Effectiveness of one dose of killed oral cholera vaccine in an endemic community in the Democratic Republic of the Congo: a matched case-control study
A global shortage of cholera vaccines has increased the use of single-dose regimens, rather than the standard two-dose regimen. There is sparse evidence on single-dose protection, particularly in children. In 2020, a mass vaccination campaign was conducted in Uvira, an endemic urban setting in easte...
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| Veröffentlicht in: | The Lancet infectious diseases 2024-05, Vol.24 (5), p.514-522 |
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| creator | Malembaka, Espoir Bwenge Bugeme, Patrick Musole Hutchins, Chloe Xu, Hanmeng Hulse, Juan Dent Demby, Maya N Gallandat, Karin Saidi, Jaime Mufitini Rumedeka, Baron Bashige Itongwa, Moïse Tshiwedi-Tsilabia, Esperance Kitoga, Faida Bodisa-Matamu, Tavia Kavunga-Membo, Hugo Bengehya, Justin Kulondwa, Jean-Claude Debes, Amanda K Taty, Nagède Lee, Elizabeth C Lunguya, Octavie Lessler, Justin Leung, Daniel T Cumming, Oliver Okitayemba, Placide Welo Mukadi-Bamuleka, Daniel Knee, Jackie Azman, Andrew S |
| description | A global shortage of cholera vaccines has increased the use of single-dose regimens, rather than the standard two-dose regimen. There is sparse evidence on single-dose protection, particularly in children. In 2020, a mass vaccination campaign was conducted in Uvira, an endemic urban setting in eastern Democratic Republic of the Congo, resulting in largely single-dose coverage. We examined the effectiveness of a single-dose of the oral cholera vaccine Euvichol-Plus in this high-burden setting.
In this matched case-control study, we recruited individuals with medically attended confirmed cholera in the two cholera treatment facilities in the city of Uvira. The control group consisted of age-matched, sex-matched, and neighbourhood-matched community individuals. We recruited across two distinct periods: Oct 14, 2021, to March 10, 2022 (12–17 months after vaccination), and Nov 21, 2022, to Oct 18, 2023 (24–36 months after vaccination). Study staff administered structured questionnaires to all participants to capture demographics, household conditions, potential confounding variables, and vaccination status. The odds of vaccination for the case and control groups were contrasted in conditional logistic regression models to estimate unadjusted and adjusted vaccine effectiveness.
We enrolled 658 individuals with confirmed cholera and 2274 matched individuals for the control group. 99 (15·1%) individuals in the case group were younger than 5 years at the time of vaccination. The adjusted single-dose vaccine effectiveness was 52·7% (95% CI 31·4 to 67·4) 12–17 months after vaccination and 44·7% (24·8 to 59·4) 24–36 months after vaccination. Although protection in the first 12–17 months after vaccination was similar for children aged 1–4 years and older individuals, the estimate of protection in children aged 1–4 years appeared to wane during the third year after vaccination (adjusted vaccine effectiveness 32·9%, 95% CI –30·7 to 65·5), with CIs spanning the null.
A single dose of Euvichol-Plus provided substantial protection against medically attended cholera for at least 36 months after vaccination in this cholera-endemic setting. Although the evidence provides support for similar levels of protection in young children and others in the short term, protection among children younger than 5 years might wane significantly during the third year after vaccination.
Wellcome Trust and Gavi, the Vaccine Alliance. |
| doi_str_mv | 10.1016/S1473-3099(23)00742-9 |
| format | Article |
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In this matched case-control study, we recruited individuals with medically attended confirmed cholera in the two cholera treatment facilities in the city of Uvira. The control group consisted of age-matched, sex-matched, and neighbourhood-matched community individuals. We recruited across two distinct periods: Oct 14, 2021, to March 10, 2022 (12–17 months after vaccination), and Nov 21, 2022, to Oct 18, 2023 (24–36 months after vaccination). Study staff administered structured questionnaires to all participants to capture demographics, household conditions, potential confounding variables, and vaccination status. The odds of vaccination for the case and control groups were contrasted in conditional logistic regression models to estimate unadjusted and adjusted vaccine effectiveness.
