nat Microbiol. 2017 11;2(11):1457

Authors:

PMID: 29070822 [PubMed - indexed for MEDLINE]

The case-area targeted rapid response strategy to control cholera in Haiti: a four-year implementation study.

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The case-area targeted rapid response strategy to control cholera in Haiti: a four-year implementation study.

PLoS Negl Trop Dis. 2019 04;13(4):e0007263

Authors: Rebaudet S, Bulit G, Gaudart J, Michel E, Gazin P, Evers C, Beaulieu S, Abedi AA, Osei L, Barrais R, Pierre K, Moore S, Boncy J, Adrien P, Duperval Guillaume F, Beigbeder E, Piarroux R

Abstract
BACKGROUND: In October 2010, Haiti was struck by a large-scale cholera epidemic. The Haitian government, UNICEF and other international partners launched an unprecedented nationwide alert-response strategy in July 2013. Coordinated NGOs recruited local rapid response mobile teams to conduct case-area targeted interventions (CATIs), including education sessions, household decontamination by chlorine spraying, and distribution of chlorine tablets. An innovative red-orange-green alert system was also established to monitor the epidemic at the communal scale on a weekly basis. Our study aimed to describe and evaluate the exhaustiveness, intensity and quality of the CATIs in response to cholera alerts in Haiti between July 2013 and June 2017.
METHODOLOGY/PRINCIPAL FINDINGS: We analyzed the response to 7,856 weekly cholera alerts using routine surveillance data and severity criteria, which was based on the details of 31,306 notified CATIs. The odds of CATI response during the same week (exhaustiveness) and the number of complete CATIs in responded alerts (intensity and quality) were estimated using multivariate generalized linear mixed models and several covariates. CATIs were carried out significantly more often in response to red alerts (adjusted odds ratio (aOR) [95%-confidence interval, 95%-CI], 2.52 [2.22-2.87]) compared with orange alerts. Significantly more complete CATIs were carried out in response to red alerts compared with orange alerts (adjusted incidence ratio (aIR), 1.85 [1.73-1.99]). Over the course of the eight-semester study, we observed a significant improvement in the exhaustiveness (aOR, 1.43 [1.38-1.48] per semester) as well as the intensity and quality (aIR, 1.23 [1.2-1.25] per semester) of CATI responses, independently of funds available for the strategy. The odds of launching a CATI response significantly decreased with increased rainfall (aOR, 0.99 [0.97-1] per each accumulated cm). Response interventions were significantly heterogeneous between NGOs, communes and departments.
CONCLUSIONS/SIGNIFICANCE: The implementation of a nationwide case-area targeted rapid response strategy to control cholera in Haiti was feasible albeit with certain obstacles. Such feedback from the field and ongoing impact studies will be very informative for actors and international donors involved in cholera control and elimination in Haiti and in other affected countries.

PMID: 30990822 [PubMed - indexed for MEDLINE]

Outbreak investigation of cholera outbreak in a slum area of urban Wardha, India: An interventional epidemiological study.

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Outbreak investigation of cholera outbreak in a slum area of urban Wardha, India: An interventional epidemiological study.

J Family Med Prim Care. 2019 Mar;8(3):1112-1116

Authors: Goswami S, Jha A, Sivan SP, Dambhare D, Gupta SS

Abstract
Introduction: Cholera, though a preventable and treatable disease, is still regarded as an important public health problem in developing countries including India. Migration, unhygienic living conditions, overcrowding, open field defecation, and ignorance about the spread of disease are the major reasons for the occurrence of cholera in the slum areas. Cholera was detected in the stool sample of a 3-year-old child from a slum area of urban Wardha, which demanded an urgent outbreak investigation to be carried out before it progressed into an epidemic.
Materials and Methods: This was a cross-sectional epidemiological study, where we have used pretested, predesigned epidemiological case sheets obtained from IDSP. A case definition was proposed before beginning the investigation. Linelisting, collection of stool and water samples, immediate referral, and treatment of the patients suffering from loose stool and/or vomiting were performed. A detailed epidemiological report was made with recommendations and plan of action that was forwarded to the district health system.
Results: In all, 28 suspected cases of cholera were line listed. Among the affected population, more than half of the suspected cases were from the age group of 0-10 years of age. Males were more affected when compared with females. The overall attack rate was 27% and case fatality rate was 0%. There was positive history of travel in the index case. Two of the water samples were found to be unsatisfactory for drinking.
Conclusion: The investigation report was soon developed and shared with the district health authorities, and recommendations were given to prevent such outbreaks in future.

