- WHO recommends that the use of OCVs should be systematically considered as an additional measure to limit the spread of disease during cholera outbreaks, to contribute to cholera control in humanitarian crises with high risk of cholera, and in endemic areas.
- OCVs should be used in conjunction with other cholera prevention and control strategies.
- Vaccination should not disrupt the provision of other high-priority health interventions to control or prevent cholera.
- Geographical areas and populations to be targeted for OCV should be clearly identified following a thorough investigation of the current and historical epidemiological situation and the current local infrastructure and capacities.
- Vaccination should cover as many people who are eligible to receive the vaccine as possible and should be conducted as quickly as possible.
- The global OCV stockpile was created in 2013 for deployment of OCV to countries in need
Mass vaccination campaigns with OCV can be used during cholera outbreaks, in humanitarian crises with high risk of cholera, or as part of cholera control in endemic settings.
- Vaccination during cholera outbreaks is used to contain ongoing outbreaks (if implemented early) and to limit the spread of the outbreak into new areas (such as neighbouring communities and those across borders, or areas linked by river systems or water and sanitation systems).
- The geographic areas and populations to vaccinate are determined following in-depth analysis of the historical and current epidemiological data and current risk factors.
- Based on current evidence on short-term protection, a single-dose strategy could be considered. Administering a second dose should be considered to ensure longer-term protection if the risk of cholera persists.
- Vaccination in humanitarian crises with high risk of cholera is used to prevent outbreak occurrence.
- The decision to vaccinate should be guided by a thorough investigation of the current and historical epidemiological situation, an assessment of the risk of cholera and the WASH context. This information should be used to clearly identify the geographic areas and populations to target.
- Campaign planning should be carried out to ensure that vaccination takes place prior to any known cholera season.
- Preparation, including microplanning, cold chain preparation, logistics and social mobilization should be carried out to ensure high vaccine coverage as soon as vaccines become available in the area.
- Vaccination in endemic areas or hotspots is used to reduce disease transmission and to reduce the incidence of the disease. Preventive vaccination should be considered as an additional control measure and implemented in conjunction with other long-term and sustainable measures.
- Three OCVs are currently prequalified by WHO: Dukoral®, Shanchol™ and Euvichol-Plus®.
- All are oral, killed, whole-cell vaccines that provide sustained protection of greater than 60% for at least 2 years in endemic populations, induce an immune response relatively quickly and have a good safety profile.
- Shanchol™ and Euvichol-Plus® are the two vaccines available through the Global Stockpile for use in mass vaccination campaigns.
- Shanchol™ and Euvichol-Plus® are killed modified whole-cell bivalent (O1 and O139) vaccines. Shanchol™ and Euvichol-Plus® have the same formulation and comparable safety and immunogenicity profiles. Shanchol™ and Euvichol-Plus® are each recommended to be given as a two-dose regimen, with the two doses given a minimum of 14 days apart. The recommended age for vaccination is 1 year or older.
- OCVs are effective tools for cholera control. Two doses provide protection against cholera for at least 3 years. One dose provides at least short-term protection (at least 6 months), which has important implications for outbreak management.
- Several additional cholera vaccines are in different stages of development; these are mainly live attenuated vaccines that have the potential to provide longer-term protection with a single dose.
For additional information, see Cholera vaccines: WHO position paper – August 2017. Weekly epidemiological record. WHO
Use of OCV in Pregnant and Lactating Women and HIV-Infected Individuals
- Based on analysis of the risks and benefits, there are considerable benefits and very few risks from including pregnant and lactating women and HIVinfected individuals in a vaccine campaign.
- For additional information, see GTFCC. OCV and pregnant women. 2016
Monitoring and Evaluation of OCV Campaigns
- OCVs have been used extensively in multiple settings globally and have been proven to be safe. Passive surveillance of adverse events following immunization should be conducted systematically following national policies.
- Monitoring and evaluation following vaccination (such as coverage surveys, cost-effectiveness analysis, impact assessment on disease burden, etc.) provide essential information to ensure quality provision of services and the development of future recommendations for OCV use.
For additional Information:
- Cholera vaccines: WHO position paper. Weekly Epidemiological Record. World Health Organization. August 2017 Click here
- Oral Cholera Vaccine stockpile for cholera emergency response. World Health Organization. 2013 Click here
- Technical Note. Evidence of the risks and benefits of vaccinating pregnant women with WHO pre-qualified cholera vaccines during mass campaigns. Global Task Force on Cholera Control. November 2016 Click here