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Purpose: Active immunotherapy is a promising antitumoral strategy; however its use in combination with chemotherapy in dogs with large B-cell lymphoma (DLBCL) remains largely untested. Heat shock proteins (HSP) bind the small peptides they chaperone (HSPPC), allowing for immunization of the host against a large repertoire of tumor-associated antigens. Hydroxylapatite vehicles HSPPCs and acts as an immunologic adjuvant. The aim of this study was to show that an autologous vaccine with hydroxylapatite and tumor-derived HSPPCs is safe and therapeutically effective in dogs with DLBCL.Experimental Design: Nineteen dogs with naturally occurring DLBCL were entered into a prospective randomized placebo-controlled double-blinded trial of HSPPCs–hydroxylapatite plus chemotherapy versus chemotherapy alone. Endpoints included time to progression (TTP), lymphoma-specific survival (LSS), and incidence of toxicoses.Results: Median first TTP after randomization to the vaccine arm was 304 days versus 41 days for the control arm (P = 0.0004). There was also a statistically significant difference in duration of second remission between the two groups (P = 0.02). Median LSS was 505 days for the vaccinated dogs versus 159 days for the unvaccinated dogs (P = 0.0018). Six vaccinated dogs achieved molecular remission, as shown by clonal immunoglobulin H (IgH) rearrangement. Toxicoses were comparable between the two treatment arms.Conclusions: The results of this trial demonstrate that the autologous vaccine tested here is safe and efficacious in prolonging TTP and LSS in dogs with DLBCL when used in combination with dose-intense chemotherapy. On the basis of these results, additional evaluation of this novel therapeutic strategy is warranted in human DLBCL. Clin Cancer Res; 20(3); 668–77. ©2013 AACR.

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Summary Background Between 2014 and 2017, successive cholera epidemics occurred in South Sudan within the context of civil war, population displacement, flooding, and drought. We aim to describe the spatiotemporal and molecular features of the three distinct epidemic waves and explore the role of vaccination campaigns, precipitation, and population movement in shaping cholera spread in this complex setting. Methods In this descriptive epidemiological study, we analysed cholera linelist data to describe the spatiotemporal progression of the epidemics. We placed whole-genome sequence data from pandemic Vibrio cholerae collected throughout these epidemics into the global phylogenetic context. Using whole-genome sequence data in combination with other molecular attributes, we characterise the relatedness of strains circulating in each wave and the region. We investigated the association of rainfall and the instantaneous basic reproduction number using distributed lag non-linear models, compared county-level attack rates between those with early and late reactive vaccination campaigns, and explored the consistency of the spatial patterns of displacement and suspected cholera case reports. Findings The 2014 (6389 cases) and 2015 (1818 cases) cholera epidemics in South Sudan remained spatially limited whereas the 2016–17 epidemic (20 438 cases) spread among settlements along the Nile river. Initial cases of each epidemic were reported in or around Juba soon after the start of the rainy season, but we found no evidence that rainfall modulated transmission during each epidemic. All isolates analysed had similar genotypic and phenotypic characteristics, closely related to sequences from Uganda and Democratic Republic of the Congo. Large-scale population movements between counties of South Sudan with cholera outbreaks were consistent with the spatial distribution of cases. 21 of 26 vaccination campaigns occurred during or after the county-level epidemic peak. Counties vaccinated on or after the peak incidence week had 2·2 times (95% CI 2·1–2·3) higher attack rates than those where vaccination occurred before the peak. Interpretation Pandemic V cholerae of the same clonal origin was isolated throughout the study period despite interepidemic periods of no reported cases. Although the complex emergency in South Sudan probably shaped some of the observed spatial and temporal patterns of cases, the full scope of transmission determinants remains unclear. Timely and well targeted use of vaccines can reduce the burden of cholera; however, rapid vaccine deployment in complex emergencies remains challenging. Funding The Bill & Melinda Gates Foundation.

Cholera disproportionately affects the most vulnerable segments of the population, particularly those who have low or no access to basic water, sanitation, and hygiene (WASH). Despite some improvements in WASH conditions, cholera still represents a persistent challenge in Mozambique, where outbreaks occur almost every year, with high case fatality rates, posing a threat to the country's economic development. The Government of Mozambique has started developing a revised National Cholera Plan (NCP), which aligns with "ending cholera-a global roadmap to 2030" launched by the Global Task Force on Cholera Control (GTFCC) in 2017. Ending cholera represents a critical step towards achieving the sustainable development goals and requires effective prevention and control interventions, ensuring that no one is left behind. The NCP must use a multi-sector approach and broad stakeholder collaboration with well-coordinated roles and functions of different partners to address major areas for cholera elimination - water and sanitation, health care services and management, epidemiology and surveillance, and health and hygiene promotion. Every cholera death is preventable. In this review, we reiterate the need for effective coordinated actions to control and eliminate cholera in Mozambique and decrease the cholera burden, enabling a healthy population over the generations.

Detection and surveillance of vaccine safety hazards is a public health staple. In the post-marketing phase, when vaccines are used in mass, it is crucial to monitor potential signals of adverse reactions that may have been missed in the pre-marketing phase. We analysed spontaneous reports of drug adverse events in El Salvador to assess a potential safety signal related to an increase in febrile seizures following the pentavalent (diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae Type B) vaccine in 2019. This was a retrospective observational study of adverse event notifications in the national electronic drug safety database from 2011 to 2019. We performed standard disproportionality analysis computing Proportional Reporting Risk (PRR), Reporting Odds Ratio (ROR), Relative Reporting Ratio (RRR), Chi-squared, and Information Component (IC), comparing the pairing of febrile seizures and pentavalent vaccine to all other drugs and adverse events recorded in 2019. The occurrence of febrile seizures following pentavalent vaccination exceeded the WHO expected rate of six cases × 100 000 doses administered from April 2019, with a maximum of 9.2 in September. IC was 4.3, ORR 421.9 (95% Confidence Interval, CI: 123.8–1437.7), PRR 223.5 (95 %CI: 70.2–710.9), RRR was 19.5. The first booster presented the highest rate (14.6 per 100,000 doses) of febrile seizures, more than double than expected. Rates for 2018 remained below expected. Reports of febrile seizures following pentavalent vaccine were also on the increase globally since 2014, with highest rates in 2018 and 2019. There was a disproportion of febrile seizures notifications following pentavalent in El Salvador in 2019, suggesting the existence of a safety signal. This may be due to the change in provider. Further studies should assess the causes of the increase and compute costs and benefits of this vaccination to determine if switching to a less reactogenic vaccine formulation is indicated.

BackgroundBetween 2014 and 2017, successive cholera epidemics occurred in South Sudan within the context of civil war, population displacement, flooding, and drought. Understanding the determinants of cholera spread in complex settings like this can provide valuable insights for mitigating future cholera risk.MethodsWe analyzed cholera linelist and molecular data to describe the spatio-temporal progression of the epidemics. We explored the role of rainfall, population movement and vaccination campaigns in shaping the explaining incidence and the spatial distribution of reported cases.FindingsSouth Sudan experienced three distinct cholera epidemic waves of cholera ranging from 6-18 months with more than 28,000 cases reported and more than 2 million cholera vaccine doses delivered to curb transmission. The 2014 and 2015 epidemics remained spatially limited while the 2016/17 epidemic exploded along the Nile river. Initial cases of each epidemic were reported in or around Juba soon after the start of the rainy season, but we found no evidence that rainfall modulated transmission during each epidemic. All isolates analyzed had similar genotypic and phenotypic characteristics, closely related to sequences from Uganda and Democratic Republic of Congo. The direction of large-scale population movements between counties with cholera outbreaks was consistent with the spatial distribution of outbreaks. As of September 2020, zero cholera cases have been confirmed within South Sudan since 2017.InterpretationThe three epidemic waves were caused byV. choleraeof the same clonal origin despite the periods of no reported cases between waves. While the complex emergency likely shaped some of the observed spatial and temporal patterns of reported cases, the full scope of transmission determinants remains unclear. Timely and well targeted use of cholera vaccine can avert cases and deaths, however, most of the vaccine campaigns occurred after the epidemic peak highlighting the challenges of delivering vaccines quickly in response to an outbreak in settings like South Sudan. These analyses provide a multi-faceted template for examining cholera dynamics through epidemiological, microbiological, climatic, and behavioral lenses.FundingTheBill and Melinda Gates Foundation

BackgroundAssessing the quality of mass drug administration (MDA) rounds is a key component of lymphatic filariasis (LF) elimination programs. Routine collection of administrative coverage is unreliable, especially when pockets with low program coverage exist. To address this gap, we used lot quality assurance sampling (LQAS) following the 10th annual LF-MDA round in Fiji to explore whether there was any area in which target coverage was not reached. We also assessed the level of drug compliance and satisfaction with the LF-MDA implementation strategy.Methodology/principal findingsWe conducted a cross-sectional household survey in 3 divisions of Fiji. For LQAS, we defined 19 lots in 7 medical areas of the Suva sub-division and another 12 sub-divisions in the Central, Northern, and Eastern Divisions. A sample of 16 randomly selected household members was taken un each lot. We defined our decision rule as follows: if more than 1 person in a given lot did not swallow the medication, coverage was considered inadequate, i.e. less than 80%. Of the 7 lots in Suva sub-division and 12 lots in the 3 divisions, five and two lots, respectively, were identified as having inadequate coverage. The overall program coverage estimated from 304 samples was 92%, which was higher than the reported administrative coverage of 82%. About 98% of interviewees were offered the medication and 96% swallowed it. Non-participation arose from insufficient information on how to obtain the drugs. At least 92% were satisfied with the LF-MDA implementation strategy.ConclusionsAreas of low program coverage with results discordant with the reported administrative coverage existed in both urban and rural settings. Drug compliance and satisfaction were high, even after repeated rounds. We recommend increasing efforts to deliver the service in those areas with inadequate program coverage, as well as conducting timely coverage assessment through LQAS for corrective action.