We enrolled 658 individuals with confirmed cholera and 2274 matched individuals for the control group. 99 (15·1%) individuals in the case group were younger than 5 years at the time of vaccination. The adjusted single-dose vaccine effectiveness was 52·7% (95% CI 31·4 to 67·4) 12–17 months after vaccination and 44·7% (24·8 to 59·4) 24–36 months after vaccination. Although protection in the first 12–17 months after vaccination was similar for children aged 1–4 years and older individuals, the estimate of protection in children aged 1–4 years appeared to wane during the third year after vaccination (adjusted vaccine effectiveness 32·9%, 95% CI –30·7 to 65·5), with CIs spanning the null.
A single dose of Euvichol-Plus provided substantial protection against medically attended cholera for at least 36 months after vaccination in this cholera-endemic setting. Although the evidence provides support for similar levels of protection in young children and others in the short term, protection among children younger than 5 years might wane significantly during the third year after vaccination.
Wellcome Trust and Gavi, the Vaccine Alliance.</description><identifier>ISSN: 1473-3099</identifier><identifier>ISSN: 1474-4457</identifier><identifier>EISSN: 1474-4457</identifier><identifier>DOI: 10.1016/S1473-3099(23)00742-9</identifier><identifier>PMID: 38246191</identifier><language>eng</language><publisher>United States: Elsevier Ltd</publisher><subject>Administration, Oral ; Adolescent ; Adult ; Case studies ; Case-Control Studies ; Child ; Child, Preschool ; Children ; Cholera ; Cholera - epidemiology ; Cholera - prevention & control ; Cholera Vaccines - administration & dosage ; Cholera Vaccines - immunology ; Democratic Republic of the Congo - epidemiology ; Demographic variables ; Demographics ; Drinking water ; Effectiveness ; Endemic Diseases - prevention & control ; Epidemics ; Estimates ; Female ; Health facilities ; Households ; Humans ; Immunization ; Infant ; Male ; Mass Vaccination ; Middle Aged ; Observational studies ; Regression analysis ; Regression models ; Urban areas ; Urban environments ; Vaccination - statistics & numerical data ; Vaccine Efficacy ; Vaccines ; Vaccines, Inactivated - administration & dosage ; Vaccines, Inactivated - immunology ; Waterborne diseases ; Young Adult</subject><ispartof>The Lancet infectious diseases, 2024-05, Vol.24 (5), p.514-522</ispartof><rights>2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license</rights><rights>Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.</rights><rights>2024. The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. This work is published under https://creativecommons.org/licenses/by/3.0/ (theLicense”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c496t-309ab897bbaaba8852e289fccf1a7226dd79d3785dc64d19343db429efbb4dd73</citedby><cites>FETCH-LOGICAL-c496t-309ab897bbaaba8852e289fccf1a7226dd79d3785dc64d19343db429efbb4dd73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/3046508969?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>230,314,777,781,882,3537,27905,27906,45976,64364,64366,64368,72218</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38246191$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Malembaka, Espoir Bwenge</creatorcontrib><creatorcontrib>Bugeme, Patrick Musole</creatorcontrib><creatorcontrib>Hutchins, Chloe</creatorcontrib><creatorcontrib>Xu, Hanmeng</creatorcontrib><creatorcontrib>Hulse, Juan Dent</creatorcontrib><creatorcontrib>Demby, Maya N</creatorcontrib><creatorcontrib>Gallandat, Karin</creatorcontrib><creatorcontrib>Saidi, Jaime