PMID: 31041259 [PubMed]

The case for ring vaccinations with special consideration of oral cholera vaccines.

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The case for ring vaccinations with special consideration of oral cholera vaccines.

Hum Vaccin Immunother. 2018;14(8):2069-2074

Authors: Deen J, von Seidlein L

Abstract
Ring vaccinations create a zone of immune contacts around a case to prevent further disease transmission and have been successfully employed in the eradication of smallpox and the control of other infections. Millions of oral cholera vaccine (OCV) doses have been effectively deployed through mass vaccination campaigns. But there are situations when the OCV supply, resources, and time are limited and alternative strategies need to be considered. People living in close proximity of cholera cases often share risk factors such as contaminated water supply and poor sanitation. Targeting people within a given radius around a cholera case for intervention including vaccination, improved water supply and sanitation may be a practical and effective approach. A ring oral cholera vaccination strategy could be considered before, after or as an alternative to a mass vaccination approach. We review here the use of the ring vaccinations in general and specifically during cholera outbreaks.

PMID: 29630444 [PubMed - indexed for MEDLINE]

Use of oral cholera vaccine as a vaccine probe to determine the burden of culture-negative cholera.

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Use of oral cholera vaccine as a vaccine probe to determine the burden of culture-negative cholera.

PLoS Negl Trop Dis. 2019 03;13(3):e0007179

Authors: Im J, Islam MT, Ahmmed F, Kim DR, Chon Y, Zaman K, Khan AI, Ali M, Marks F, Qadri F, Clemens JD

Abstract
Analyses of stool from patients with acute watery diarrhea (AWD) using sensitive molecular diagnostics have challenged whether fecal microbiological cultures have acceptably high sensitivity for cholera diagnosis. If true, these findings imply that current estimates of the global burden of cholera, which rely largely on culture-confirmation, may be underestimates. We conducted a vaccine probe study to evaluate this possibility, assessing whether an effective killed oral cholera vaccine (OCV) tested in a field trial in a cholera-endemic population conferred protection against cholera culture-negative AWD, with the assumption that if cultures are indeed insensitive, OCV protection in such cases should be detectable. We re-analysed the data of a Phase III individually-randomized placebo-controlled efficacy trial of killed OCVs conducted in Matlab, Bangladesh in 1985. We calculated the protective efficacy (PE) of a killed whole cell-only (WC-only) OCV against first-episodes of cholera culture-negative AWD during two years of post-dosing follow-up. In secondary analyses, we evaluated PE against cholera culture-negative AWD by age at vaccination, season of onset, and disease severity. In this trial 50,770 people received at least 2 complete doses of either WC-only OCV or placebo, and 791 first episodes of AWD were reported during the follow-up period, of which 365 were culture-positive for Vibrio cholerae O1. Of the 426 culture-negative AWD episodes, 215 occurred in the WC group and 211 occurred in the placebo group (adjusted PE = -1.7%; 95%CI -23.0 to 13.9%, p = 0.859). No measurable PE of OCV was observed against all or severe cholera culture-negative AWD when measured overall or by age and season subgroups. In this OCV probe study we detected no vaccine protection against AWD episodes for which fecal cultures were negative for Vibrio cholera O1. Results from this setting suggest that fecal cultures from patients with AWD were highly sensitive for cholera episodes that were etiologically attributable to this pathogen. Similar analyses of other OCV randomized controlled trials are recommended to corroborate these findings.

PMID: 30870416 [PubMed - indexed for MEDLINE]

Defining endemic cholera at three levels of spatiotemporal resolution within Bangladesh.

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Defining endemic cholera at three levels of spatiotemporal resolution within Bangladesh.

