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Feasibility, coverage and cost of oral cholera vaccination conducted by icddr,b using the existing national immunization service delivery mechanism in rural setting Keraniganj, Bangladesh.

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Feasibility, coverage and cost of oral cholera vaccination conducted by icddr,b using the existing national immunization service delivery mechanism in rural setting Keraniganj, Bangladesh.

Hum Vaccin Immunother. 2019;15(6):1302-1309

Authors: Khan AI, Khan IA, Siddique SA, Rahman A, Islam MT, Bhuiya MAI, Saha NC, Biswas PK, Saha A, Chowdhury F, Qadri F

Abstract
Background: Cholera is a considerable health burden in developing country settings including Bangladesh. The oral cholera vaccine (OCV) is a preventative tool to control the disease. The objective of this study was to describe whether the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b), could provide the OCV to rural communities using existing government infrastructure. Methods: The study was conducted in rural sub-district Keraniganj, 20 km from the capital city Dhaka. All listed participants one year and above in age (excluding pregnant women) were offered two doses of OCV at a 14 day interval. Existing government facilities were used to deliver and also maintain the cold chain required for the vaccine. All events related to vaccination were recorded at the 17 vaccination sites to evaluate the coverage and feasibility of OCV program. Results: A total of 29,029 individuals received the 1st dose (90% of target) and 26,611 individuals received the 2nd dose (83% of target and 92% of 1st dose individuals) of OCV. The highest vaccination coverage was in younger children (1-9 years) and the lowest was amongst 18-29-year age group. Somewhat better coverage was seen amongst the female participants than males (92% vs. 88% for the 1st dose and 93% vs. 90% for the 2nd dose). The cost of vaccine cost was calculated as US$1.00 per dose plus freight, insurance, and transportation and the total vaccine delivery cost was US$70,957. Conclusion: This was a project undertaken using existing public health program resources to collect empirical evidence on the use of a mass OCV campaign in the rural setting. Mass vaccination with the OCV is feasible in the rural setting using existing governmental vaccine delivery systems in Bangladesh.

PMID: 30261152 [PubMed - indexed for MEDLINE]

Oral cholera vaccines and their impact on the global burden of disease.

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Oral cholera vaccines and their impact on the global burden of disease.

Hum Vaccin Immunother. 2019;15(6):1294-1301

Authors: Wierzba TF

Abstract
With one-third of nations at risk of cholera, we can expect to experience massive, rapidly disseminated, and prolonged cholera outbreaks such as those recently experienced in Yemen and Haiti. The prevention of cholera outbreaks like these includes the provision of potable water, sanitation, and hygiene (WASH). This approach has been known for generations. However, it will be many years before universal global access to WASH is achieved. While working toward universal WASH, study data has shown that licensed and WHO prequalified cholera vaccines are important tools for cholera prevention. Oral inactivated whole-cell vaccines such as Shanchol and Euvichol-plus provide well-documented direct benefits to vaccine recipients and to the unimmunized through herd protection. Manufacturers have now increased the cholera vaccine supply, and since 2013 vaccine doses have been available for emergency and endemic control through a global stockpile. Advances in packaging and vaccine temperature control, reduced vaccine costs, the inclusion of pregnant women in vaccine campaigns, and a targeted approach to high incidence endemic areas are further increasing the usefulness of these vaccines for reducing the global cholera burden.

PMID: 30183486 [PubMed - indexed for MEDLINE]

Delayed second dose of oral cholera vaccine administered before high-risk period for cholera transmission: Cholera control strategy in Lusaka, 2016.

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Delayed second dose of oral cholera vaccine administered before high-risk period for cholera transmission: Cholera control strategy in Lusaka, 2016.