Mufitini</creatorcontrib><creatorcontrib>Rumedeka, Baron Bashige</creatorcontrib><creatorcontrib>Itongwa, Moïse</creatorcontrib><creatorcontrib>Tshiwedi-Tsilabia, Esperance</creatorcontrib><creatorcontrib>Kitoga, Faida</creatorcontrib><creatorcontrib>Bodisa-Matamu, Tavia</creatorcontrib><creatorcontrib>Kavunga-Membo, Hugo</creatorcontrib><creatorcontrib>Bengehya, Justin</creatorcontrib><creatorcontrib>Kulondwa, Jean-Claude</creatorcontrib><creatorcontrib>Debes, Amanda K</creatorcontrib><creatorcontrib>Taty, Nagède</creatorcontrib><creatorcontrib>Lee, Elizabeth C</creatorcontrib><creatorcontrib>Lunguya, Octavie</creatorcontrib><creatorcontrib>Lessler, Justin</creatorcontrib><creatorcontrib>Leung, Daniel T</creatorcontrib><creatorcontrib>Cumming, Oliver</creatorcontrib><creatorcontrib>Okitayemba, Placide Welo</creatorcontrib><creatorcontrib>Mukadi-Bamuleka, Daniel</creatorcontrib><creatorcontrib>Knee, Jackie</creatorcontrib><creatorcontrib>Azman, Andrew S</creatorcontrib><title>Effectiveness of one dose of killed oral cholera vaccine in an endemic community in the Democratic Republic of the Congo: a matched case-control study</title><title>The Lancet infectious diseases</title><addtitle>Lancet Infect Dis</addtitle><description>A global shortage of cholera vaccines has increased the use of single-dose regimens, rather than the standard two-dose regimen. There is sparse evidence on single-dose protection, particularly in children. In 2020, a mass vaccination campaign was conducted in Uvira, an endemic urban setting in eastern Democratic Republic of the Congo, resulting in largely single-dose coverage. We examined the effectiveness of a single-dose of the oral cholera vaccine Euvichol-Plus in this high-burden setting.
In this matched case-control study, we recruited individuals with medically attended confirmed cholera in the two cholera treatment facilities in the city of Uvira. The control group consisted of age-matched, sex-matched, and neighbourhood-matched community individuals. We recruited across two distinct periods: Oct 14, 2021, to March 10, 2022 (12–17 months after vaccination), and Nov 21, 2022, to Oct 18, 2023 (24–36 months after vaccination). Study staff administered structured questionnaires to all participants to capture demographics, household conditions, potential confounding variables, and vaccination status. The odds of vaccination for the case and control groups were contrasted in conditional logistic regression models to estimate unadjusted and adjusted vaccine effectiveness.
We enrolled 658 individuals with confirmed cholera and 2274 matched individuals for the control group. 99 (15·1%) individuals in the case group were younger than 5 years at the time of vaccination. The adjusted single-dose vaccine effectiveness was 52·7% (95% CI 31·4 to 67·4) 12–17 months after vaccination and 44·7% (24·8 to 59·4) 24–36 months after vaccination. Although protection in the first 12–17 months after vaccination was similar for children aged 1–4 years and older individuals, the estimate of protection in children aged 1–4 years appeared to wane during the third year after vaccination (adjusted vaccine effectiveness 32·9%, 95% CI –30·7 to 65·5), with CIs spanning the null.
A single dose of Euvichol-Plus provided substantial protection against medically attended cholera for at least 36 months after vaccination in this cholera-endemic setting. Although the evidence provides support for similar levels of protection in young children and others in the short term, protection among children younger than 5 years might wane significantly during the third year after vaccination.
