Zambia is currently grappling with the fight against cholera. More than 3000 cases have been reported since the 2017/18 rain season begun and more than 70 deaths recorded. A multisectoral approach to combat the outbreak has been implemented including the use of security personnel to maintain public order and more than ZMW100 million (USD10m) has been spent so far.
The first outbreak of cholera in the country was recorded between 1977 followed by another outbreak in 1982; and since then, there has been outbreaks though, not on an annual basis. These outbreaks, once they occur, put the country under serious economic and health stress.
Several strategies on the prevention of cholera such as providing clean water and proper sanitation, health education and good food hygiene have been promoted as long term measures to prevent such outbreaks, however, the need to integrate oral cholera vaccines (OCV) to these strategies continues to be emphasised.
Professor David Sack, from the Department of International Health at Johns Hopkins Bloomberg School of Public Health shade more light on OCV during the CIDRZ research meeting when he made a presentation on ‘How can CIDRZ contribute to elimination of cholera in Zambia?’.
The World Health Organization (WHO) agrees “given the current availability of killed whole-cell OCVs and data on their safety, efficacy, field effectiveness, feasibility, impact and acceptability in cholera-affected populations, these vaccines should be used in areas with endemic cholera, in humanitarian crises with high risk of cholera, and during cholera outbreaks. The vaccines should always be used in conjunction with other cholera prevention and control strategies”.
Prof Sack reiterates that “sanitation is the long term solution; but vaccine will provide results more quickly. The first round of OCV in Zambia in April 2016 showed 89% effectiveness from 423,774 doses administered to a target population of 543,755 people. OCV reduces the risk for persons to receive vaccine, if coverage is high, OCV also reduces the risk for persons who do not receive vaccine and further reduces the risk for persons who receive the vaccine. Clearly vaccine is not an alternative to safe water; however, vaccine and improved water/sanitation actually work together—each reinforces the benefit of the other”.
He added that critical elements towards cholera elimination included understanding the disease burden (epidemiology, transmission, surveillance, seasonality, hotspots), an integrated national plan to focus efforts on Hotspots as well as resources and leadership.
CIDRZ is currently implementing the Delivering Oral Vaccine Effectively (DOVE) Project in collaboration with Johns Hopkins Bloomberg School of Public Health, a cholera vaccine study in the Lukanga Swamps. The goal of the DOVE project is to ensure that populations at risk of cholera will benefit from receiving OCV in an appropriate and effective manner.
The project provides tools and resources to countries and agencies who are dealing with the threat of cholera in order to assist them in making evidence-based decisions regarding when and how to use OCV.