BACKGROUND: In war-torn Yemen, reports of confirmed cholera started in late September, 2016. The disease continues to plague Yemen today in what has become the largest documented cholera epidemic of modern times. We aimed to describe the key epidemiological features of this epidemic, including the drivers of cholera transmission during the outbreak.METHODS: The Yemen Health Authorities set up a national cholera surveillance system to collect information on suspected cholera cases presenting at health facilities. Individual variables included symptom onset date, age, severity of dehydration, and rapid diagnostic test result. Suspected cholera cases were confirmed by culture, and a subset of samples had additional phenotypic and genotypic analysis. We first conducted descriptive analyses at national and governorate levels. We divided the epidemic into three time periods: the first wave (Sept 28, 2016, to April 23, 2017), the increasing phase of the second wave (April 24, 2017, to July 2, 2017), and the decreasing phase of the second wave (July 3, 2017, to March 12, 2018). We reconstructed the changes in cholera transmission over time by estimating the instantaneous reproduction number, Rt. Finally, we estimated the association between rainfall and the daily cholera incidence during the increasing phase of the second epidemic wave by fitting a spatiotemporal regression model.FINDINGS: From Sept 28, 2016, to March 12, 2018, 1 103 683 suspected cholera cases (attack rate 3·69%) and 2385 deaths (case fatality risk 0·22%) were reported countrywide. The epidemic consisted of two distinct waves with a surge in transmission in May, 2017, corresponding to a median Rt of more than 2 in 13 of 23 governorates. Microbiological analyses suggested that the same Vibrio cholerae O1 Ogawa strain circulated in both waves. We found a positive, non-linear, association between weekly rainfall and suspected cholera incidence in the following 10 days; the relative risk of cholera after a weekly rainfall of 25 mm was 1·42 (95% CI 1·31–1·55) compared with a week without rain.INTERPRETATION: Our analysis suggests that the small first cholera epidemic wave seeded cholera across Yemen during the dry season. When the rains returned in April, 2017, they triggered widespread cholera transmission that led to the large second wave. These results suggest that cholera could resurge during the ongoing 2018 rainy season if transmission remains active. Therefore, health authorities and partners should immediately enhance current control efforts to mitigate the risk of a new cholera epidemic wave in Yemen.FUNDING: Health Authorities of Yemen, WHO, and Médecins Sans Frontières.

Historically, the human prevalence of Wuchereria bancrofti infection in Wallis and Futuna (WAF) was among the highest in the Pacific and mass drug administration (MDA) against lymphatic filariasis (LF) either with diethylcarbamazine citrate (DEC) or the combination of DEC and albendazole had been implemented for decades. To determine whether LF antigen prevalence in WAF was lower than 1%, the infection threshold for elimination in an area where Aedes spp. are the principal vectors, we conducted the WHO-recommended transmission assessment survey in 2012. We present the results of a school-based survey, which targeted 1,014 students in all 13 elementary schools in WAF. From a fingerprick, the circulating filarial antigen (CFA) positivity was checked for grade 2-5 students using BinaxNOW filariasis test (immunochromatographic test). Of 935 children tested, three were positive for CFA in two schools. At the territory level, this was below the critical cutoff of nine cases, if the whole territory was considered as a single evaluation unit. The prevalence of CFA in WAF is less than 1%, reaching the goal for LF elimination set by the WHO. We were able to recommend stopping LF MDA and move to post-MDA surveillance to detect any recrudescence. This survey successfully paved the way for WAF to be validated as achieving LF elimination as a public health problem by 2020.

Background In response to a cholera outbreak among mobile, difficult-to-reach fishermen on Lake Chilwa, Malawi in 2016, a novel vaccine distribution strategy exploited the proven vaccine thermostability. Fishermen, while taking the first vaccine dose under supervision, received the second dose in a sealed bag, and were told to drink it two weeks later. This study assessed short-term vaccine protection of this strategy. Methods Patients with diarrhoea admitted to health facilities around lake were interviewed and a stool sample collected for PCR testing. Vaccine effectiveness was assessed in a case-control test-negative design by comparing cases (PCR-positive for V. cholerae O1) and controls (patients with diarrhoea but PCR-negative) and with the screening method that compared the proportions of vaccinated among cholera cases versus the general fishermen population. Results Of 145 study participants, 120 were fishermen living on the lake. Vaccine effectiveness at three-months was 90.0% [95% CI: 38.8; 98.4] among fishermen and 83.3% [95% CI: 20.8; 96.5] among all participants in the case-control test-negative design, and 97.5% [95% CI: 90.9; 99.3] with the screening method. Conclusion This strategy was effective in providing short-term protection in fishermen against cholera. Further research is needed to determine the adding value of the second dose and to identify the optimal vaccination strategies for different contexts.

Introduction/BackgroundIn August 2017, a cholera outbreak started in Muna Garage IDPs camp, Borno State-Nigeria, and >5000 cases occurred in six local government areas. This qualitative study evaluated perspectives about the emergency response to this outbreak.Methods/FindingsWe conducted 39 key informant interviews and focused group discussions, and reviewed 21 documents with participants involved with surveillance, water-sanitation-hygiene, case management, oral cholera vaccine, communications, logistics, and coordination. Qualitative data analysis used thematic techniques comprising key-words-in-context, word-repetition, and key-sector-terms.Authorities were alerted quickly, but outbreak declaration took 12 days due to a 10 day delay waiting for culture confirmation. Outbreak investigation revealed several potential transmission channels, but a leaking latrine around the index cases’ house was not repaired for >7 days.Use of chlorine disinfectant was initially not accepted by the community due to rumors that it would sterilize women. This could have been avoided with improved community consultation. Initially, key messages were communicated in Hausa, although ‘Kanuri’ was the primary language; later this was corrected. Planning would have benefited using exercise drills to identify weaknesses, and inventory sharing to avoid stock outs.The response by the Rural Water Supply and Sanitation Agency was perceived to be slow and an increased risk from Eid El Jabir festival with increased movement and food sharing was not recognized. Case management was provided at treatment centers, but some partners were concerned that their work was recognized asking, “who gets the glory and the data?”OCV was provided to nearly one million people and it distribution benefited from a robust polio vaccine structure; however, logistical problems related to payment of staff needed resolution.Initial coordination was thought to be slow, but improved by activating an Emergency Operations Centre. The Borno Ministry of Health used an Incident Management System to coordinate multi-sectoral response activities.These were informed by daily reviews of epi curves and geo-coordinate maps. The synergy between partners and government improved when each recognized the government’s leadership role.Conclusions/SignificanceDespite a timely alert of the outbreak, the delayed declaration led to a slowed initial response, but this improved during the course of the outbreak. OCV distribution was efficient and benefited from the OPV infrastructure. Improvements in laboratory capacity are urgently needed.Author SummaryIn August 2017, a cholera outbreak started in the Muna Garage Internally Displaced Persons (IPDs) camp in Borno State, Nigeria. By October, it appeared in six local government areas with a total of 5,340 cases reported including 61 deaths. We evaluated the perspectives of the emergency response by the government of Nigeria and implementing partners to stop the outbreak. We conducted 39 interviews and group discussions and also studied 21 documents related to the outbreak response. We found that epidemiologic surveillance timely alerted the health authorities about the outbreak, but the outbreak was declared 12 days later, awaiting for culture confirmation. This led to delays in the initial response. We also observed that conditions in the IDPs camps like overflowing latrines, overcrowding, and open defecation were highly favorable to cholera transmission. Improved IDP camp conditions are needed to prevent cholera and other water born infections and strengthened laboratory capacity is needed to enable a more rapid response.

Cholera remains an important but neglected public health threat, affecting the health of the poorest populations and imposing substantial costs on public health systems. Cholera can be eliminated where access to clean water, sanitation, and satisfactory hygiene practices are sustained, but major improvements in infrastructure continue to be a distant goal. New developments and trends of cholera disease burden, the creation of affordable oral cholera vaccines (OCVs) for use in developing countries, as well as recent evidence of vaccination impact has created an increased demand for cholera vaccines. The global OCV stockpile was established in 2013 and with support from Gavi, has assisted in achieving rapid access to vaccine in emergencies. Recent WHO prequalification of a second affordable OCV supports the stockpile goals of increased availability and distribution to affected populations. It serves as an essential step toward an integrated cholera control and prevention strategy in emergency and endemic settings.

