Assessment of Efficient and Sustainable Tools for Cholera Detection and Intervention in Low Resource Settings

Vibrio cholerae;cholera;oral cholera vaccine;not listed

Debes, Amanda KayGreenough, William B. ;

Johns Hopkins University

关键词: Vibrio cholerae;    cholera;    oral cholera vaccine;    not listed;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39351/DEBES-DISSERTATION-2015.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Objective Cholera is it is estimated to infect millions of people every year resulting in over 100,000 deaths annually.There are two WHO pre-qualified oral cholera vaccines that are recommended for use in conjunction with other prevention and control strategies in endemic and outbreak areas.There is currently a limited availability of vaccine supply, therefore, its use must be administered strategically.This study sought to improve the understanding of cholera disease burden and outbreak risk worldwide through the development of simplified and sustainable tools for use in low resource settings.Methods Data from 949 clinical diarrhea cases and 1,102 environmental specimens from 7 Health Facilities were analyzed using simplified laboratory diagnostic methods to assess the cholera burden in the Far North of Cameroon.V. cholerae 01 positive specimens were analyzed to determine the genetic relationship between geographically distinct areas in Cameroon. To further evaluate tools for determining disease burden, a rapid risk assessment tool (RAT) for cholera was developed and evaluated using surveillance data from the Republic of Kenya.Results In the sentinel surveillance study, the simplified laboratory diagnostics identified outbreaks early and with no false positive results.Sequencing revealed that outbreak specimens from the Bourrha Health district in June of 2014 were related to outbreak specimens from Darak and Blangoua Health districts in October of 2014.The cholera RAT identified a few key districts in Kenya where implementation of cholera interventions, to include vaccination, may be targeted.Conclusions The simplified laboratory diagnostics demonstrated improved specificity and feasibility of use in the remote areas in our surveillance study.While V. cholerae was minimally present in the first year of surveillance, the outbreaks were detected early due to the application of our epidemiological and laboratory methodologies in the study area.We found that while the outbreaks in Bourrha, Cameroon and Darak, Cameroon were from distinct clonal complexes, there was a genetic relationship among the genotypes suggesting that the strain mutated between the geographic areas.The cholera RAT demonstrated the value of a risk factor weighting system to identify areas of heightened cholera risk for consideration of cholera intervention programs.