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epidemiology</topic><topic>Cholera - prevention & control</topic><topic>Cholera Vaccines - administration & dosage</topic><topic>Cholera Vaccines - immunology</topic><topic>Democratic Republic of the Congo - epidemiology</topic><topic>Demographic variables</topic><topic>Demographics</topic><topic>Drinking water</topic><topic>Effectiveness</topic><topic>Endemic Diseases - prevention & control</topic><topic>Epidemics</topic><topic>Estimates</topic><topic>Female</topic><topic>Health facilities</topic><topic>Households</topic><topic>Humans</topic><topic>Immunization</topic><topic>Infant</topic><topic>Male</topic><topic>Mass Vaccination</topic><topic>Middle Aged</topic><topic>Observational studies</topic><topic>Regression analysis</topic><topic>Regression models</topic><topic>Urban areas</topic><topic>Urban environments</topic><topic>Vaccination - statistics & numerical data</topic><topic>Vaccine Efficacy</topic><topic>Vaccines</topic><topic>Vaccines, Inactivated - administration & dosage</topic><topic>Vaccines, Inactivated - immunology</topic><topic>Waterborne diseases</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Malembaka, Espoir Bwenge</creatorcontrib><creatorcontrib>Bugeme, Patrick Musole</creatorcontrib><creatorcontrib>Hutchins, Chloe</creatorcontrib><creatorcontrib>Xu, Hanmeng</creatorcontrib><creatorcontrib>Hulse, Juan Dent</creatorcontrib><creatorcontrib>Demby, Maya N</creatorcontrib><creatorcontrib>Gallandat, Karin</creatorcontrib><creatorcontrib>Saidi, Jaime Mufitini</creatorcontrib><creatorcontrib>Rumedeka, Baron Bashige</creatorcontrib><creatorcontrib>Itongwa, Moïse</creatorcontrib><creatorcontrib>Tshiwedi-Tsilabia, Esperance</creatorcontrib><creatorcontrib>Kitoga, Faida</creatorcontrib><creatorcontrib>Bodisa-Matamu, Tavia</creatorcontrib><creatorcontrib>Kavunga-Membo, Hugo</creatorcontrib><creatorcontrib>Bengehya, Justin</creatorcontrib><creatorcontrib>Kulondwa, Jean-Claude</creatorcontrib><creatorcontrib>Debes, Amanda K</creatorcontrib><creatorcontrib>Taty, Nagède</creatorcontrib><creatorcontrib>Lee, Elizabeth C</creatorcontrib><creatorcontrib>Lunguya, Octavie</creatorcontrib><creatorcontrib>Lessler, Justin</creatorcontrib><creatorcontrib>Leung, Daniel T</creatorcontrib><creatorcontrib>Cumming, Oliver</creatorcontrib><creatorcontrib>Okitayemba, Placide Welo</creatorcontrib><creatorcontrib>Mukadi-Bamuleka, Daniel</creatorcontrib><creatorcontrib>Knee, Jackie</creatorcontrib><creatorcontrib>Azman, Andrew S</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Pharma and Biotech Premium PRO</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Lancet Titles</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Lancet infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Malembaka, Espoir Bwenge</au><au>Bugeme, Patrick Musole</au><au>Hutchins, Chloe</au><au>Xu, Hanmeng</au><au>Hulse, Juan Dent</au><au>Demby, Maya N</au><au>Gallandat, Karin</au><au>Saidi, Jaime Mufitini</au><au>Rumedeka, Baron Bashige</au><au>Itongwa, Moïse</au><au>Tshiwedi-Tsilabia, Esperance</au><au>Kitoga, Faida</au><au>Bodisa-Matamu, Tavia</au><au>Kavunga-Membo, Hugo</au><au>Bengehya, Justin</au><au>Kulondwa, Jean-Claude</au><au>Debes, Amanda K</au><au>Taty, Nagède</au><au>Lee, Elizabeth C</au><au>Lunguya, Octavie</au><au>Lessler, Justin</au><au>Leung, Daniel T</au><au>Cumming, Oliver</au><au>Okitayemba, Placide Welo</au><au>Mukadi-Bamuleka, Daniel</au><au>Knee, Jackie</au><au>Azman, Andrew S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of one dose of killed oral cholera vaccine in an endemic community in the Democratic Republic of the Congo: a matched case-control study</atitle><jtitle>The Lancet infectious diseases</jtitle><addtitle>Lancet Infect Dis</addtitle><date>2024-05</date><risdate>2024</risdate><volume>24</volume><issue>5</issue><spage>514</spage><epage>522</epage><pages>514-522</pages><issn>1473-3099</issn><issn>1474-4457</issn><eissn>1474-4457</eissn><abstract>A global shortage of cholera vaccines has increased the use of single-dose regimens, rather than the standard two-dose regimen. There is sparse evidence on single-dose protection, particularly in children. In 2020, a mass vaccination campaign was conducted in Uvira, an endemic urban setting in eastern Democratic Republic of the Congo, resulting in largely single-dose coverage. We examined the effectiveness of a single-dose of the oral cholera vaccine Euvichol-Plus in this high-burden setting.