IntroductionIn 2017, amidst insecurity and displacements posed by Boko Haram armed insurgency, cholera outbreak started in the Muna Garage camp for Internally Displaced Persons (IDPs) in Borno State, Nigeria. In response, the Borno Ministry of Health and partners determined to provide oral cholera vaccine (OCV) to about 1 million people in IDP camps and surrounding communities in six Local Government Areas (LGAs) including Maiduguri, Jere, Konduga, Mafa, Dikwa, and Monguno. As part of Monitoring and Evaluation, we described the coverage achieved, adverse events following immunisation (AEFI), non-vaccination reasons, vaccination decisions as well as campaign information sources.MethodsWe conducted two-stage probability cluster surveys with clusters selected without replacement according to probability-proportionate-to-population-size in the six LGAs targeted by the campaign. Individuals aged ≥1 years were the eligible study population. Data sources were household interviews with vaccine card verification and memory recall, if no card, as well as multiple choice questions with an open-ended option.ResultsOverall, 12 931 respondents participated in the survey. Overall, 90% (95% CI: 88 to 92) of the target population received at least one dose of OCV, range 87% (95% CI: 75 to 94) in Maiduguri to 94% (95% CI: 88 to 97) in Monguno. The weighted two-dose coverage was 73% (95% CI: 68 to 77) with a low of 68% (95% CI: 46 to 86) in Maiduguri to a high of 87% (95% CI: 74 to 95) in Dikwa. The coverage was lower during first round (76%, 95% CI: 71 to 80) than second round (87%, 95% CI: 84 to 89) and ranged from 72% (95% CI: 42 to 89) and 82% (95% CI: 82 to 91) in Maiduguri to 87% (95% CI: 75 to 95) and 94% (95% CI: 88 to 97) in Dikwa for the respective first and second rounds. Also, coverage was higher among females of age 5 to 14 and ≥15 years than males of same age groups. There were mild AEFI with the most common symptoms being fever, headache and diarrhoea occurring up to 48 hours after ingesting the vaccine. The most common actions taken after AEFI symptoms included ‘did nothing’ and ‘self-medicated at home’. The top reason for taking vaccine was to protect from cholera while top reason for non-vaccination was travel/work. The main source of campaign information was a neighbour. An overwhelming majority (96%, 95% CI: 95% to 98%) felt the campaign team treated them with respect. While 43% (95% CI: 36% to 50%) asked no questions, 37% (95% CI: 31% to 44%) felt the team addressed all their concerns.ConclusionThe campaign achieved high coverage using door-to-door and fixed sites strategies amidst insecurity posed by Boko Haram. Additional studies are needed to improve how to reduce non-vaccination, especially for the first round. While OCV provides protection for a few years, additional actions will be needed to make investments in water, sanitation and hygiene infrastructure.

Producción Científica, Killed oral cholera vaccines (OCVs) are part of the standard response package to a cholera outbreak, although the two-dose regimen of vaccines that has been prequalified by the World Health Organization (WHO) poses challenges to timely and efficient reactive vaccination campaigns.1 Recent data suggest that the first dose alone provides short-term protection, similar to that of two doses, which may largely dictate the effect of OCVs during epidemics

Rotavirus vaccine was introduced in El Salvador in 2006 and is recommended to be given concomitantly with DTP–HepB–Haemophilus influenzae type b (pentavalent) vaccine at ages 2 months (upper age limit 15 weeks) and 4 months (upper age limit 8 months) of age. However, rotavirus vaccination coverage continues to lag behind that of pentavalent vaccine, even in years when national rotavirus vaccine stock-outs have not occurred. We analyzed factors associated with receipt of oral rotavirus vaccine among children who received at least 2 doses of pentavalent vaccine in a stratified cluster survey of children aged 24–59 months conducted in El Salvador in 2011. Vaccine doses included were documented on vaccination cards (94.4%) or in health facility records (5.6%). Logistic regression and survival analysis were used to assess factors associated with vaccination status and age at vaccination. Receipt of pentavalent vaccine by age 15 weeks was associated with rotavirus vaccination (OR: 5.1; 95% CI 2.7, 9.4), and receipt of the second pentavalent dose by age 32 weeks was associated with receipt of two rotavirus vaccine doses (OR: 5.0; 95% CI 2.1–12.3). Timely coverage with the first pentavalent vaccine dose was 88.2% in the 2007 cohort and 91.1% in the 2008 cohort (p=0.04). Children born in 2009, when a four-month national rotavirus vaccine stock-out occurred, had an older median age of receipt of rotavirus vaccine and were less likely to receive rotavirus on the same date as the same dose of pentavalent vaccine than children born in 2007 and 2008. Upper age limit recommendations for rotavirus vaccine administration contributed to suboptimal vaccination coverage. Survey data suggest that late rotavirus vaccination and co-administration with later doses of pentavalent vaccine among children born in 2009 helped increase rotavirus vaccine coverage following shortages.