PLoS One. 2019;14(8):e0219040

Authors: Ferreras E, Matapo B, Chizema-Kawesha E, Chewe O, Mzyece H, Blake A, Moonde L, Zulu G, Poncin M, Sinyange N, Kasese-Chanda N, Phiri C, Malama K, Mukonka V, Cohuet S, Uzzeni F, Ciglenecki I, Danovaro-Holliday MC, Luquero FJ, Pezzoli L

Abstract
BACKGROUND: In April 2016, an emergency vaccination campaign using one dose of Oral Cholera Vaccine (OCV) was organized in response to a cholera outbreak that started in Lusaka in February 2016. In December 2016, a second round of vaccination was conducted, with the objective of increasing the duration of protection, before the high-risk period for cholera transmission. We assessed vaccination coverage for the first and second rounds of the OCV campaign.
METHODS: Vaccination coverage was estimated after each round from a sample selected from targeted-areas for vaccination using a cross-sectional survey in to establish the vaccination status of the individuals recruited. The study population included all individuals older than 12 months residing in the areas targeted for vaccination. We interviewed 505 randomly selected individuals after the first round and 442 after the second round. Vaccination status was ascertained either by vaccination card or verbal reporting. Households were selected using spatial random sampling.
RESULTS: The vaccination coverage with two doses was 58.1% (25/43; 95%CI: 42.1-72.9) in children 1-5 years old, 59.5% (69/116; 95%CI: 49.9-68.5) in children 5-15 years old and 19.9% (56/281; 95%CI: 15.4-25.1) in adults above 15 years old. The overall dropout rate was 10.9% (95%CI: 8.1-14.1). Overall, 69.9% (n = 309/442; 95%CI: 65.4-74.1) reported to have received at least one OCV dose.
CONCLUSIONS: The areas at highest risk of suffering cholera outbreaks were targeted for vaccination obtaining relatively high vaccine coverage after each round. However, the long delay between doses in areas subject to considerable population movement resulted in many individuals receiving only one OCV dose. Additional vaccination campaigns may be required to sustain protection over time in case of persistence of risk. Further evidence is needed to establish a maximum optimal interval time of a delayed second dose and variations in different settings.

PMID: 31469853 [PubMed - indexed for MEDLINE]

Knowledge, attitude and practices on cholera in an arid county, Kenya, 2018: A mixed-methods approach.

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Knowledge, attitude and practices on cholera in an arid county, Kenya, 2018: A mixed-methods approach.

PLoS One. 2020;15(2):e0229437

Authors: Orimbo EO, Oyugi E, Dulacha D, Obonyo M, Hussein A, Githuku J, Owiny M, Gura Z

Abstract
BACKGROUND: Cholera remains a public health problem in Kenya despite increased efforts to create awareness. Assessment of knowledge, attitude and practice (KAP) in the community is essential for the planning and implementation of preventive measures. We assessed cholera KAP in a community in Isiolo County, Kenya.
METHODS: This cross-sectional study involved a mixed-methods approach utilizing a questionnaire survey and focus group discussions (FGDs). Using multistage sampling with household as the secondary sampling unit, interviewers administered structured questionnaires to one respondent aged ≥18 years old per household. We created knowledge score by allotting one point for each correct response, considered any total score ≥ median score as high knowledge score, calculated descriptive statistics and used multivariate logistic regression to examine factors associated with high knowledge score. In FGDs, we randomly selected the participants aged ≥18 years and had lived in Isiolo for >1 year, conducted the FGDs using an interview guide and used content analysis to identify salient emerging themes.
RESULTS: We interviewed 428 participants (median age = 30 years; Q1 = 25, Q3 = 38) comprising 372 (86.9%) females. Of the 425/428 (99.3%) who had heard about cholera, 311/425 (73.2%) knew that it is communicable. Although 273/428 (63.8%) respondents knew the importance of treating drinking water, only 216/421 (51.3%) treated drinking water. Those with good defecation practice were 209/428 (48.8%). Respondents with high knowledge score were 227/428 (53.0%). Positive attitude (aOR = 2.88, 95% C.I = 1.34-6.20), treating drinking water (aOR = 2.21, 95% C.I = 1.47-3.33), age <36 years (aOR = 1.75, 95% C.I = 1.11-2.74) and formal education (aOR = 1.71, 95% C.I = 1.08-2.68) were independently associated with high knowledge score. FGDs showed poor latrine coverage, inadequate water treatment and socio-cultural beliefs as barriers to cholera prevention and control.
CONCLUSIONS: There was a high knowledge score on cholera with gaps in preventive practices. We recommend targeted health education to the old and uneducated persons and general strengthening of health education in the community.

