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Background New-generation, orally administered cholera vaccines offer the promise of improved control of cholera in sub-Saharan Africa. However, the high prevalence of human immunodeficiency virus (HIV) infection in many cholera-affected African populations has raised doubts about the level of protection possible with vaccination. We evaluated a mass immunization program with recombinant cholera-toxin B subunit, killed whole-cell (rBS-WC) oral cholera vaccine in Beira, Mozambique, a city where the seroprevalence of HIV is 20 to 30 percent.
Methods From December 2003 to January 2004, we undertook mass immunization of nonpregnant persons at least two years of age, using a two-dose regimen of rBS-WC vaccine in Esturro, Beira (population 21,818). We then assessed vaccine protection in a case–control study during an outbreak of El Tor Ogawa cholera in Beira between January and May 2004. To estimate the level of vaccine protection, antecedent rates of vaccination were compared between persons with culture-confirmed cholera severe enough to have prompted them to seek treatment and age- and sex-matched neighborhood controls without treated diarrhea.
Results We assessed the effectiveness of the vaccine in 43 persons with cholera and 172 controls. Receipt of one or more doses of rBS-WC vaccine was associated with 78 percent protection (95 percent confidence interval, 39 to 92 percent; P=0.004). The vaccine was equally effective in children younger than five years of age and in older persons. A concurrently conducted case–control study designed to detect bias compared persons with treated, noncholeraic diarrhea and controls without diarrhea in the same population and found no protection associated with receipt of the rBS-WC vaccine.
Conclusions The rBS-WC vaccine was highly effective against clinically significant cholera in an urban sub-Saharan African population with a high prevalence of HIV infection.
Source Information
From the Ministry of Health, Maputo, Mozambique (M.E.S.L., J. Amos, A.M., A.B., F.F.S.); the International Vaccine Institute, Seoul, Korea (J.L.D., L.S., X.-Y.W., M.P., M. Ali, J.D.C.); the Centre for Health and Population Research, Dhaka, Bangladesh (M. Ansaruzzaman); Epicentre, Paris (J. Ampuero, P.C., P.J.G.); Médecins Sans Frontières, Geneva (C.M.); the World Health Organization, Maputo, Mozambique (P.K.-S.) and Geneva (C.-L.C.); and the National Institute of Child Health and Human Development, Bethesda, Md. (J.D.C.).
Address reprint requests to Dr. Deen at the International Vaccine Institute, Kwanak, P.O. Box 14, Seoul 151-600, Korea, or at jdeen{at}ivi.int.
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