Nat Genet. 2018 07;50(7):951-955

Authors: Domman D, Chowdhury F, Khan AI, Dorman MJ, Mutreja A, Uddin MI, Paul A, Begum YA, Charles RC, Calderwood SB, Bhuiyan TR, Harris JB, LaRocque RC, Ryan ET, Qadri F, Thomson NR

Abstract
Although much focus is placed on cholera epidemics, the greatest burden occurs in settings in which cholera is endemic, including areas of South Asia, Africa and now Haiti1,2. Dhaka, Bangladesh is a megacity that is hyper-endemic for cholera, and experiences two regular seasonal outbreaks of cholera each year3. Despite this, a detailed understanding of the diversity of Vibrio cholerae strains circulating in this setting, and their relationships to annual outbreaks, has not yet been obtained. Here we performed whole-genome sequencing of V. cholerae across several levels of focus and scale, at the maximum possible resolution. We analyzed bacterial isolates to define cholera dynamics at multiple levels, ranging from infection within individuals, to disease dynamics at the household level, to regional and intercontinental cholera transmission. Our analyses provide a genomic framework for understanding cholera diversity and transmission in an endemic setting.

PMID: 29942084 [PubMed - indexed for MEDLINE]

Food insecurity and self-reported cholera in Haitian households: An analysis of the 2012 Demographic and Health Survey.

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Food insecurity and self-reported cholera in Haitian households: An analysis of the 2012 Demographic and Health Survey.

PLoS Negl Trop Dis. 2019 01;13(1):e0007134

Authors: Richterman A, Franke MF, Constant G, Jerome G, Ternier R, Ivers LC

Abstract
BACKGROUND: Both cholera and food insecurity tend to occur in impoverished communities where poor access to food, inadequate sanitation, and an unsafe water supply often coexist. The relationship between the two, however, has not been well-characterized.
METHODS: We performed a secondary analysis of household-level data from the 2012 Demographic and Health Survey in Haiti, a nationally and sub-nationally representative cross-sectional household survey conducted every five years. We used multivariable logistic regression to evaluate the relationship between household food security (as measured by the Household Hunger Scale) and (1) reported history of cholera since 2010 by any person in the household and (2) reported death by any person in the household from cholera (among households reporting at least one case). We performed a complete case analysis because there were <1% missing data for all variables.
RESULTS: There were 13,181 households in the survey, 2,104 of which reported at least one household member with history of cholera. After adjustment for potential confounders, both moderate hunger in the household [Adjusted Odds Ratio (AOR) 1.51, 95% Confidence Interval (CI) 1.30-1.76; p <.0001] and severe hunger in the household (AOR 1.73, 95% CI 1.45-2.08; p <.0001) were significantly associated with reported history of cholera in the household. Severe hunger in the household (AOR 1.85, 95% CI 1.05-3.26; p = 0.03), but not moderate hunger in the household, was independently associated with reported death from cholera in households with at least one case of cholera.
CONCLUSIONS: In this study we identified an independent relationship between household food insecurity and both reported history of cholera and death from cholera in a general population. The directionality of this relationship is uncertain and should be further explored in future prospective research.

PMID: 30699107 [PubMed - indexed for MEDLINE]

Better Cholera Counts Through Machine Learning Models.

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Better Cholera Counts Through Machine Learning Models.

JAMA. 2019 Apr 09;321(14):1343

Authors: Abbasi J

PMID: 30964509 [PubMed - indexed for MEDLINE]

Detection of Uncommon Enteric Bacterial Pathogens from Acute Diarrheal Specimens Using SYBR-Green Real Time PCR.

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Detection of Uncommon Enteric Bacterial Pathogens from Acute Diarrheal Specimens Using SYBR-Green Real Time PCR.

Jpn J Infect Dis. 2019 Mar 25;72(2):88-93

Authors: Chowdhury G, Stine OC, Rajendran K, Mukhopadhyay AK, Okamoto K, Ramamurthy T

Abstract
Acute diarrheal disease is a major health problem, and the second most common cause of death in children under 5 years of age. Conventional diagnostic methods are laborious, time consuming, and occasionally inaccurate. We used SYBR-Green real-time PCR for the detection of 10 uncommon bacterial pathogens using fecal specimens from acute diarrheal patients. In the SYBR-Green real-time PCR assay, the products formed were identified based on a melting point temperature curve analysis, and the assay was validated with the respective reference strain. In a retrospective study, we tested 1,184 stool specimens previously examined using conventional culture methods. Enterotoxigenic Bacteriodes fragilis was detected in 6.7% of the samples followed by enterotoxigenic Bacillus cereus (5.1%), Clostridium perfringens (3.9%), and Aeromonas hydrophila (3.8%). In the prospective study, A. hydrophila, Staphylococcus aureus, and C. perfringens were predominantly detected in 11 > 5 years of age, using real-time PCR. The real-time PCR assay is comprehensive, rapid, accurate, and well suited for surveillance or diagnostic purposes to detect uncommon bacterial pathogens, and should be useful in initiating appropriate care and thereby reducing patient risk.