PMID: 32101587 [PubMed - as supplied by publisher]

A comparison of Lyse-It to other cellular sample preparation, bacterial lysing, and DNA fragmentation technologies.

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A comparison of Lyse-It to other cellular sample preparation, bacterial lysing, and DNA fragmentation technologies.

PLoS One. 2019;14(7):e0220102

Authors: Santaus TM, Li S, Saha L, Chen WH, Bhagat S, Stine OC, Geddes CD

Abstract
The ability for safe and rapid pathogenic sample transportation and subsequent detection is an increasing challenge throughout the world. Herein, we describe and use bead-beating, vortex, sonication, 903 protein saver cards, and Lyse-It methods, aiming to inactivate Gram-positive and -negative bacteria with subsequent genome DNA (quantitative Polymerase Chain Reaction) qPCR detection. The basic concepts behind the four chosen technologies is their versatility, cost, and ease of use in developed and underdeveloped countries. The four methods target the testing of bacterial resilience, cellular extraction from general and complex media and subsequent DNA extraction for qPCR detection and amplification. These results demonstrate that conventional high temperature heating, 903 protein saver cards, and Lyse-It are all viable options for inactivating bacterial growth for safe shipping. Additionally, Lyse-It was found to be particularly useful as this technology can inactivate bacteria, extract cells from 903 protein saver cards, lyse bacterial cells, and additionally keep genomic DNA viable for qPCR detection.

PMID: 31335892 [PubMed - indexed for MEDLINE]

Genomic insights into Vibrio cholerae O1 responsible for cholera epidemics in Tanzania between 1993 and 2017.

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Genomic insights into Vibrio cholerae O1 responsible for cholera epidemics in Tanzania between 1993 and 2017.

PLoS Negl Trop Dis. 2019 12;13(12):e0007934

Authors: Hounmanou YMG, Leekitcharoenphon P, Kudirkiene E, Mdegela RH, Hendriksen RS, Olsen JE, Dalsgaard A

Abstract
BACKGROUND: Tanzania is one of seven countries with the highest disease burden caused by cholera in Africa. We studied the evolution of Vibrio cholerae O1 isolated in Tanzania during the past three decades.
METHODOLOGY/PRINCIPAL FINDINGS: Genome-wide analysis was performed to characterize V. cholerae O1 responsible for the Tanzanian 2015-2017 outbreak along with strains causing outbreaks in the country for the past three decades. The genomes were further analyzed in a global context of 590 strains of the seventh cholera pandemic (7PET), as well as environmental isolates from Lake Victoria. All Tanzanian cholera outbreaks were caused by the 7PET lineage. The T5 sub-lineage (ctxB3) dominated outbreaks until 1997, followed by the T10 atypical El Tor (ctxB1) up to 2015, which were replaced by the T13 atypical El Tor of the current third wave (ctxB7) causing most cholera outbreaks until 2017 with T13 being phylogenetically related to strains from East African countries, Yemen and Lake Victoria. The strains were less drug resistant with approximate 10-kb deletions found in the SXT element, which encodes resistance to sulfamethoxazole and trimethoprim. Nucleotide deletions were observed in the CTX prophage of some strains, which warrants further virulence studies. Outbreak strains share 90% of core genes with V. cholerae O1 from Lake Victoria with as low as three SNPs difference and a significantly similar accessory genome, composed of genomic islands namely the CTX prophage, Vibrio Pathogenicity Islands; toxin co-regulated pilus biosynthesis proteins and the SXT-ICE element.
CONCLUSION/SIGNIFICANCE: Characterization of V. cholerae O1 from Tanzania reveals genetic diversity of the 7PET lineage composed of T5, T10 and T13 sub-lineages with introductions of new sequence types from neighboring countries. The presence of these sub-lineages in environmental isolates suggests that the African Great Lakes may serve as aquatic reservoirs for survival of V. cholerae O1 favoring continuous human exposure.