With limited global supplies of oral cholera vaccine, countries need to identify priority areas for vaccination while longer-term solutions, such as water and sanitation infrastructure, are being developed.In 2017, Malawi integrated oral cholera vaccine into its national cholera control plan. The process started with a desk review and analysis of previous surveillance and risk factor data. At a consultative meeting, researchers, national health and water officials and representatives from nongovernmental and international organizations reviewed the data and local epidemiological knowledge to determine priority districts for oral cholera vaccination. The final stage was preparation of an application to the global oral cholera vaccine stockpile for non-emergency use.Malawi collects annual data on cholera and most districts have reported cases at least once since the 1970s.The government's application for 3.2 million doses of vaccine to be provided over 20 months in 12 districts was accepted in April 2017. By April 2018, over 1 million doses had been administered in five districts. Continuing surveillance in districts showed that cholera outbreaks were notably absent in vaccinated high-risk areas, despite a national outbreak in 2017-2018.Augmenting advanced mapping techniques with local information helped us extend priority areas beyond those identified as high-risk based on cholera incidence reported at the district level. Involvement of the water, sanitation and hygiene sectors is key to ensuring that short-term gains from cholera vaccine are backed by longer-term progress in reducing cholera transmission.En raison de stocks mondiaux réduits de vaccins anticholériques oraux, les pays doivent identifier les zones prioritaires en matière de vaccination tout en développant des solutions à plus long terme, telles que des infrastructures d'alimentation en eau et d'assainissement.En 2017, le Malawi a intégré la vaccination anticholérique orale dans son plan national de lutte contre le choléra. Le processus a commencé par un examen documentaire et une analyse des données disponibles concernant la surveillance et les facteurs de risque. Lors d'une réunion consultative, des chercheurs, les responsables nationaux des secteurs de la santé et de l'eau et les représentants d'organisations non gouvernementales et internationales ont examiné les données et les connaissances épidémiologiques locales pour déterminer les districts où devait être pratiquée en priorité la vaccination anticholérique orale. L'étape finale a consisté à préparer une demande relative au stock mondial de vaccins anticholériques oraux destinés à être utilisés en dehors des situations d'urgence.Le Malawi collecte des données annuelles sur le choléra et la plupart des districts ont signalé des cas à au moins une reprise depuis les années 1970.La demande du gouvernement visant la fourniture de 3,2 millions de doses de vaccins pendant 20 mois dans 12 districts a été acceptée en avril 2017. En avril 2018, plus d'un million de doses ont été distribuées dans cinq districts. Une surveillance continue au sein des districts a révélé un fait frappant, à savoir que les zones à risque épidémiologique élevé ayant fait l'objet d'une vaccination n'ont pas été touchées par des épidémies de choléra, malgré une épidémie nationale en 2017-2018.L'association de techniques avancées de cartographie à des informations locales nous a permis d'élargir les zones prioritaires au-delà de celles identifiées comme présentant un risque épidémiologique élevé en fonction de l'incidence du choléra signalée au niveau des districts. La mobilisation des secteurs de l'eau, de l'assainissement et de l'hygiène est essentielle pour garantir que les avantages à court terme des vaccins anticholériques sont confirmés par un recul à plus long terme de la transmission du choléra.Con suministros mundiales limitados de la vacuna oral contra el cólera, los países deben identificar las áreas prioritarias para la vacunación mientras se desarrollan soluciones a más largo plazo, como las infraestructuras de agua y el saneamiento.En 2017, Malawi integró la vacuna oral contra el cólera en su plan nacional para el control del cólera. El proceso empezó con un estudio preliminar y un análisis de los datos previos de vigilancia y factores de riesgo. En una reunión consultiva, investigadores, funcionarios nacionales de salud y agua y representantes de organizaciones no gubernamentales e internacionales revisaron los datos y el conocimiento epidemiológico local para determinar los distritos prioritarios para la vacunación oral contra el cólera. La etapa final fue la preparación de una aplicación a la reserva global de la vacuna oral contra el cólera para usos de no emergencia.Malawi recopila datos anuales sobre el cólera y la mayoría de los distritos han registrado casos al menos una vez desde los años setenta.La solicitud del gobierno de 3,2 millones de dosis de vacunas para suministrarlas a lo largo de 20 meses en 12 distritos se aceptó en abril de 2017. En abril de 2018, se habían administrado más de 1 millón de dosis en cinco distritos. La vigilancia constante en los distritos mostró que los brotes de cólera estuvieron notablemente ausentes en las áreas vacunadas de alto riesgo, a pesar de un brote nacional en 2017-2018.El aumento de las técnicas avanzadas de mapeo con información local ayudó a ampliar las áreas prioritarias más allá de las identificadas como de alto riesgo según la incidencia del cólera registrada a nivel de distrito. La participación de los sectores del agua, el saneamiento y la higiene es clave para garantizar que las victorias a corto plazo de la vacuna contra el cólera estén respaldadas por un progreso a más largo plazo en la reducción de la transmisión del cólera.مع الشح العالمي في إمدادات تطعيم الكوليرا عبر الفم، تحتاج البلدان إلى تحديد المناطق التي تستحق الأولوية في تقديم التطعيمات في الوقت الذي يتم فيه تطوير حلول أطول مدى، مثل بناء البنية التحتية للمياه والصرف الصحي.قامت ملاوي في عام 2017 بإدماج تطعيم الكوليرا عبر الفم في خطتها الوطنية للسيطرة على مرض الكوليرا. وبدأت العملية باستعراض مستندي وتحليل لبيانات الرصد السابقة وعوامل الخطورة. وفي اجتماع استشاري، قام الباحثون، والمسؤولون المختصون بشؤون الصحة والمياه على مستوى البلاد، وممثلون عن مؤسسات دولية وغير حكومية بمراجعة البيانات والمعرفة المحلية عن الأوبئة لتحديد المقاطعات المستحقة للأولوية في التعامل مع تطعيم الكوليرا عبر الفم. وكانت المرحلة الأخيرة تتمثل في تحضير طلب للاستفادة من المخزون العالمي لتطعيم الكوليرا عبر الفم لاستخدامه في غير حالات الطوارئ.تقوم ملاوي بتجميع البيانات السنوية حول الكوليرا، وقامت أغلب المقاطعات بتقديم بلاغات عن الحالات مرة واحدة على الأقل منذ سبعينيات القرن العشرين.تم قبول طلب الحكومة للحصول على 3.2 مليون جرعة من التطعيم ليتم تقديمها على مدار 20 شهرًا في 12 مقاطعة في شهر أبريل/نيسان من عام 2017. وبحلول شهر أبريل/نيسان من عام 2018، تم تقديم أكثر من مليون جرعة في خمس مقاطعات. وأظهرت عمليات الرصد المستمرة في المقاطعات أن حالات تفشي الكوليرا قد اختفت بشكل ملحوظ في المناطق المحصنة المعرضة لمخاطر عالية، على الرغم من تفشي المرض على مستوى البلاد في عام 2017-2018.لقد استفدنا من توظيف المعلومات المحلية لاستكمال أساليب المطابقة المتقدمة وذلك لمد نطاق مناطق الأولوية بما يتعدى تلك المناطق التي تم تحديدها باعتبارها مناطق عالية الخطورة من واقع تفشي الكوليرا التي يتم الإبلاغ على مستوى المقاطعات. وتلعب مشاركة قطاعات المياه والصرف الصحي والصحة دورًا رئيسيًا في ضمان تدعيم المكاسب قصيرة المدى من التطعيم بالكوليرا بفعل التقدم المحقق على المدى الأبعد في مجال الحد من انتقال الكوليرا.由于全球口服霍乱疫苗的供应有限，各国需要确定接种疫苗的优先区域，而长期的解决方案（例如饮水和卫生基础设施）尚在发展中。.2017 年，马拉维将口服霍乱疫苗纳入其全国霍乱控制计划。进程开始于书面材料审查和对之前监控与风险因素数据的分析。在一次协商会议上，研究人员、全国健康与水资源官员和来自非政府组织与国际组织的代表评估了数据以及对当地流行病的认识，决定了口服霍乱疫苗的优先地区。最终阶段是非紧急用途下为全球口服霍乱疫苗储备申请做准备。.马拉维收集了霍乱的年度数据，自 20 世纪 70 年代以来，绝大部分地区都汇报过至少一次病例。.截至 2017 年 4 月，政府在 20 多个月内为 12 个地区提供 320 万支疫苗的申请被批准。截至 2018 年 4 月，超过 100 万支疫苗在 5 个地区被使用。各地区的持续监控显示，尽管在 2017 年至 2018 年出现了一次全国性的霍乱爆发，但在注射疫苗的高风险地区霍乱爆发的情况明显消失。.强化先进的测绘技术并结合当地信息，有助于我们基于地区层面有关霍乱病例的汇报来确定除霍乱爆发的高风险地区之外的优先区域。饮水、环境卫生和卫生部门的参与对于确保霍乱疫苗的短期收益能够得到减少霍乱传播的长期过程支持非常关键。.В условиях ограниченного глобального обеспечения пероральной вакциной против холеры странам необходимо определить приоритетные области для вакцинации одновременно с разработкой долгосрочных решений, таких как объекты инфраструктуры водоснабжения и санитарии.В 2017 году Малави включила пероральную вакцину против холеры в свой национальный план борьбы с этим заболеванием. Процесс начался с камеральной проверки и анализа ранее полученных данных эпиднадзора и информации о факторах риска. На консультативном совещании исследователи, должностные лица в области общественного здравоохранения и водных ресурсов и представители неправительственных и международных организаций изучили данные о местной эпидемиологической обстановке и факторах риска для определения приоритетных районов для вакцинации против холеры. Заключительным этапом стало создание заявки на получение из глобальных резервных запасов пероральной вакцины против холеры для проведения плановой вакцинации.Малави собирает ежегодные данные о холере, и большинство районов сообщили по крайней мере об одном случае заболевания с 1970-х годов.В апреле 2017 года была принята заявка правительства на 3,2 миллиона доз вакцины, которые должны быть предоставлены в течение 20 месяцев в 12 районах. К апрелю 2018 года в пяти районах было введено более 1 миллиона доз вакцины. Действующий на местах эпиднадзор показал, что в районах повышенного риска, в которых была проведена вакцинация, отсутствовали вспышки холеры, несмотря на общенациональную вспышку в 2017–2018 годах.Совместное использование передовых методов картирования и информации о местной эпидемиологической обстановке помогло авторам расширить приоритетные области, помимо тех, которые были определены как районы повышенного риска по заболеваемости холерой, зарегистрированному на районном уровне. Участие секторов водоснабжения, санитарии и гигиены имеет ключевое значение для обеспечения того, чтобы краткосрочные выгоды от вакцинации против холеры подкреплялись долгосрочным прогрессом в сокращении передачи этого заболевания.

To evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak.We performed a two-stage cluster survey. The population interviewed was divided in three strata according to the second-dose vaccine distribution strategy: (i) a standard strategy in 1477 individuals (68 clusters of 5 households) on the lake shores; (ii) a simplified cold-chain strategy in 1153 individuals (59 clusters of 5 households) on islands in the lake; and (iii) an out-of-cold-chain strategy in 295 fishermen (46 clusters of 5 to 15 fishermen) in floating homes, calledVaccination coverage with at least one dose was 79.5% (1153/1451) on the lake shores, 99.3% (1098/1106) on the islands and 84.7% (200/236) onVaccination coverage on the shores of Lake Chilwa was moderately high and the innovative distribution strategies tailored to people living on the lake provided adequate coverage, even among hard-to-reach communities. Community engagement and simplified delivery procedures were critical for success. Off-label, out-of-cold-chain administration of oral cholera vaccine should be considered as an effective strategy for achieving high coverage in hard-to-reach communities. Nevertheless, coverage and effectiveness must be monitored over the short and long term.Évaluer la couverture vaccinale, identifier les raisons de non-vaccination et estimer le degré de satisfaction vis-à-vis de deux stratégies innovantes de distribution de la seconde dose vaccinale, dans le cadre d'une campagne de vaccination orale anticholérique menée en 2016 sur le lac Chilwa et ses environs, au Malawi, en réponse à une flambée de choléra.Nous avons réalisé une enquête en grappes à deux degrés. La population interrogée a été divisée en trois strates, en fonction de la stratégie de distribution employée pour la seconde dose du vaccin: (i) une stratégie standard pour 1477 personnes (68 grappes de 5 ménages) résidant en bordure du lac; (ii) une stratégie de chaîne du froid simplifiée pour 1153 personnes (59 grappes de 5 ménages) résidant sur des îles du lac; et (iii) une stratégie sans chaîne du froid pour 295 pêcheurs (46 grappes de 5 à 15 pêcheurs) vivant dans des maisons flottantes appeléesLa couverture vaccinale avec administration d'au moins une dose de vaccin a été de 79,5% (1153/1451) dans la population du rivage du lac, de 99,3% (1098/1106) dans la population des îles et de 84,7% (200/236) chez les habitants desLa couverture vaccinale sur les rives du lac Chilwa a été modérément élevée, et les stratégies innovantes de distribution spécifiquement adaptées pour les personnes vivant sur le lac ont permis une couverture adéquate, y compris parmi les populations difficiles à atteindre. L'implication de la communauté et l'utilisation de procédures simplifiées de distribution ont été des facteurs déterminants de succès. L'administration hors AMM, sans chaîne du froid, de vaccins oraux anticholériques devrait être considérée comme une stratégie efficace pour obtenir une couverture vaccinale élevée dans les communautés difficiles à atteindre. Néanmoins, la couverture et son efficacité doivent être surveillées à court et à long termes.Evaluar la cobertura de vacunación, identificar los motivos de la no vacunación y evaluar la satisfacción con dos estrategias innovadoras para la distribución de segundas dosis en una campaña de vacunación oral contra el cólera en 2016 en el Lago Chilwa, Malawi, en respuesta a un brote de cólera.Se llevó a cabo una encuesta de conglomerados en dos etapas. La población entrevistada se dividió en tres estratos de acuerdo con la estrategia de distribución de la segunda dosis de la vacuna: (i) una estrategia estándar en 1477 individuos (68 grupos de 5 hogares) a orillas del lago; (ii) una estrategia simplificada de la cadena de frío en 1153 individuos (59 grupos de 5 hogares) en las islas del lago; y (iii) una estrategia fuera de la cadena de frío en 295 pescadores (46 grupos de 5 a 15 pescadores) en hogares flotantes, llamados zimboweras.La cobertura de vacunación con al menos una dosis fue del 79,5 % (1153/1451) en las orillas del lago, del 99,3 % (1098/1106) en las islas y del 84,7 % (200/236) en las zimboweras. La cobertura con dos dosis fue del 53,0 % (769/1451), del 91,1 % (1010/1106) y del 78,8 % (186/236) en los tres estratos, respectivamente. La razón más común para no vacunarse fue estar ausentes del hogar durante la campaña. A la mayoría de los entrevistados les gustaron las nuevas estrategias de distribución.La cobertura de vacunación a las orillas del lago Chilwa fue moderadamente alta y las innovadoras estrategias de distribución adaptadas a las personas que viven en el lago proporcionaron una cobertura adecuada, incluso entre las comunidades de difícil acceso. La participación de la comunidad y la simplificación de los procedimientos de administración fueron fundamentales para el éxito. La administración de la vacuna oral contra el cólera sin receta y fuera de la cadena de frío debería considerarse una estrategia eficaz para lograr una cobertura alta en comunidades de difícil acceso. No obstante, la cobertura y la eficacia deben ser objeto de seguimiento a corto y largo plazo.تقييم التغطية التي يقدمها التطعيم، وتحديد أسباب عدم التطعيم وتقييم مدى الرضا من خلال استراتيجيتين مبتكرتين لتوزيع الجرعات الثانية في حملة لقاح الكوليرا الفموية في عام 2016 في ليك شيلوا بملاوي، كرد فعل بعد تفشي الكوليرا.أجرينا مسحا مجمعاً يتكون من مرحلتين. تم تقسيم السكان الذين تمت مقابلتهم إلى ثلاث طبقات وفقًا لاستراتيجية توزيع لقاح الجرعة الثانية: استراتيجية قياسية لعدد 1477 فردًا (68 مجموعة من 5 أسر) على شواطئ البحيرة؛ و(2) استراتيجية مبسطة لسلسلة التبريد لعدد 1153 فرداً (59 مجموعة من 5 أسر) في جزر البحيرة؛ و(3) استراتيجية لسلسلة من خارج التبريد لعدد 295 صياداً (46 مجموعة من 5 إلى 15 صياداً) في منازل عائمة تسمىوصلت نسبة التغطية بجرعة واحدة على الأقل التي يقدمها التطعيم إلى 79.5٪ (1153/1451) على شواطئ البحيرة، وبلغت 99.3٪ (1098/1106) في الجزر، و84.7٪ (200/236) في منازلكانت التغطية التي يقدمها التطعيم على شواطئ ليك تشيلوا عالية إلى حد ما، وقدمت استراتيجيات التوزيع المبتكرة، المصممة للأشخاص الذين يعيشون في البحيرة تغطية كافية، حتى بين المجتمعات التي يصعب الوصول إليها. كانت مشاركة المجتمع والإجراءات المبسطة لطرح التطعيم، عوامل حاسمة بالنسبة للنجاح. إن تقديم اللقاح الفموي من الكوليرا بدون تسمية من خارج سلسلة التبريد، ينبغي اعتباره كاستراتيجية فعالة لتحقيق تغطية عالية في المجتمعات التي يصعب الوصول إليها. ومع ذلك، فإنه يجب مراقبة التغطية والفعالية على المدى القصير والطويل.旨在评估疫苗接种覆盖率、确定未接种疫苗的原因并评估对两项创新策略的满意度。这两项创新策略是针对霍乱疫情爆发、为 2016 年马拉维共和国奇尔瓦湖一次口服霍乱疫苗运动中的第二剂疫苗分发而制定。.我们执行了双阶段类集调查。基于第二剂疫苗分发策略，将受访人群分为三个层级：(i) 覆盖湖岸 1477 人（68 个群组，以 5 户为一单位）的标准策略；(ii) 覆盖湖中岛屿 1153 人（59 个群组，以 5 户为一单位）的简化冷链策略；(iii) 覆盖水上房屋（亦称 至少接种一剂疫苗的覆盖率分别是湖岸：79.5％(1153/1451)，岛屿：99.3％(1098/1106) 和水上房屋 (奇尔瓦湖岸边的疫苗接种覆盖率较高。同时，即便是在难以触及的社区，为湖上居民量身定制的创新分发策略也达到了足够的覆盖率。社区参与和简化交付流程对此次成功至关重要。对口服霍乱疫苗标签外、无冷链外的管理应被视为一项在难以触及的社区实现高覆盖率的有效战略。然而，对覆盖率和有效性的短期、长期监测是必不可少的。.Оценить покрытие вакцинацией, выявить причины отсутствия вакцинации и оценить удовлетворенность двумя инновационными стратегиями распределения второй дозы вакцинации пероральной холерной вакцины в рамках кампании, проводившейся в 2016 году в районе озера Чилва (Малави) в ответ на вспышку холеры в регионе.Авторы провели двухэтапный кластерный опрос. Опрашиваемое население делилось на три группы согласно стратегиям распределения второй дозы вакцины: (i) стандартная стратегия для 1477 человек (68 кластеров 5 семейств) на побережье озера; (ii) упрощенная стратегия холодовой цепи для 1153 человек (59 кластеров 5 семейств) на островах; (iii) не предусматривающая холодовой цепи стратегия для 295 рыбаков (46 кластеров численностью от 5 до 15 рыбаков) в плавучих домах, так называемыхКоличество людей, принявших хотя бы одну дозу вакцины, составило 79,5% (1153/1451) на побережье озера, 99,3% (1098/1106) на островах и 84,7% (200/236) вВакцинирование областей, расположенных на берегах озера Чилва, было умеренно высоким, и инновационные стратегии распределения вакцины, примененные с учетом особенностей населения озера, обеспечили достаточное покрытие даже в труднодоступных сообществах. Привлечение общественности и упрощение порядка распределения были критически важны для успеха кампании. Прием пероральной холерной вакцины с нарушением в обход инструкции по применению (без соблюдения холодовой цепи) оказался эффективной стратегией для обеспечения высокого покрытия в труднодоступных сообществах. Тем не менее следует продолжить мониторинг покрытия и эффективности как в краткосрочной, так и в долгосрочной перспективе.

SUMMARYWe used the clustered lot quality assurance sampling (clustered-LQAS) technique to identify districts with low immunization coverage and guide mop-up actions during the last 4 days of a combined oral polio vaccine (OPV) and yellow fever (YF) vaccination campaign conducted in Cameroon in May 2009. We monitored 17 pre-selected districts at risk for low coverage. We designed LQAS plans to reject districts with YF vaccination coverage

The prevalence of hepatitis B virus (HBV) in Wallis and Futuna (WAF) was one of the highest in the Pacific and was the driving factor for introducing hepatitis B (HepB) vaccination in 1992 and HepB birth dose (HepB-BD) in 2006. Using lymphatic filariasis (LF) transmission assessment survey (TAS) as a survey platform for eliminating LF, we assessed HBV surface antigen (HBsAg) seroprevalence, HepB vaccination coverage, and its timeliness among schoolchildren in WAF. From one finger prick of all registered fourth and fifth grade students, we tested HBsAg and filariasis antigen simultaneously, and estimated HepB vaccination coverage and timeliness by reviewing students' immunization cards. Since the children targeted were born when the three-dose HepB schedule was 2, 3, and 8 months, we defined timely vaccination if each dose was given by 3, 4, and 12 months. Of 476 targeted, 427 were enrolled. HBsAg prevalence was 0.9%. Estimated HepB vaccination coverage was 97%, 97%, and 96% for the first, second, and third doses, respectively, yielding coverage for all three doses of 96%. Proportion of timely vaccination was lower: 80%, 56%, and 65%, respectively, and less than 50% for all three doses combined. The seroprevalence of HBsAg among schoolchildren in WAF is less than 1%, close to the control goal. HepB vaccination coverage was high, but many children were vaccinated late. We recommend increasing the efforts for timely HepB vaccination. By combining an HBV seroprevalence survey and coverage assessment, we demonstrated the benefit of using TAS as a public health platform to access schoolchildren.

SUMMARYThe EPIET Alumni Network (EAN) is an association of professionals who have completed field epidemiology or public health microbiology training programmes in the European Union. In 2013, we conducted a survey of EAN members to investigate this network's role within European public health. We distributed an online questionnaire to members registered at the time, collecting data on demographics, professional background, and attitudes towards EAN. Out of 362 registered members, 189 (52%) responded; 97% were from Europe; 65% were female. Their mean age was 39 years. The highest academic qualification was PhD for 44% and Master's degree for 55%. The majority (60%) worked in public health institutes. They were especially satisfied with having access to job offers and professional networking via EAN, but requested more learning opportunities and knowledge-sharing between members. EAN is a unique platform where highly skilled professionals can connect to control infectious diseases locally and internationally. Having a network of professionals that know each other, speak the same ‘language’, and can easily access each other's expertise, represents an important resource for European and global public health, which should be nurtured by encouraging more collaborations devoted to professional development.

