Considerations for oral cholera vaccine use during outbreak after earthquake in Haiti, 2010-2011

Abstract

Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and preemptively during outbreaks and complex emergencies. However, experience and guidelines for reactive use after an outbreak has started are limited. In 2010, after over a century without epidemic cholera, an outbreak was reported in Haiti after an earthquake. As intensive nonvaccine cholera control measures were initiated, the feasibility of OCV use was considered. We reviewed OCV characteristics and recommendations for their use and assessed global vaccine availability and capacity to implement a vaccination campaign. Real-time modeling was conducted to estimate vaccine impact. Ultimately, cholera vaccination was not implemented because of limited vaccine availability, complex logistical and operational challenges of a multidose regimen, and obstacles to conducting a campaign in a setting with population displacement and civil unrest. Use of OCVs is an option for cholera control; guidelines for their appropriate use in epidemic and emergency settings are urgently needed.

Figure 1

Distribution of cases of cholera among departments in Haiti, October 2010–January 16, 2011. Department population, earliest known date of confirmed case, and number of hospitalizations and deaths are indicated. Totals for Haiti: population, 9,923,243; cholera cases, 194,095; hospitalizations, 109,015; deaths: 3,889. Port-au-Prince includes the following communes: Carrefour, Cité Soleil, Delmas, Kenscoff, Petion-Ville, Port-au-Prince, and Tabarre. Data sources: Ministère de la Santé Publique et de la Population, Institut Haitien de Statistique et d’Informatique, Centre National de l’Information Géo Spatiale, and Laboratoire National De Santé Publique.

Figure 2

Events and actions related to considerations for cholera vaccination, Haiti, October 2010–April 2011. The full epicurve after January 18 is shown for reference only. Events and discussions regarding vaccination or other events after that date are not depicted. UN, United Nations; CFR, case-fatality rate; CDC, Centers for Disease Control and Prevention; MSPP, Haiti Ministère de Santé Publique et de la Population; PAHO, Pan American Health Organization.