Cholera

Oral cholera vaccines

In October 2017, The Global Task Force on Cholera Control (GTFCC) launched a renewed strategy for cholera control to support countries in the implementation of cholera control plans, based on multisectoral interventions targeting cholera hotspots. Oral Cholera Vaccine (OCV) can play an important role in outbreak prevention and control, and in long term control of cholera.

Cholera prevention and control

Effective cholera prevention and control interventions are well known and rely to a great extent on the implementation of integrated and comprehensive approaches that involve activities both inside and outside of the health sector, including:

  • Enhanced epidemiological and laboratory surveillance to identify endemic areas and detect, confirm, and quickly respond to outbreaks;
  • Universal use of safe water and basic sanitation;
  • Community engagement for behavioral changes and improved hygiene practices;
  • Use of basic drinking water services;
  • Use of basic sanitation services;
  • Quick access to treatment, such as Oral Rehydration Solution (ORS), which is used to successfully treat most cases, and intravenous fluids and antibiotics for severe cases;
  • Immunization with Oral Cholera Vaccine (OCV)

OCV stockpile and its use

In 2013, WHO established the Global Oral Cholera Vaccine (OCV) stockpile and received long term support from Gavi, the Vaccine Alliance for use of OCV in epidemic and endemic settings. Since then the targeted use of the vaccine in endemic, epidemic and humanitarian settings has increased dramatically under the guidance from the Global Task Force on Cholera Control (GTFCC).

In line with the updated WHO position paper on cholera vaccines published in August 2017, many countries are now integrating the use of OCV within their cholera control programs. To date (May 2018) over 25M doses have been administered through mass vaccination campaigns in 19 countries since the stockpile was created in 2013.

Accessing OCV through the Global Stockpile

To request OCV, countries need to submit a request form documenting the country needs for OCV, describing the local context including identification of areas to target (hotspots), and how the use of cholera vaccine is integrated in the multisectoral cholera control plan, in complement with the plans for improvements of Water, Sanitation and Hygiene (WASH), reinforced surveillance, social mobilization and case management.

Countries requests are then reviewed by the GTFCC OCV Working Group – which comprises over 15 partner institutions. The review is based on the following criteria:

  • Risk of cholera
  • Severity of cholera
  • WASH conditions and capacity to improve
  • Healthcare conditions and capacity to improve
  • Capacity to implement OCV campaigns
  • Capacity to conduct M&E activities
  • Commitment at national and local level

Operational Cost support for OCV campaigns is available for Gavi eligible countries. Technical support is also available from WHO and the partners of the GTFCC to prepare, implement and monitor and evaluate the campaigns.

GTFCC support

The GTFCC Secretariat is available to support countries with the development of OCV requests and more broadly with the development and implementation of cholera control plans. Please contact the GTFCC Secretariat for any question or request for support: GTFCCSecretariat@who.int

Summary of WHO OCV position paper

Cholera prevention and control should be a priority in areas at risk for cholera or where endemic cholera is present. 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.

Control of endemic cholera

In cholera-endemic countries, vaccination of the entire population (throughout a country regardless of risk) is usually not warranted. Vaccination policies and strategies should be guided by an assessment of the risk of cholera and targeted to cholera hotspots.

Control of cholera outbreaks

Appropriate treatment of people with cholera, implementation of clean water and sanitation and community mobilization should remain the principal control measures during ongoing epidemics. Cholera vaccination should be considered to help prevent the spread of current outbreaks to new areas. The decision to implement vaccination should be taken only after a thorough investigation of the current and historical epidemiological situation and a clear identification of geographical areas and populations to be targeted, as well as assessment of the feasibility of organizing a vaccination campaign.

Cholera control in humanitarian emergencies

During humanitarian emergencies with a risk of cholera, but without a current cholera outbreak, vaccination with OCV should be considered as an additional preparedness measure for outbreak prevention, depending on the local infrastructure (capacity to organize a vaccination campaign).