PMID: 31869327 [PubMed - indexed for MEDLINE]

Safety and immunogenicity of a killed bivalent (O1 and O139) whole-cell oral cholera vaccine in adults and children in Vellore, South India.

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Safety and immunogenicity of a killed bivalent (O1 and O139) whole-cell oral cholera vaccine in adults and children in Vellore, South India.

PLoS One. 2019;14(6):e0218033

Authors: Raghava Mohan V, Raj S, Dhingra MS, Aloysia D'Cor N, Singh AP, Saluja T, Kim DR, Midde VJ, Kim Y, Vemula S, Narla SK, Sah B, Ali M

Abstract
This open-label study assessed the safety and immunogenicity of two doses (14 days apart) of an indigenously manufactured, killed, bivalent (Vibrio cholerae O1 and O139), whole-cell oral cholera vaccine (SHANCHOL; Shantha Biotechnics) in healthy adults (n = 100) and children (n = 100) in a cholera endemic area (Vellore, South India) to fulfill post-licensure regulatory requirements and post-World Health Organization (WHO) prequalification commitments. Safety and reactogenicity were assessed, and seroconversion rates (i.e. proportion of participants with a ≥ 4-fold rise from baseline in serum vibriocidal antibody titers against V. cholerae O1 Inaba, O1 Ogawa and O139, respectively) were determined 14 days after each vaccine dose. No serious adverse events were reported during the study. Commonly reported solicited adverse events were headache and general ill feeling. Seroconversion rates after the first and second dose in adults were 67.7% and 55.2%, respectively, against O1 Inaba; 47.9% and 45.8% against O1 Ogawa; and 19.8% and 20.8% against O139. In children, seroconversion rates after the first and second dose were 80.2% and 68.8%, respectively, against O1 Inaba; 72.9% and 67.7% against O1 Ogawa; and 26.0% and 18.8% against O139. The geometric mean titers against O1 Inaba, O1 Ogawa, and O139 in both adults and children were significantly higher after each vaccine dose compared to baseline titers (P < 0.001; for both age groups after each dose versus baseline). The seroconversion rates for O1 Inaba, O1 Ogawa, and O139 in both age groups were similar to those in previous studies with the vaccine. In conclusion, the killed, bivalent, whole-cell oral cholera vaccine has a good safety and reactogenicity profile, and is immunogenic in healthy adults and children. Trial Registration: ClinicalTrials.gov NCT00760825; CTRI/2012/01/002354.

PMID: 31211792 [PubMed - indexed for MEDLINE]

A decade-long temporal analyses of human group-A rotavirus among children with gastroenteritis: pre-vaccination scenario in West Bengal, eastern India.

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A decade-long temporal analyses of human group-A rotavirus among children with gastroenteritis: pre-vaccination scenario in West Bengal, eastern India.

J Med Virol. 2020 Feb 19;:

Authors: Chawla-Sarkar M, Banerjee A, Lo M, Mitra S, Okamoto K, Deb A, Dutta S

Abstract
Despite the significant reduction in global infantile death toll due to rotaviral diarrhea, India still contributes substantially to rotavirus-related hospitalization as well as mortality rates. The rotavirus surveillance study conducted from 2008 through 2017 among children (≤5 years) with moderate to severe gastroenteritis seeking healthcare facilities at two hospitals in eastern India, revealed a change in the proportion of rotavirus positivity, seasonality and age-group specificity along with the cycling of different usual and unusual genotypes in this endemic setting. G1 strains predominated during 2008-10, while G2 and G9 genotypes eventually upsurged during 2011-13. G1 strains re-established their lead during 2013-15, while G3 emerged for the first time in eastern India in 2015 and rooted itself as the cardinal strain 2016 onwards. Evolutionary analyses of all the predominant genotypes (G1, G2, G3 and G9) revealed that they were mostly phylogenetically distant to the rotavirus vaccine strains as depicted in the phylogenetic dendrogram. These decade-long epidemiological study during the pre-vaccination period in West Bengal (eastern India) underscore the co-circulation of multiple rotavirus genotypes in addition to sporadic occurrence of zoonotic strains like G10P[6] and G11P[25]. This article is protected by copyright. All rights reserved.

