Nepal implemented its largest oral cholera vaccine campaign to date

Background 

In early 2017 stakeholders from the Nepal Ministry of Health, International Vaccine Institute (IVI), Group for Technical Assistance (GTA), and Delivering Oral Cholera Vaccine Effectively (DOVE) Project came together to implement the first oral cholera vaccine (OCV) campaign in the Banke district of Nepal. Campaign implementation spanned a total of ten days—five days for the first dose and five days for the second dose—and produced a successful two-dose coverage rate of 73% of the target population. This was the largest oral cholera vaccination campaign conducted in Nepal to date.

Implementation 

  • The Nepal Ministry of Health decided to implement a vaccination campaign in Banke district, a region in the mid-western area of Nepal after a review of the cholera prevalence and data from the 2010 cholera outbreak.
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  • Around 50,000 doses of Euvichol were donated by the Rotary Club of Seoul and were distributed throughout three sites in Banke district (two rural and one urban).
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  • A short training on the vaccine, behavioral messaging, healthy water, sanitation and hygiene behaviors, and social mobilization was conducted for health workers prior to vaccine administration.
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  • The Group for Technical Assistance designed and carried out street dramas that illustrated how cholera is spread, the signs and symptoms of cholera, how to prevent cholera and future outbreaks, and how to seek treatment.
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  • 126 female health workers and volunteers provided the vaccine over a total period of ten days—with 14 days between doses. Implementation partners went door-to-door to administer the vaccine to ensure it was distributed to the targeted population of around 28,000 people. The vaccination teams were composed of three people: a team leader (medical or paramedical staff), a vaccinator and a health educator, responsible for filling in and signing the vaccination card and communicating key health education to households. Pregnant women and children under one year of age were excluded from the target population.
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  • Social mobilization activities were carried out via FM radio, TV and newspaper and included information regarding: hand washing, latrine use, vaccine safety, and the importance of continuing to practice healthy hygiene behaviors after receiving the vaccine.
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  • Community leaders helped campaign organizers overcome religious and cultural barriers regarding use of the vaccine.
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  • The campaign resulted in 74% two-dose coverage of the target population—with 85% receiving at least one dose of vaccine during the campaign.

Lessons Learned 

  • Government Ownership: The OCV campaign can only be initiated with a decision by the Ministry of Health that the campaign is critical for the people and with their full ownership of the campaign to make it a success. Collaboration between different government sectors develops partnerships and fosters commitment to the prevention and control of cholera for future vaccination campaigns.
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  • Community Mobilization: Spend time building relationships with local members of the community in areas where the campaign is being planned. Community leaders must understand why the vaccine campaign is being conducted so they can explain it to others. The campaign experienced some religious/cultural resistance from certain populations in Banke district, and the community leaders proved to be a resource to help resolve barriers such as these.
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  • Stakeholder Support: Having a vaccine champion in the Ministry of Health can streamline vaccination implementation efforts. Strong relationships between partners and key stakeholders was key to successful campaign implementation.
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  • Evidence: Vaccine campaigns must be based on data in order to decide where to vaccinate to achieve the best results. Extensive planning prior to vaccine distribution is imperative to decide where to implement the campaign.

Further Considerations 

  • Surveillance: Functioning surveillance systems that include baseline data and information from previous vaccination campaigns should be in place and used to develop and guide the implementation of OCV campaigns.
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  • Media: Be proactive about addressing questions and concerns that might be raised by journalists and other media outlets to avoid the spread of rumors and false information about OCV and any future vaccination campaigns. Reaching out to educate media personnel from the early stages can be essential to the success of the campaign.
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  • Systems: Work through and utilize existing government or national systems and structures for vaccination campaigns whenever possible. For example, adapt and use existing cold chain networks to transport OCV.
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Contributors: Khim Khadka, MOH; Mellisa Roskosky, Johns Hopkins University DOVE Project; David Sack, Johns Hopkins University DOVE Project; Emily Nagourney, Johns Hopkins University DOVE Project; Christina Shaw, Johns Hopkins University DOVE Project; Anne Ballard Sara, Johns Hopkins University DOVE Project.