The most commonly used treatment for sensorineural sudden hearing loss (SSHL) in clinical practice is the administration of steroids; however, a favorable result is not always obtained. We studied 58 patients who failed to recover after primary treatment with IV steroids, 44 of these met our inclusion criteria (mean age 50.7, 27 males, range 30-74). We treated 23 patients (mean age 47.3, 16 males, age range 22-74) with hyperbaric oxygen therapy (HBO) (2.5 ATA for 60 min for 15 treatments), while 21 (mean age 54.5, 11 males, age range 22-71) patients refused to be treated and served as a non-randomized control group. Patients treated with HBO had a mean improvement of 15.6 dB (SD ± 15.3), with 1 of them completely healed, 5 with a good recovery, 10 with a fair recovery and 7 unchanged. Patients who were not treated had a spontaneous mean improvement of 5.0 dB (SD ± 11.4) with 3 patients with a good recovery, 1 patient with a fair recovery and 17 patients unchanged. Mean improvement was significantly better in patients treated with HBO compared to controls (p = 0.0133). Patients with worst hearing had the greater degree of improvement whether or not they were treated in the first 10 days after the onset of the hearing loss or between 11 and 30 days. In conclusion, hyperbaric oxygen therapy can lead to significant improvement of pure tone hearing thresholds in patients with SSHL who failed primary corticosteroid treatment and are within 4 weeks of the onset of deafness.

MenAfriVac™ is a conjugate vaccine against meningitis A specifically designed for Africa. In Niger, the MenAfriVac™ vaccination campaign was conducted in people aged 1-29 years in three phases. The third phase was conducted in November/December 2011 targeting more than 7 million people. We estimated vaccination coverage for the third phase; classified the 31 target districts according to vaccination coverage levels; analysed the factors associated with being vaccinated; described the reasons for non-vaccination; and estimated coverage of the MenAfriVac™ introduction in Niger by aggregating data from all three phases. We classified the districts by clustered lot quality assurance sampling according to a 75% lower threshold and a 90% upper threshold. We estimated coverage using a minimum cluster-sample of 30 x 10 in each region. Two criteria were used to document vaccination status: presentation of vaccination card only or by card and/or verbal history of vaccination (card+history). We surveyed 2390 persons. After the third phase, estimated coverage was 68.8% (95% CI 64.9-72.8) by card only and 90.9% (95% CI 88.6-93.2) by card+history. Five districts were accepted for coverage above 75% based on card only, whereas 25 were accepted based on card+history. Factors positively associated with being vaccinated were younger age (15 years), female sex, residing in the same household for more than three months, and being informed about the vaccination campaign. The main reason for non-vaccination was not being at home during the campaign. Overall coverage for MenAfriVac™ introduction via 3 phases was 76.1% (95% CI: 72.5-79.6) by card only and 91.9% (95%CI: 89.7-94.1) by card+history.Although estimated coverage was high, pockets of non-vaccination probably still exist in the country; thus, the implementation of mop-up campaigns should be considered. Priorities for the future should include incorporating meningitis A vaccination into the existing immunization schedule and assessing its impact at a population level.

To describe the implementation and feasibility of an innovative mass vaccination strategy - based on single-dose oral cholera vaccine - to curb a cholera epidemic in a large urban setting.In April 2016, in the early stages of a cholera outbreak in Lusaka, Zambia, the health ministry collaborated with Médecins Sans Frontières and the World Health Organization in organizing a mass vaccination campaign, based on single-dose oral cholera vaccine. Over a period of 17 days, partners mobilized 1700 health ministry staff and community volunteers for community sensitization, social mobilization and vaccination activities in 10 townships. On each day, doses of vaccine were delivered to vaccination sites and administrative coverage was estimated.Overall, vaccination teams administered 424 100 doses of vaccine to an estimated target population of 578 043, resulting in an estimated administrative coverage of 73.4%. After the campaign, few cholera cases were reported and there was no evidence of the disease spreading within the vaccinated areas. The total cost of the campaign - 2.31 United States dollars (US$) per dose - included the relatively low cost of local delivery - US$ 0.41 per dose.We found that an early and large-scale targeted reactive campaign using a single-dose oral vaccine, organized in response to a cholera epidemic within a large city, to be feasible and appeared effective. While cholera vaccines remain in short supply, the maximization of the number of vaccines in response to a cholera epidemic, by the use of just one dose per member of an at-risk community, should be considered.Rendre compte de la mise en œuvre et de la faisabilité d'une stratégie de vaccination de masse innovante – fondée sur un vaccin anticholérique oral à dose unique – pour enrayer une épidémie de choléra dans une vaste zone urbaine.En avril 2016, aux premiers stades d'une flambée de choléra à Lusaka, en Zambie, le ministère de la Santé a collaboré avec Médecins Sans Frontières et l'Organisation mondiale de la Santé pour organiser une campagne de vaccination de masse fondée sur un vaccin anticholérique oral à dose unique. Pendant 17 jours, ces partenaires ont fait appel à 1700 membres du personnel du ministère de la Santé et bénévoles communautaires pour mener des activités de sensibilisation des communautés, de mobilisation sociale et de vaccination dans 10 municipalités. Chaque jour, des doses de vaccins ont été livrées sur les sites de vaccination et une estimation de la couverture administrative a été effectuée.En tout, les équipes de vaccination ont administré 424 100 doses de vaccins à une population cible estimée à 578 043 individus, ce qui se traduit par une couverture administrative estimée à 73,4%. Après la campagne, seuls de rares cas de choléra ont été signalés et aucun signe de propagation de la maladie dans les zones de vaccination n'a été noté. Le coût total de la campagne – 2,31 dollars des États-Unis ($US) par dose – incluait le coût relativement bas de la livraison locale – 0,41 $US par dose.L'organisation d'une campagne de vaccination réactive précoce, ciblée et à grande échelle – fondée sur un vaccin oral à dose unique – pour répondre à une épidémie de choléra dans une grande ville s'est avérée faisable et efficace. Alors que les vaccins anticholériques demeurent rares, il convient d'envisager la maximisation du nombre de vaccins pour faire face à une épidémie de choléra à travers l'utilisation d'une seule dose par membre d'une communauté vulnérable.describir la aplicación y la viabilidad de una estrategia innovadora de vacunación masiva, basada en una vacuna oral contra el cólera de una sola dosis, para frenar una epidemia de cólera en un entorno urbano grande.en abril de 2016, en las primeras etapas de un brote de cólera en Lusaka, Zambia, el Ministerio de Salud colaboró con Médecins Sans Frontières y la Organización Mundial de la Salud en la organización de una campaña masiva de vacunación basada en una vacuna oral contra el cólera de una sola dosis. Durante un período de 17 días, los socios movilizaron a 1700 voluntarios de personal sanitario y voluntarios de la comunidad para sensibilizar a la comunidad y para actividades de vacunación y movilización social en 10 municipios. Cada día, las dosis de la vacuna se entregaron en los lugares de vacunación y se estimó la cobertura administrativa.en general, los equipos de vacunación administraron 424.100 dosis de la vacuna a una población objetivo de unos 578.043 habitantes, lo que resultó en una cobertura administrativa estimada del 73,4%. Después de la campaña, se registraron pocos casos de cólera y no hubo pruebas de propagación de la enfermedad dentro de las zonas vacunadas. El costo total de la campaña (2,31 dólares estadounidenses (USD) por dosis) incluyó el coste relativamente bajo de la entrega local (0,41 $ por dosis).se descubrió que una campaña reactiva temprana dirigida y en gran escala con una vacuna oral de dosis única, organizada en respuesta a una epidemia de cólera dentro de una gran ciudad, era factible y aparentemente efectiva. Si bien las vacunas contra el cólera siguen siendo escasas, se debe considerar la maximización del número de vacunados en respuesta a una epidemia de cólera, mediante el uso de una sola dosis por miembro de una comunidad en riesgo.وصف لإجراءات تنفيذ استراتيجية مبتكرة للتطعيم الجماعي وإمكانية تطبيقها – إذ تقوم الاستراتيجية على تقديم جرعة واحدة من لقاح الكوليرا يتم تلقيها عبر الفم – وذلك للحد من انتشار وباء الكوليرا في منطقة حضرية واسعة النطاق.شهد عام 2016، مع المراحل الأولى لظهور مرض الكوليرا في مدينة "لوساكا" في زامبيا، تعاونًا بين وزارة الصحة بالبلاد من جهة ومنظمة أطباء بلا حدود (Médecins Sans Frontières) ومنظمة الصحة العالمية من جهة أخرى بشأن تنظيم حملة تطعيم جماعي تقوم على تقديم جرعة واحدة عبر الفم من لقاح الكوليرا. وخلال فترة تبلغ 17 يومًا، عملت الأطراف المتعاونة على حشد 1700 فرد من العاملين بوزارة الصحة والمتطوعين في الخدمات المجتمعية من أجل تحقيق التوعية المجتمعية والتعبئة الاجتماعية وتنفيذ أنشطة التطعيم في 10 أقاليم. وتم توفير جرعات التطعيم في كل يوم في مواقع التطعيم وجرى تقييم للتغطية المتعلقة بالجرعات المقدمة.قدمت فرق التطعيم بوجه عام 424100 جرعة من اللقاح لمجموعة مستهدفة من السكان بلغ عددها 578043 فردًا حسب التقديرات، مما أثمر عن وجود تغطية للجرعات المقدمة تم تقديرها بنسبة ‏73.4%. وبعد الحملة، قل العدد الذي يتم الإبلاغ به من حالات الإصابة بالكوليرا، ولم يوجد أي دليل على انتشار المرض في المناطق التي تم فيها التطعيم. وكانت التكلفة الإجمالية للحملة – التي بلغت 2.31 دولارًا أمريكيًا للجرعة الواحدة، شاملةً التكلفة المنخفضة نسبيًا لتوفير الجرعة محليًا – قد بلغت 0.41 دولارًا أمريكيًا للجرعة الواحدة.تبين لنا أن تنفيذ حملة موجهة واسعة النطاق في مرحلة مبكرة للتصدي للمرض باستخدام جرعة واحدة من لقاح فموي – وهي الحملة التي تم تنظيمها لمواجهة وباء الكوليرا على نطاق مدينة كبرى – أمر يمكن تحقيقه وبدت له نتائج مجدية. وبالرغم من استمرار المعاناة من النقص في الموارد المتاحة للقاح الكوليرا، يجب النظر في تحقيق أقصى استفادة ممكنة من عدد اللقاحات المتاحة للتصدي لوباء الكوليرا، وذلك عن طريق استخدام جرعة واحدة فقط لكل فرد من أفراد المجتمع المهدد بالإصابة بالمرض.旨在说明基于单剂量口服霍乱疫苗的创新型大规模接种策略的实施和可行性，以遏制大型城市环境中的霍乱疫情。.2016 年 4 月，在赞比亚卢萨卡霍乱爆发的早期阶段，卫生部门与无国界医生组织和世界卫生组织合作组织了基于单剂量口服霍乱疫苗的大规模疫苗接种活动。在 17 天的时间里，合作方共动员了 1700 名卫生部工作人员和社区志愿者在 10 个乡镇开展社区宣传、社会动员和疫苗接种活动。每天将疫苗剂量送到疫苗接种处并估计接种覆盖率。.总体而言，疫苗接种小组对估计的目标人群 578043 人进行了 424100 剂疫苗接种，估计接种覆盖率为 73.4％。此项活动后，报告的霍乱案例很少，没有证据表明疫苗接种区域内有传染病。活动的总费用——每剂量 2.31 美元，包括相对较低的本地交付成本（每剂量 0.41 美元）。.我们发现，使用单剂量口服疫苗的早期大规模针对性反应性活动是为了应对大城市内的霍乱疫情而组织起来的，可行且有效。尽管霍乱疫苗仍然供不应求，但每一名处于危险社区中的成员只需一个剂量，应对霍乱疫情所需的最大接种疫苗数量应该考虑在内。.Описать реализацию и осуществимость инновационной стратегии массовой вакцинации, основанной на применении однодозовой пероральной противохолерной вакцины, для борьбы с эпидемией холеры в условиях крупных городов.В апреле 2016 года на ранних стадиях вспышки холеры в Лусаке, Замбия, Министерство здравоохранения сотрудничало с организацией «Врачи без границ» и Всемирной организацией здравоохранения при проведении кампании массовой вакцинации, основанной на применении однодозовой пероральной противохолерной вакцины. В течение 17 дней партнеры мобилизовали 1700 сотрудников Министерства здравоохранения и общинных добровольцев для повышения информированности населения, социальной мобилизации и вакцинации в 10 поселках. Ежедневно на участки вакцинации доставлялись дозы вакцины и оценивался административный охват вакцинацией.В целом группами вакцинации были введены 424 100 доз вакцины в предполагаемой целевой популяции в количестве 578 043 человек, в результате чего административный охват оценивался как 73,4%. После кампании сообщалось о редких случаях заболевания холерой и не было признаков распространения болезни в вакцинированных районах. Общие расходы на кампанию составили 2,31 доллара США (US$) на 1 дозу, включая относительно низкую стоимость местной доставки — 0,41 доллара США на 1 дозу.Мы обнаружили, что ранняя и крупномасштабная целевая реактивная кампания с применением однодозовой пероральной вакцины, организованная в ответ на эпидемию холеры в крупном городе, осуществима и эффективна. Поскольку по-прежнему имеется дефицит противохолерных вакцин, следует рассмотреть вопрос об увеличении числа доступных вакцин в ответ на эпидемию холеры за счет использования только одной дозы на одного члена сообщества, находящегося в зоне риска.