PMID: 30381678 [PubMed - indexed for MEDLINE]

Genome sequence of a multidrug resistant Klebsiella pneumoniae ST78 with high colistin resistance isolated from a patient.

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Genome sequence of a multidrug resistant Klebsiella pneumoniae ST78 with high colistin resistance isolated from a patient.

J Glob Antimicrob Resist. 2019 Apr 18;:

Authors: Paul M, Narendrakumar L, R Vasanthakumary A, Joseph I, Thomas S

Abstract
OBJECTIVES: Multidrug resistantKlebsiella pneumoniae with colistin resistance have been considered as a major concern in healthcare settings. The present study aims to evaluate the genome wide distribution of antibiotic resistance genes in K. pneumoniae CRKP I with high colistin resistance isolated from a patient.
METHODS: The genome was sequenced on Illumina MiSeq platform. De novo genome assembly was performed using SPAdes version 3.0.0. and the genome sequence was analysed using bioinformatics tools from the Center of Genomic Epidemiology.
RESULTS: The genome of K. pneumoniae CRKP I is 5.1 Mb in size and contain different classes of antibiotic resistance genes. The isolate was highly resistant to colistin due to the point mutation in mgrB gene, the negative regulator of PhoP/PhoQ two component system. MLST analysis showed that K. pneumoniae CRKP I belongs to sequence type 78 (ST78).
CONCLUSION: These data provide useful information for comparative genomic analysis regarding the dissemination of antibiotic resistance genes in K. pneumoniae. To our knowledge, this is the first report of a MDR K. pneumoniae with high colistin resistance belonging to ST78 causing infections in human beings.

PMID: 31005731 [PubMed - as supplied by publisher]

Recurrent Cholera Outbreaks, Democratic Republic of the Congo, 2008-2017.

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Recurrent Cholera Outbreaks, Democratic Republic of the Congo, 2008-2017.

Emerg Infect Dis. 2019 May;25(5):856-864

Authors: Ingelbeen B, Hendrickx D, Miwanda B, van der Sande MAB, Mossoko M, Vochten H, Riems B, Nyakio JP, Vanlerberghe V, Lunguya O, Jacobs J, Boelaert M, Kebela BI, Bompangue D, Muyembe JJ

Abstract
In 2017, the exacerbation of an ongoing countrywide cholera outbreak in the Democratic Republic of the Congo resulted in >53,000 reported cases and 1,145 deaths. To guide control measures, we analyzed the characteristics of cholera epidemiology in DRC on the basis of surveillance and cholera treatment center data for 2008-2017. The 2017 nationwide outbreak resulted from 3 distinct mechanisms: considerable increases in the number of cases in cholera-endemic areas, so-called hot spots, around the Great Lakes in eastern DRC; recurrent outbreaks progressing downstream along the Congo River; and spread along Congo River branches to areas that had been cholera-free for more than a decade. Case-fatality rates were higher in nonendemic areas and in the early phases of the outbreaks, possibly reflecting low levels of immunity and less appropriate prevention and treatment. Targeted use of oral cholera vaccine, soon after initial cases are diagnosed, could contribute to lower case-fatality rates.

PMID: 31002075 [PubMed - in process]

Haitian cholera outbreak-United Nations admits involvement.

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Haitian cholera outbreak-United Nations admits involvement.

J Infect Public Health. 2017 Jul - Aug;10(4):483-484

Authors: Qadir TF, Pasha SB, Fatima H, Ahmed S

PMID: 28277251 [PubMed - indexed for MEDLINE]

Credibility, integrity, transparency & courage: The Haitian Cholera outbreak and the United Nations (UN).

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Credibility, integrity, transparency & courage: The Haitian Cholera outbreak and the United Nations (UN).

J Infect Public Health. 2018 Jan - Feb;11(1):140-141

Authors: Houghton F, Norris A

PMID: 28209469 [PubMed - indexed for MEDLINE]

Unmasking herd protection by an oral cholera vaccine in a cluster-randomized trial.