PMID: 32073164 [PubMed - as supplied by publisher]

Psychiatric Comorbidity of Unipolar Mood, Anxiety, and Trauma Disorders Prior to HIV Testing and the Effect on Linkage to Care Among HIV-Infected Adults in South Africa.

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Psychiatric Comorbidity of Unipolar Mood, Anxiety, and Trauma Disorders Prior to HIV Testing and the Effect on Linkage to Care Among HIV-Infected Adults in South Africa.

AIDS Behav. 2019 Dec;23(12):3444-3451

Authors: Belus JM, Cholera R, Miller WC, Bassett J, Gaynes BN

Abstract
Psychiatric comorbidity, the presence of two or more psychiatric disorders, leads to worse HIV outcomes in the United States; this relationship has not been studied in sub-Saharan Africa. We conducted a preliminary study to describe the prevalence of psychiatric comorbidity (unipolar mood, anxiety, and trauma disorders) among 363 adults prior to HIV testing at Witkoppen Health and Welfare Centre, a primary care clinic in Johannesburg, South Africa. We also examined whether psychiatric comorbidity predicted subsequent linkage to HIV care 3 months later. Prevalence of psychiatric comorbidity prior to HIV testing was approximately 5.5%. In the final HIV-positive subsample (n = 76), psychiatric comorbidity of unipolar mood, anxiety, and trauma disorders did not predict linkage to care [adjusted relative risk = 1.01 (0.59, 1.71)] or number of follow-up appointments (adjusted relative risk = 0.86 (0.40, 1.82)]. A similar psychiatric profile emerged for HIV-positive and HIV-negative individuals before becoming aware of their HIV status. The psychiatric burden typically seen in HIV-positive individuals may manifest over time.

PMID: 31297682 [PubMed - indexed for MEDLINE]

Incubation periods impact the spatial predictability of cholera and Ebola outbreaks in Sierra Leone.

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Incubation periods impact the spatial predictability of cholera and Ebola outbreaks in Sierra Leone.

Proc Natl Acad Sci U S A. 2020 Feb 13;:

Authors: Kahn R, Peak CM, Fernández-Gracia J, Hill A, Jambai A, Ganda L, Castro MC, Buckee CO

Abstract
Forecasting the spatiotemporal spread of infectious diseases during an outbreak is an important component of epidemic response. However, it remains challenging both methodologically and with respect to data requirements, as disease spread is influenced by numerous factors, including the pathogen's underlying transmission parameters and epidemiological dynamics, social networks and population connectivity, and environmental conditions. Here, using data from Sierra Leone, we analyze the spatiotemporal dynamics of recent cholera and Ebola outbreaks and compare and contrast the spread of these two pathogens in the same population. We develop a simulation model of the spatial spread of an epidemic in order to examine the impact of a pathogen's incubation period on the dynamics of spread and the predictability of outbreaks. We find that differences in the incubation period alone can determine the limits of predictability for diseases with different natural history, both empirically and in our simulations. Our results show that diseases with longer incubation periods, such as Ebola, where infected individuals can travel farther before becoming infectious, result in more long-distance sparking events and less predictable disease trajectories, as compared to the more predictable wave-like spread of diseases with shorter incubation periods, such as cholera.

PMID: 32054785 [PubMed - as supplied by publisher]

Evolution of the World Health Organization's programmatic actions to control diarrheal diseases.

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Evolution of the World Health Organization's programmatic actions to control diarrheal diseases.

J Glob Health. 2019 Dec;9(2):020802

Authors: Wolfheim C, Fontaine O, Merson M

Abstract
The Program for the Control of Diarrheal Diseases (CDD) of the World Health Organization (WHO) was created in 1978, the year the Health for All Strategy was launched at the Alma Ata International Conference on Primary Health Care. CDD quickly became one of the pillars of this strategy, with its primary goal of reducing diarrhea-associated mortality among infants and young children in developing countries. WHO expanded the previous cholera-focused unit into one that addressed all diarrheal diseases, and uniquely combined support to research and to national CDD Programs. We describe the history of the Program, summarize the results of the research it supported, and illustrate the outcome of the Program's control efforts at country and global levels. We then relate the subsequent evolution of the Program to an approach that was more technically broad and programmatically narrow and describe how this affected diarrheal diseases-related activities globally and in countries.