Summary Background Oral cholera vaccines represent a new effective tool to fight cholera and are licensed as two-dose regimens with 2–4 weeks between doses. Evidence from previous studies suggests that a single dose of oral cholera vaccine might provide substantial direct protection against cholera. During a cholera outbreak in May, 2015, in Juba, South Sudan, the Ministry of Health, Medecins Sans Frontieres, and partners engaged in the first field deployment of a single dose of oral cholera vaccine to enhance the outbreak response. We did a vaccine effectiveness study in conjunction with this large public health intervention. Methods We did a case-cohort study, combining information on the vaccination status and disease outcomes from a random cohort recruited from throughout the city of Juba with that from all the cases detected. Eligible cases were those aged 1 year or older on the first day of the vaccination campaign who sought care for diarrhoea at all three cholera treatment centres and seven rehydration posts throughout Juba. Confirmed cases were suspected cases who tested positive to PCR for Vibrio cholerae O1. We estimated the short-term protection (direct and indirect) conferred by one dose of cholera vaccine (Shanchol, Shantha Biotechnics, Hyderabad, India). Findings Between Aug 9, 2015, and Sept 29, 2015, we enrolled 87 individuals with suspected cholera, and an 898-person cohort from throughout Juba. Of the 87 individuals with suspected cholera, 34 were classified as cholera positive, 52 as cholera negative, and one had indeterminate results. Of the 858 cohort members who completed a follow-up visit, none developed clinical cholera during follow-up. The unadjusted single-dose vaccine effectiveness was 80·2% (95% CI 61·5–100·0) and after adjusting for potential confounders was 87·3% (70·2–100·0). Interpretation One dose of Shanchol was effective in preventing medically attended cholera in this study. These results support the use of a single-dose strategy in outbreaks in similar epidemiological settings. Funding Medecins Sans Frontieres.

During 2002-2013, a total of 1,890 tuberculosis cases were recorded in Fiji. Notification rates per 100,000 population increased from 17.4 cases in 2002 to 28.4 in 2013. Older persons were most affected, but tuberculosis also increased sharply in persons 25-44 years of age.

MenAfriVac™ is a new meningococcal A conjugate vaccine developed to prevent meningitis outbreaks in Africa. It was first introduced during the last quarter of 2010 in three West African countries. We report on the monitoring of adverse events following immunization (AEFI) in Burkina Faso where more than 11 million people aged 1-29 years were vaccinated. Vaccine pharmacovigilance relied on stimulated passive AEFI surveillance countrywide and active surveillance for 12 clinical conditions in one sentinel district (Ziniaré) with 97,715 people eligible for vaccination. All AEFI occurring during the 10 days of mass campaign or the 42 subsequent days were to be notified. Serious AEFI were submitted to a national expert committee (NEC) for causality assessment. A total of 11,466,950 people were vaccinated with 1471 vaccinees reported to have experienced at least one AEFI (12.83 cases per 100,000). 1444 AEFI were minor; the most common of which were fever, headache, gastro-intestinal disorders and local reactions (2-7 cases per 100,000). Of 27 serious AEFI reported, four cases were classified by the NEC as related to vaccine (1 case per 3 million vaccinated) including one case each of exanthematous pustulosis, angioedema, bronchospasm and severe vomiting. Active surveillance identified 71 cases of the 12 conditions of interest. Convulsions, urticaria and bronchospasm were more frequently reported. Attack rates for those conditions were similar to the baseline rates recorded in the same population, over the same time period, a year earlier. With the exception of convulsions in the days following vaccination the distribution of time intervals between vaccination and the occurrence of symptoms did not reveal any temporal clustering. The monitoring of AEFI of MenAfriVac™ in Burkina Faso did not suggest special concern regarding the vaccine safety. However, reported possible hypersensitivity reactions to vaccine components would require further review to rule out any anaphylactic reaction.

OBJECTIVES To evaluate oral poliovirus vaccine (OPV) coverage of the November 2009 round in five Northern Nigeria states with ongoing wild poliovirus transmission using clustered lot quality assurance sampling (CLQAS). METHODS We selected four local government areas in each pre-selected state and sampled six clusters of 10 children in each Local Government Area, defined as the lot area. We used three decision thresholds to classify OPV coverage: 75-90%, 55-70% and 35-50%. A full lot was completed, but we also assessed in retrospect the potential time-saving benefits of stopping sampling when a lot had been classified. RESULTS We accepted two local government areas (LGAs) with vaccination coverage above 75%. Of the remaining 18 rejected LGAs, 11 also failed to reach 70% coverage, of which four also failed to reach 50%. The average time taken to complete a lot was 10 h. By stopping sampling when a decision was reached, we could have classified lots in 5.3, 7.7 and 7.3 h on average at the 90%, 70% and 50% coverage targets, respectively. CONCLUSIONS Clustered lot quality assurance sampling was feasible and useful to estimate OPV coverage in Northern Nigeria. The multi-threshold approach provided useful information on the variation of IPD vaccination coverage. CLQAS is a very timely tool, allowing corrective actions to be directly taken in insufficiently covered areas.