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Unmasking herd protection by an oral cholera vaccine in a cluster-randomized trial.

Int J Epidemiol. 2019 Apr 09;:

Authors: Ali M, Qadri F, Kim DR, Islam T, Im J, Ahmmed F, Chon Y, Islam Khan A, Zaman K, Marks F, Clemens JD

Abstract
BACKGROUND: Several studies have shown that inactivated, whole-cell oral cholera vaccines (OCVs) confer both direct protection on vaccinees and herd protection on populations. Because our earlier cluster-randomized effectiveness trial (CRT) in urban Bangladesh failed to detect OCV herd protection, we reanalysed the trial to assess whether herd effects were masked in our original analysis.
METHODS: A total of 267 270 persons were randomized to 90 approximately equal-sized clusters. In 60 clusters persons aged 1 year and older were eligible to receive OCV and in 30 clusters persons received no intervention and served as controls. We analysed OCV protection against severely dehydrating cholera for the entire clusters, as in our original analysis, and for subclusters consisting of residents of innermost households. We hypothesized that if OCV herd protection was attenuated by cholera transmission into the clusters from the outside in this densely populated setting, herd protection would be most evident in the innermost households.
RESULTS: During 2 years of follow-up of all residents of the clusters, total protection (protection of OCV recipients relative to control residents) was 58% [95% confidence interval (CI): 43%, 70%; P<0.0001], indirect protection (protection of non-OCV recipients in OCV clusters relative to control participants) was 16% (95% CI: -20%, 41%; P=0.35) and overall OCV protection (protection of all residents in the OCV clusters relative to control residents) was 46% (95% CI: 30%, 59%; P<0.0001). Analyses of the inner 75% and 50% households of the clusters showed similar findings. However, total protection was 75% (95% CI: 50%, 87%, P<0.0001), indirect protection 52% (95% CI: -9%, 79%; P=0.08) and overall protection 72% (95% CI: 49%, 84%; P<0.0001) for the innermost 25% households.
CONCLUSION: Consistent with past studies, substantial OCV herd protective effects were identified, but were unmasked only by analysing innermost households of the clusters. Caution is needed in defining clusters for analysis of vaccine herd effects in CRTs of vaccines.

PMID: 30968110 [PubMed - as supplied by publisher]

Exploring the development of a household cholera-focused health literacy scale in James Town, Accra.

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Exploring the development of a household cholera-focused health literacy scale in James Town, Accra.

J Infect Public Health. 2019 Jan - Feb;12(1):62-69

Authors: Tutu RA, Gupta S, Elavarthi S, Busingye JD, Boateng JK

Abstract
BACKGROUND: Foodborne diseases are significant reasons for in-patient and out-patient morbidity in Ghana. Of the foodborne illnesses reported in the country, cholera incidence and outbreaks have resulted in food-related mortality since the disease was first reported in the 1970s. Cholera is now endemic in the country. This study attempts to develop and pilot a tool to measure household health literacy among the urban poor in James Town, a cholera endemic neighborhood.
METHODS: A survey questionnaire was developed based on four of the World Health Organization's (WHO) recommendations on issues for measurement of health literacy in low- and middle-income countries. The instrument was administered to 401 households in the community. We undertook reliability and validity analyses. T-test, Kruskal Wallis test, and Mann-Whitney test were used to examine the association between the health literacy scores of the scale and subscales and the demographic characteristics of households.
RESULTS: The reliability analyses showed that the instrument was internally consistent (Cronbach alpha=0.762). All the subscales were reliable except the beliefs about health and healthcare subscale. Based on content and construct validity analyses, 13 items were used for further examination of health literacy. We found that majority of households know about the information, education, and communication materials and 52% of households indicated that these materials remind them about the dangers of cholera. About 39% of the households decide together as a unit on steps to avoid getting cholera during an outbreak. Overall health literacy scores and the subscales were significantly associated with sex, age, marital status, and educational level of household head. Specifically, females, being married, increasing age and higher household income had a significant association with higher health literacy scores.
CONCLUSION: Household units in James Town impacts individual health literacy through: family discussions; access to information, education, and communication materials on cholera; and intentional efforts made to get information on cholera risk factors.

PMID: 30219358 [PubMed - indexed for MEDLINE]

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