PMID: 31673346 [PubMed - indexed for MEDLINE]

Cholera in the time of likes. Inspirational pathogens and an important pump.

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Cholera in the time of likes. Inspirational pathogens and an important pump.

Microbes Infect. 2019 Oct - Nov;21(8-9):341-342

Authors: Häfner S

PMID: 31004789 [PubMed - indexed for MEDLINE]

Cuban Public Health History: The 19th Century Board of Health in the City of Holguín.

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Cuban Public Health History: The 19th Century Board of Health in the City of Holguín.

MEDICC Rev. 2019 Apr-Jul;21(2-3):69-74

Authors: Calzadilla-González A, Calzadilla-Anido IM, Calzadilla-González A

Abstract
INTRODUCTION In 19th century colonial Cuba, Boards of Health (Juntas de Sanidad) were created to administer public health, in tandem with and later replacing the older Royal Protomedicato Court (Real Tribunal de Protomedicato). Development of the Board of Health in the northeastern city of Holguín reflected local historical processes, as well as class relations and social issues characteristic of this period. Among the highlights of the Board's activities were epidemic control during cholera and smallpox outbreaks, monitoring the city's sanitary conditions, and support for charitable work. Studying the history of such epidemiological surveillance activities may benefit design and implementation of related current research and prevention/control campaigns. OBJECTIVE Describe the development of the 19th century Board of Health in the city of Holguín. EVIDENCE ACQUISITION The research was conducted through a critical analysis of primary sources contained in the Historical Archives of (today's) Holguín Province, specifically relevant documents from the regional and city government (Fondo Tenencia de Gobierno y Ayuntamiento) and town council (Cabildo). Cuban and international scientific publications were also consulted. DEVELOPMENT The Board of Health was the main institution conducting health and hygiene control and charitable activities in the city of Holguín during the 19th century. It was created mainly to take preventive measures against diseases affecting the population, an effort it undertook with support from the Urban Health Police. Its efforts to confront smallpox and cholera epidemics greatly helped to reduce the toll of these diseases on the population, albeit not sufficiently to prevent their reccurrence. Beginning in the 1870s, weakened government support eroded the Board's position, and health-related measures were implemented mainly by the Board of Charity, which focused on matters concerning the city's Civil Hospital. CONCLUSIONS Although established in 1820, Holguín's Board of Health carried out preventive actions most actively from 1850 to 1865, with support from the Urban Health Police. Its gradual disappearance from the health policy arena beginning in the 1870s reflects its failure as an institution, in large part due to weak government support. KEYWORDS Board of Health, prevention, epidemics, Cuba.

PMID: 31401639 [PubMed - indexed for MEDLINE]

Cognate T and B cell interaction and association of follicular helper T cells with B cell responses in Vibrio cholerae O1 infected Bangladeshi adults.

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Cognate T and B cell interaction and association of follicular helper T cells with B cell responses in Vibrio cholerae O1 infected Bangladeshi adults.

Microbes Infect. 2019 Apr - May;21(3-4):176-183

Authors: Rashu R, Bhuiyan TR, Hoq MR, Hossain L, Paul A, Khan AI, Chowdhury F, Harris JB, Ryan ET, Calderwood SB, Weil AA, Qadri F

Abstract
Vibrio cholerae O1 can cause life threatening diarrheal disease if left untreated. T cells can play critical roles in inducing B cell mediated immunity. As the mechanism of T cell dependent B cell maturation is not well established, we hypothesized that a specific population of T (follicular helper T, Tfh) cells, are involved in B cell maturation following cholera. We found flowcytometrically that V. cholerae infection induces significant increases in circulating Tfh cells expressing B cell maturation associated protein CD40L early in disease. The increased Tfh cells expressing CD40L recognize cholera toxin most prominently, with lessened responses to V. cholerae membrane preparation (MP) and V. cholerae cytolysin (VCC). We further showed that early induction of Tfh cells and CD40L was associated with later memory B cell responses to same antigens. Lastly, we demonstrated in vitro that Tfh cells isolated after cholera can stimulate class switching of co-cultured, isolated B cells from patients with cholera, leading to production of the more durable IgG antibody isotype colorimetrically. These studies were conducted on circulating Tfh cells; future studies will be directed at examining role of Tfh cells during cholera directly in gut mucosa of biopsied samples, at the single cell level if feasible.