OBJECTIVE To estimate the yellow fever (YF) vaccine coverage for the endemic and non-endemic areas of Bolivia and to determine whether selected districts had acceptable levels of coverage (>70%). METHODS We conducted two surveys of 600 individuals (25 x 12 clusters) to estimate coverage in the endemic and non-endemic areas. We assessed 11 districts using lot quality assurance sampling (LQAS). The lot (district) sample was 35 individuals with six as decision value (alpha error 6% if true coverage 70%; beta error 6% if true coverage 90%). To increase feasibility, we divided the lots into five clusters of seven individuals; to investigate the effect of clustering, we calculated alpha and beta by conducting simulations where each cluster's true coverage was sampled from a normal distribution with a mean of 70% or 90% and standard deviations of 5% or 10%. RESULTS Estimated coverage was 84.3% (95% CI: 78.9-89.7) in endemic areas, 86.8% (82.5-91.0) in non-endemic and 86.0% (82.8-89.1) nationally. LQAS showed that four lots had unacceptable coverage levels. In six lots, results were inconsistent with the estimated administrative coverage. The simulations suggested that the effect of clustering the lots is unlikely to have significantly increased the risk of making incorrect accept/reject decisions. CONCLUSIONS Estimated YF coverage was high. Discrepancies between administrative coverage and LQAS results may be due to incorrect population data. Even allowing for clustering in LQAS, the statistical errors would remain low. Catch-up campaigns are recommended in districts with unacceptable coverage.

Salmonella Senftenberg is uncommon in the United Kingdom. In January-June 2007, the Health Protection Agency reported on 55 primary human cases of Salmonella Senftenberg in England and Wales. In May 2007, fresh basil sold in the United Kingdom was found to be contaminated with Salmonella Senftenberg. We launched an investigation to elucidate the cause of this outbreak. Isolates were examined using plasmid profiling and pulsed-field gel electrophoresis, and the outbreak strain (SSFTXB.0014) was identified. We enquired via Enter-net whether other countries had isolated the outbreak strain, analyzed samples of fresh herbs from U.K. retailers, and interviewed patients on food history. Thirty-two patient-cases were referred to this outbreak in England and Wales. Onsets of illness occurred between 5 March and 6 June 2007. Fifty-six percent of patient-cases were females and 90% adults (>20 years old); three were admitted to hospital as a result of Salmonella infection. Scotland, Denmark, the Netherlands, and the United States reported on 19 cases of Salmonella Senftenberg infection presenting with the outbreak strain since January 2007. Eight samples of prepacked fresh basil imported from Israel tested positive with the same strain. A minority of patients could recall the consumption of basil before illness, and some reported consumption of products where basil was a likely ingredient. Environmental investigations in Israel did not identify the contamination source. Microbiological evidence suggested an association between contamination of fresh basil and the cases of Salmonella Senftenberg infection, leading to withdrawal of basil from all potentially affected batches from the U.K. market.

Objective:This study aimed to examine tinnitus prevalence in patients with different types of headache and the relationship between tinnitus and the pericranial muscle tenderness and cervical muscle tenderness scores.Methods:A cross-sectional study was conducted of 1251 patients with migraine and/or myogenous pain, arthrogenous temporomandibular joint disorders and tension-type headache. Standardised palpation of the pericranial and cervical muscles was carried out and univariable and multivariable analysis was used to measure the odds ratio of suffering tinnitus by the different diagnoses and muscular tenderness grade.Results:A univariable analysis showed that myogenous pain, pericranial muscle tenderness and cervical muscle tenderness scores, sex, and age were associated with tinnitus. When a multivariable model including only age, sex and a headache diagnosis was used, myogenous pain, migraine and age were found to be associated with tinnitus. When muscle tenderness scores were also included, only the cervical muscle tenderness and pericranial muscle tenderness scores were found to be significantly associated with tinnitus.Conclusion:In a population of patients with headache and craniofacial pain, tinnitus was related to increased cervical muscle tenderness and pericranial muscle tenderness scores, rather than to any particular form of headache.

Purpose: Active immunotherapy is a promising antitumoral strategy; however its use in combination with chemotherapy in dogs with large B-cell lymphoma (DLBCL) remains largely untested. Heat shock proteins (HSP) bind the small peptides they chaperone (HSPPC), allowing for immunization of the host against a large repertoire of tumor-associated antigens. Hydroxylapatite vehicles HSPPCs and acts as an immunologic adjuvant. The aim of this study was to show that an autologous vaccine with hydroxylapatite and tumor-derived HSPPCs is safe and therapeutically effective in dogs with DLBCL. Experimental Design: Nineteen dogs with naturally occurring DLBCL were entered into a prospective randomized placebo-controlled double-blinded trial of HSPPCs–hydroxylapatite plus chemotherapy versus chemotherapy alone. Endpoints included time to progression (TTP), lymphoma-specific survival (LSS), and incidence of toxicoses. Results: Median first TTP after randomization to the vaccine arm was 304 days versus 41 days for the control arm (P = 0.0004). There was also a statistically significant difference in duration of second remission between the two groups (P = 0.02). Median LSS was 505 days for the vaccinated dogs versus 159 days for the unvaccinated dogs (P = 0.0018). Six vaccinated dogs achieved molecular remission, as shown by clonal immunoglobulin H (IgH) rearrangement. Toxicoses were comparable between the two treatment arms. Conclusions: The results of this trial demonstrate that the autologous vaccine tested here is safe and efficacious in prolonging TTP and LSS in dogs with DLBCL when used in combination with dose-intense chemotherapy. On the basis of these results, additional evaluation of this novel therapeutic strategy is warranted in human DLBCL. Clin Cancer Res; 20(3); 668–77. ©2013 AACR.

While assessing immunization programmes, not only vaccination coverage is important, but also timely receipt of vaccines. We estimated both vaccination coverage and timeliness, as well as reasons for non-vaccination, and identified predictors of delayed or missed vaccination, for vaccines of the first two years of age, in El Salvador. We conducted a cluster survey among children aged 23-59 months. Caregivers were interviewed about the child immunization status and their attitudes towards immunization. Vaccination dates were obtained from children immunization cards at home or at health facilities. We referred to the 2006 vaccination schedule for children below two years: one dose of BCG (Bacillus Calmette-Guerin) at birth; rotavirus at two and four months; three doses of pentavalent - DTP (diphtheria-tetanus-pertussis), hepatitis B, and Haemophilus influenzae type b (Hib) - and of oral poliomyelitis vaccine (polio) at two, four, and six months; first MMR (measles-mumps-rubella) at 12 months; and first boosters of DTP and OPV at 18 months. Timeliness was assessed with Kaplan-Meier analysis; Cox and logistic regression were used to identify predictors of vaccination. We surveyed 2550 children. Coverage was highest for BCG (991%; 95% CI: 98.8-99.5) and lowest for rotavirus, especially second dose (86.3%; 95% CI: 84.2-88.4). The first doses of MMR and DTP had 991% (95% CI: 98.5-99.6) and 977% (95% CI: 970-985), respectively. Overall coverage was 837% (95% CI: 81.4-86.0); 96.4% (95% CI: 95.4-97.5), excluding rotavirus. However, only 26.7% (95% CI: 24.7-28.8) were vaccinated within the age interval recommended by the Expanded Programme on Immunization. Being employed and using the bus for transport to the health facility were associated with age-inappropriate vaccinations; while living in households with only two residents and in the "Paracentral", "Occidental", and "Oriental" regions was associated with age-appropriate vaccinations. Vaccination coverage was high in El Salvador, but general timeliness and rotavirus uptake could be improved.

SUMMARYOrnithosis outbreaks in poultry processing plants are well-described, but evidence for preventive measures is currently lacking. This study describes a case-control study into an outbreak of ornithosis at a poultry processing plant in the East of England, identified following three employees being admitted to hospital. Workers at the affected plant were recruited via their employer, with exposures assessed using a self-completed questionnaire. Cases were ascertained using serological methods or direct antigen detection in sputum. 63/225 (28%) staff participated, with 10% of participants showing evidence of recent infection. Exposure to the killing/defeathering and automated evisceration areas, and contact with viscera or blood were the main risk factors for infection. Personal protective equipment (goggles and FFP3 masks) reduced the effect of exposure to risk areas and to self-contamination with potentially infectious material. Our study provides some evidence of effectiveness for respiratory protective equipment in poultry processing plants where there is a known and current risk of ornithosis. Further studies are required to confirm this tentative finding, but in the meantime respiratory protective equipment is recommended as a precautionary measure in plants where outbreaks of ornithosis occur.

Background In November 2009, Sierra Leone conducted a preventive yellow fever (YF) vaccination campaign targeting individuals aged nine months and older in six health districts. The campaign was integrated with a measles follow-up campaign throughout the country targeting children aged 9–59 months. For both campaigns, the operational objective was to reach 95% of the target population. During the campaign, we used clustered lot quality assurance sampling (C-LQAS) to identify areas of low coverage to recommend timely mop-up actions. Methods We divided the country in 20 non-overlapping lots. Twelve lots were targeted by both vaccinations, while eight only by measles. In each lot, five clusters of ten eligible individuals were selected for each vaccine. The upper threshold (UT) was set at 90% and the lower threshold (LT) at 75%. A lot was rejected for low vaccination coverage if more than 7 unvaccinated individuals (not presenting vaccination card) were found. After the campaign, we plotted the C-LQAS results against the post-campaign coverage estimations to assess if early interventions were successful enough to increase coverage in the lots that were at the level of rejection before the end of the campaign. Results During the last two days of campaign, based on card-confirmed vaccination status, five lots out of 20 (25.0%) failed for having low measles vaccination coverage and three lots out of 12 (25.0%) for low YF coverage. In one district, estimated post-campaign vaccination coverage for both vaccines was still not significantly above the minimum acceptable level (LT = 75%) even after vaccination mop-up activities. Conclusion C-LQAS during the vaccination campaign was informative to identify areas requiring mop-up activities to reach the coverage target prior to leaving the region. The only district where mop-up activities seemed to be unsuccessful might have had logistical difficulties that should be further investigated and resolved.