Organization and implementation of an oral cholera vaccination campaign in an endemic urban setting in Dhaka, Bangladesh

ABSTRACT

Bangladesh has historically been cholera endemic, with seasonal cholera outbreaks occurring each year. In collaboration with the government of Bangladesh, the Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) initiated operational research to test strategies to reach the high-risk urban population with an affordable oral cholera vaccine (OCV) “ShancholTM” and examine its effectiveness in reducing diarrhea due to cholera. Here we report a sub-analysis focusing on the organization, implementation and effectiveness of different oral cholera vaccine delivery strategies in the endemic urban setting in Bangladesh. We described how the vaccination program was planned, prepared and implemented using different strategies to deliver oral cholera vaccine to a high-risk urban population in Dhaka, Bangladesh based on administrative data and observations made during the program. The objective of this study is to evaluate the organization, implementation and effectiveness of different oral cholera vaccine delivery strategies in the endemic urban setting in Bangladesh. OCV administration by trained local volunteers through outreach sites and mop-up activities yielded high coverage of 82% and 72% of 172,754 targeted individuals for the first and second dose respectively, using national Expanded Program on Immunization (EPI) campaign mechanisms without disrupting routine immunization activities. The cost of delivery was low. Safety and cold chain requirements were adequately managed. The adopted strategies were technically and programmatically feasible. Current evidence on implementation strategies in different settings together with available OCV stockpiles should encourage at-risk countries to use OCV along with other preventive and control measures.

KEYWORDS:

• Cholera
• organization
• implementation
• feasible
• vaccination
• endemic
• urban
• Bangladesh

Responsible Editor

Stig Wall, Umeå University, Sweden

Responsible Editor

Stig Wall, Umeå University, Sweden

Acknowledgments

The icddr,b is thankful to the Governments of Bangladesh, Canada, Sweden, and the UK for providing core or unrestricted support. We thank the people of Mirpur; the field and data management staff who made tremendous efforts to make the study successful; and the people who provided valuable support to our study. We also thank the Nextgenediting Global Initiative (www.nextgenediting.com) for editorial support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

The study protocol was approved by the Research Review Committee and the Ethical Review Committee of the icddr,b, Dhaka, Bangladesh. The study is registered at http://clinicaltrials.gov, NCT01339845. Informed consent was obtained from the study participants. The vaccine used was licensed in India, WHO pre-qualified, and brought into Bangladesh after approval from the Drug Administration.

Paper context

OCV is an important public health tool to control cholera. This operational research was conducted to test strategies to reach high-risk urban population with an affordable oral cholera vaccine. This is one of the largest vaccination programs using a two dose oral cholera vaccine targeting a high-risk population in an endemic urban setting. This study shows that mass oral cholera vaccination of high-risk individuals in the endemic setting is technically and operationally feasible.

Additional information

Funding

This study was supported by a Grant OPP50419 from the Bill & Melinda Gates Foundation.