PMID: 30580014 [PubMed - indexed for MEDLINE]

High cholera vaccination coverage following emergency campaign in Haiti: Results from a cluster survey in three rural Communes in the South Department, 2017.

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High cholera vaccination coverage following emergency campaign in Haiti: Results from a cluster survey in three rural Communes in the South Department, 2017.

PLoS Negl Trop Dis. 2020 Jan 31;14(1):e0007967

Authors: Sharp A, Blake A, Backx J, Panunzi I, Barrais R, Nackers F, Luquero F, Deslouches YG, Cohuet S

Abstract
Oral cholera vaccine (OCV) has increasingly been used as an outbreak control measure, but vaccine shortages limit its application. A two-dose OCV campaign targeting residents aged over 1 year was launched in three rural Communes of Southern Haiti during an outbreak following Hurricane Matthew in October 2016. Door-to-door and fixed-site strategies were employed and mobile teams delivered vaccines to hard-to-reach communities. This was the first campaign to use the recently pre-qualified OCV, Euvichol. The study objective was to estimate post-campaign vaccination coverage in order to evaluate the campaign and guide future outbreak control strategies. We conducted a cluster survey with sampling based on random GPS points. We identified clusters of five households and included all members eligible for vaccination. Local residents collected data through face-to-face interviews. Coverage was estimated, accounting for the clustered sampling, and 95% confidence intervals calculated. 435 clusters, 2,100 households and 9,086 people were included (99% response rate). Across the three communes respectively, coverage by recall was: 80.7% (95% CI:76.8-84.1), 82.6% (78.1-86.4), and 82.3% (79.0-85.2) for two doses and 94.2% (90.8-96.4), 91.8% (87-94.9), and 93.8% (90.8-95.9) for at least one dose. Coverage varied by less than 9% across age groups and was similar among males and females. Participants obtained vaccines from door-to-door vaccinators (53%) and fixed sites (47%). Most participants heard about the campaign through community 'criers' (58%). Despite hard-to-reach communities, high coverage was achieved in all areas through combining different vaccine delivery strategies and extensive community mobilisation. Emergency OCV campaigns are a viable option for outbreak control and where possible multiple strategies should be used in combination. Euvichol will help alleviate the OCV shortage but effectiveness studies in outbreaks should be done.

PMID: 32004316 [PubMed - as supplied by publisher]

Improving Cross-Border Preparedness and Response: Lessons Learned from 3 Lassa Fever Outbreaks Across Benin, Nigeria, and Togo, 2017-2019.

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Improving Cross-Border Preparedness and Response: Lessons Learned from 3 Lassa Fever Outbreaks Across Benin, Nigeria, and Togo, 2017-2019.

Health Secur. 2020 Jan;18(S1):S105-S112

Authors: Kakaī CG, Okunromade OF, Dan-Nwafor CC, Chabi AIB, Martial GTP, Dalhat MM, Ward S, Tante O, Nguku PM, Hamadi A, Ilori E, Lokossou V, Brito C, Ojo OE, Kone I, Agbeko TT, Ihekweazu C, Merrill RD

