A refugee camp in Nepal. Photo: Lorenz Von Seidlein (2015).

The availability and affordability of the oral cholera vaccine (OCV) has greatly increased given the creation of the Global Oral Cholera Vaccine stockpile in 2013. However, prioritization of where to use OCV is needed given that the two million doses in the global stockpile are not sufficient to meet global endemic and epidemic vaccine needs. To date, there is no consensus as to how to implement the vaccine in the most efficient way, given different cholera epidemiology scenarios. 

The recently published, “Scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans”—authored by Jacqueline Deen, David Sack, and others—presents a systematic classification of situations based on five types of cholera epidemiology examples and provides recommendations on when and how vaccination should be used for each setting.

This scenario approach aims to “provide evidence to spur the development of detailed guidelines on how and where oral cholera vaccines could, and should, be most rationally deployed.” 

The document discusses OCV recommendations for five cholera epidemiology scenarios including:  

Scenario 1: An area with an ongoing cholera outbreak during a humanitarian crisis in which water and sanitation conditions are poor or have deteriorated severely as a result of complex natural or man-made disasters.

Scenario 2: An area with a humanitarian crisis in which water and sanitation conditions are poor or have deteriorated severely as a result of complex natural or man-made disasters but no ongoing cholera outbreak.

Scenario 3: An area with endemic cholera, or the occurrence of culture-confirmed cholera in the population during at least three of the past five years (1).

Scenario 4: An area with poor water and sanitation infrastructure and where cholera has not been detected for several years.

Scenario 5: An area where cholera has not been identified and where water and sanitation standards are high, but where the new vaccine might be of interest for special groups, such as workers from cholera-endemic countries.

References:

1. WHO. Oral cholera vaccines in mass immunization campaigns: guidance for planning and use. Geneva: World Health Organization, 2010.