In this matched case-control study, we recruited individuals with medically attended confirmed cholera in the two cholera treatment facilities in the city of Uvira. The control group consisted of age-matched, sex-matched, and neighbourhood-matched community individuals. We recruited across two distinct periods: Oct 14, 2021, to March 10, 2022 (12–17 months after vaccination), and Nov 21, 2022, to Oct 18, 2023 (24–36 months after vaccination). Study staff administered structured questionnaires to all participants to capture demographics, household conditions, potential confounding variables, and vaccination status. The odds of vaccination for the case and control groups were contrasted in conditional logistic regression models to estimate unadjusted and adjusted vaccine effectiveness.
We enrolled 658 individuals with confirmed cholera and 2274 matched individuals for the control group. 99 (15·1%) individuals in the case group were younger than 5 years at the time of vaccination. The adjusted single-dose vaccine effectiveness was 52·7% (95% CI 31·4 to 67·4) 12–17 months after vaccination and 44·7% (24·8 to 59·4) 24–36 months after vaccination. Although protection in the first 12–17 months after vaccination was similar for children aged 1–4 years and older individuals, the estimate of protection in children aged 1–4 years appeared to wane during the third year after vaccination (adjusted vaccine effectiveness 32·9%, 95% CI –30·7 to 65·5), with CIs spanning the null.
A single dose of Euvichol-Plus provided substantial protection against medically attended cholera for at least 36 months after vaccination in this cholera-endemic setting. Although the evidence provides support for similar levels of protection in young children and others in the short term, protection among children younger than 5 years might wane significantly during the third year after vaccination.
Wellcome Trust and Gavi, the Vaccine Alliance.</abstract><cop>United States</cop><pub>Elsevier Ltd</pub><pmid>38246191</pmid><doi>10.1016/S1473-3099(23)00742-9</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1473-3099 |
| ispartof | The Lancet infectious diseases, 2024-05, Vol.24 (5), p.514-522 |
| issn | 1473-3099 1474-4457 1474-4457 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11043051 |
| source | MEDLINE; Elsevier ScienceDirect Journals; ProQuest Central UK/Ireland |
| subjects | Administration, Oral Adolescent Adult Case studies Case-Control Studies Child Child, Preschool Children Cholera Cholera - epidemiology Cholera - prevention & control Cholera Vaccines - administration & dosage Cholera Vaccines - immunology Democratic Republic of the Congo - epidemiology Demographic variables Demographics Drinking water Effectiveness Endemic Diseases - prevention & control Epidemics Estimates Female Health facilities Households Humans Immunization Infant Male Mass Vaccination Middle Aged Observational studies Regression analysis Regression models Urban areas Urban environments Vaccination - statistics & numerical data Vaccine Efficacy Vaccines Vaccines, Inactivated - administration & dosage Vaccines, Inactivated - immunology Waterborne diseases Young Adult |
| title | Effectiveness of one dose of killed oral cholera vaccine in an endemic community in the Democratic Republic of the Congo: a matched case-control study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-18T03%3A46%3A38IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effectiveness%20of%20one%20dose%20of%20killed%20oral%20cholera%20vaccine%20in%20an%20endemic%20community%20in%20the%20Democratic%20Republic%20of%20the%20Congo:%20a%20matched%20case-control%20study&rft.jtitle=The%20Lancet%20infectious%20diseases&rft.au=Malembaka,%20Espoir%20Bwenge&rft.date=2024-05&rft.volume=24&rft.issue=5&rft.spage=514&rft.epage=522&rft.pages=514-522&rft.issn=1473-3099&rft.eissn=1474-4457&rft_id=info:doi/10.1016/S1473-3099(23)00742-9&rft_dat=%3Cproquest_pubme%3E3046508969%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3046508969&rft_id=info:pmid/38246191&rft_els_id=S1473309923007429&rfr_iscdi=true |