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Achieving coordinated national immunity and cholera elimination in Haiti through vaccination
Jonathan D Sugimoto
Andrea Rinaldo
Flavio Finger
Javier Perez-Saez
Damiano Pasetto
Laura Matrajt
Joseph Lemaitre
Dennis L Chao
Louise C Ivers
Justin Lessler
Andrew S Azman
Kenia Vissieres
Ralph Ternier
Ira M Longini
M Elizabeth Halloran
Elizabeth C Lee
Novel Coronavirus
Acceso Abierto
Background Cholera was introduced into Haiti in 2010. Since, there have been over 820,000 reported cases and nearly 10,000 deaths. The year 2019 has seen the lowest reported number of cases since the epidemic began. Oral cholera vaccine (OCV) is safe and effective, but has generally not been seen as a primary tool for cholera elimination due to a limited period of protection and constrained supplies. Regionally, epidemic cholera is contained to the island of Hispaniola. Hence, Haiti may represent a unique opportunity to eliminate cholera by use of OCV. Methods We assess the probability of elimination and the potential health impact of OCV use in Haiti by leveraging simulations from four independent modeling teams. For a 10-year projection period, we compared the impact of five vaccination campaign scenarios, differing in geographic scope, vaccination coverage, and rollout duration to a status quo scenario without vaccination. Teams used common calibration data and assumptions for vaccine efficacy and vaccination scenarios, but all other model features and assumptions were determined independently. Findings A two-department OCV campaign proposed in Haiti's national plan for elimination had less than 50% probability of elimination across models, and only ambitious, nationwide campaigns had a high probability of reaching this goal. Despite their low probability of elimination, two-department campaigns averted a median of 13-58% of infections across models over the five years after the start of vaccination campaigns; a nationwide campaign implemented at the same coverage and rollout duration averted a median of 58-95% of infections across models. Interpretation Despite recent declines in cholera cases in Haiti, bold action is needed to promote elimination of cholera from the region. Large-scale cholera vaccination campaigns in Haiti offer the opportunity to synchronize nationwide immunity, providing near-term protection to the population while improvements to water and sanitation infrastructure create an environment favorable to long-term cholera elimination. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement ECL, LM, ASA, and JL (JHU) are supported by the Bill and Melinda Gates Foundation (OPP1171700). DLC acknowledges Bill and Melinda Gates for their active support of the Institute for Disease Modeling and their sponsorship through the Global Good Fund. JL (EPFL), DP, JP-S, and AR acknowledge funds provided by the Swiss National Science Foundation via the project “Optimal control of intervention strategies for waterborne disease epidemics” (200021-172578). LM, JDS, MEH, and IML are supported by the National Institutes of Health National Institute of General Medical Sciences (U54GM111274). FF acknowledges support from the Swiss National Science Foundation through the Early Postdoc Mobility Fellowship (P2ELP3_175079). LCI is supported by the National Institutes of Health National Institute of Allergy and Infectious Diseases (R01AI099243) and acknowledges Bill and Melinda Gates Foundation support for cholera control and prevention (OPP1148213). The content is solely the responsibility of the authors and does not necessarily represent the official views of any funding organization. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All teams calibrated their models to publicly available weekly department-level cholera reports of suspected cases from the Haiti Ministry of Public Health and Population (MSPP) website. All modeling teams have provided a detailed supplementary methods and results section, which are assembled collectively at the summary DOI: 10.5281/zenodo.3361800. <>
Cold Spring Harbor Laboratory Press
Appears in Collections:Artículos científicos

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