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A Quantitative Systematic Review and Meta-Analysis of the Effectiveness of Oral Cholera Vaccine as a Reactive Measure in Cholera Outbreaks

Published online by Cambridge University Press:  10 January 2018

Patricia Schwerdtle ,
Coretta-Kings Onekon  and
Katrina Recoche
Patricia Schwerdtle*
Affiliation:
Nursing and Midwifery, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia Medecins Sans Frontieres, Sydney, Australia
Coretta-Kings Onekon
Affiliation:
Cameroon Ministry for Health, Cameroon, Africa
Katrina Recoche
Affiliation:
Nursing and Midwifery, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
*
Correspondence: Patricia Schwerdtle, MPH Monash University Nursing and Midwifery Faculty of Medicine, Nursing, and Health Sciences Melbourne, Victoria, Australia E-mail: patricia.schwerdtle@monash.edu
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Abstract

Introduction

The efficacy of oral cholera vaccines (OCVs) in laboratory conditions has been established, and the World Health Organization (WHO; Geneva, Switzerland) has recommended their preventative use in high-risk settings. The WHO recommendation has not been fully operationalized, nor has it been extended to apply to the reactive use of OCVs in real field epidemic conditions due to concerns about potential resource diversion, feasibility, cost, and acceptability. The purpose of this study is to assess and synthesize existing evidence of OCV effectiveness when used reactively in real field conditions.

Methods

A systematic review and meta-analysis was conducted involving studies that investigated vaccine effectiveness when used as a reactive measure; that is, cases had reached epidemic threshold and a cholera epidemic was declared in real field epidemic conditions. OVID Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA), and EMBASE (Elsevier; Amsterdam, Netherlands), along with grey literature, were systematically searched using pre-determined criteria. Two independent reviewers identified studies that met the selection criteria and data were extracted using validated tools. Pooled estimates were obtained using fixed effect models.

Results

Of the 347 articles that met the inclusion criteria, four studies were retrieved for meta-analysis (three were case-control studies and one was a case-cohort study) involving a total of 1,509 participants and comprising 175 cases and 1,334 case controls. The effectiveness of one or two doses of either Shanchol (Shantha Biotechnics; India) or ORC-Vax (Vabiotech; Vietnam) OCVs showed a combined vaccine effectiveness of 75% (95% CI, 61-84).

Conclusion

A positive association was demonstrated between the reactive use of OCVs and protection against cholera. This supported the WHO recommendation to utilize OCVs reactively as an additional measure to the standard cholera epidemic response package.

SchwerdtleP, OnekonCK, RecocheK. A Quantitative Systematic Review and Meta-Analysis of the Effectiveness of Oral Cholera Vaccine as a Reactive Measure in Cholera Outbreaks. Prehosp Disaster Med. 2018;33(1):2–6.

Keywords

choleraeffectivenessepidemicsmeta-analysisoral cholera vaccinationsystematic review
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 1 , February 2018 , pp. 2 - 6
Copyright
© World Association for Disaster and Emergency Medicine 2018 

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Footnotes

Conflicts of interest: none.

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