Abstract
Long-standing cultural, economic, and political relationships among Benin, Nigeria, and Togo contribute to the complexity of their cross-border connectivity. The associated human movement increases the risk of international spread of communicable disease. The Benin and Togo ministries of health and the Nigeria Centre for Disease Control, in collaboration with the Abidjan Lagos Corridor Organization (a 5-country intergovernmental organization) and the US Centers for Disease Control and Prevention, sought to minimize the risk of cross-border outbreaks by defining and implementing procedures for binational and multinational public health collaboration. Through 2 multinational meetings, regular district-level binational meetings, and fieldwork to characterize population movement and connectivity patterns, the countries improved cross-border public health coordination. Across 3 sequential cross-border Lassa fever outbreaks identified in Benin or Togo between February 2017 and March 2019, the 3 countries improved their collection and sharing of patients' cross-border travel histories, shortened the time between case identification and cross-border information sharing, and streamlined multinational coordination during response efforts. Notably, they refined collaborative efforts using lessons learned from the January to March 2018 Benin outbreak, which had a 100% case fatality rate among the 5 laboratory-confirmed cases, 3 of whom migrated from Nigeria across porous borders when ill. Aligning countries' expectations for sharing public health information would assist in reducing the international spread of communicable diseases by facilitating coordinated preparedness and responses strategies. Additionally, these binational and multinational strategies could be made more effective by tailoring them to the unique cultural connections and population movement patterns in the region.

PMID: 32004125 [PubMed - in process]

Public health round-up.

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Public health round-up.

Bull World Health Organ. 2019 Aug 01;97(8):517-518

Authors:

PMID: 31384068 [PubMed - indexed for MEDLINE]

Assessment of laboratory capacity of public secondary health facilities in performing assay of selected epidemic-prone diseases in Oyo State, Nigeria.

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Assessment of laboratory capacity of public secondary health facilities in performing assay of selected epidemic-prone diseases in Oyo State, Nigeria.

Diagn Microbiol Infect Dis. 2019 Oct;95(2):191-194

Authors: Bankole OT, Ajayi IO

Abstract
This study assessed the capacity of public secondary facility-based laboratories in conducting diagnostic tests for selected epidemic-prone diseases in Oyo State, Nigeria. A descriptive cross-sectional study was conducted in 17 secondary facility-based laboratories in Oyo State. Capacity was assessed on a 100-point scale in which scores were rated low (≤49%), fair (50-79%) and good (≥80%). Diagnostic testing capacity for bacterial meningitis, cholera, and measles was "low" in all the laboratories. The reasons reported for laboratories not conducting diagnostic tests for the selected diseases included inadequate instruments, unavailable reagents, and clinicians' failure to request those diagnostic tests. Laboratory capacity to perform diagnostic tests for the selected diseases was low in Oyo State secondary hospitals. There is a need for the provision of modern instruments and reagents, as well as clinician laboratorian quality assurance programs, to improve diagnostic services relating to the selected diseases.

PMID: 31296359 [PubMed - indexed for MEDLINE]

Post-infection irritable bowel syndrome in the tropical and subtropical regions: Vibrio cholerae is a new cause of this well-known condition.

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Post-infection irritable bowel syndrome in the tropical and subtropical regions: Vibrio cholerae is a new cause of this well-known condition.

Indian J Gastroenterol. 2019 04;38(2):87-94

Authors: Ghoshal UC, Rahman MM

PMID: 31073702 [PubMed - indexed for MEDLINE]

The history of OCV in India and barriers remaining to programmatic introduction.

The history of OCV in India and barriers remaining to programmatic introduction.

Vaccine. 2020 Jan 22;:

Authors: Mogasale V, Kanungo S, Pati S, Lynch J, Dutta S

Abstract
Cholera-endemic Eastern India has played an important role in the development of oral cholera vaccines (OCV) through conduct of pivotal trials in Kolkata which led to the registration of the first low-cost bivalent killed whole cell OCV in India in 2009, and subsequent prequalification by the World Health Organization prequalification in 2011. Odisha hosted an influential early demonstration project for use of the vaccine in a high-risk population and provided data and lessons that were crucial input in the Vaccine Investment Strategy developed by Gavi, the Vaccine Alliance in 2013. With Gavi's decision to finance an OCV stockpile, the demand for OCV surged and vaccine has been deployed with great success worldwide in areas of need in response to outbreaks and disasters, most notably in Africa. However, although India is considered one of the highest burden countries, no further use of OCV has occurred since the demonstration project in Odisha in 2011. In this paper we will summarize the important contributions of India to the development and use of OCV and discuss the possible barriers to OCV introduction as a public health tool to control cholera.

PMID: 31982258 [PubMed - as supplied by publisher]

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