title: Relationship between neighbourhood-level killed oral cholera vaccine coverage and protective efficacy: evidence for herd immunity.
abstract: OBJECTIVE
  The effectiveness of vaccines in populations must consider both direct and indirect protection. This study reanalyses data from a large individually randomized oral cholera vaccine trial that was conducted in rural Bangladesh from 1985 to 1990. A recent analysis of the results of that trial showed that the proportion of people in household clusters who received the vaccine was inversely related to placebo incidence during the first year of surveillance, which was attributed to herd immunity.
  
  
  METHODS
  In this study we measure the relationship between neighbourhood-level oral cholera vaccine coverage and protective efficacy (PE) during a 2 year follow-up period, controlling for known effect modifiers. We link trial data to a household geographic information system to facilitate the neighbourhood-level analysis. Findings Neighbourhood-level PE can be partially explained by vaccine coverage after adjusting for ecological variables.
  
  
  CONCLUSIONS
  The inverse relationship between vaccine coverage and efficacy illustrates that people living in high-coverage areas may be indirectly protected from cholera because people living around them are vaccinated.
authors.affiliation: Department of Geography, Saunders Hall, Campus Box 3220, University of North Carolina-Chapel Hill, 27599-3220, USA. emch@email.unc.edu
authors.forename: Michael
authors.initials: M
authors.lastname: Emch
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali
authors.forename: Jin-Kyung
authors.initials: JK
authors.lastname: Park
authors.forename: Mohammad
authors.initials: M
authors.lastname: Yunus
authors.forename: David A
authors.initials: DA
authors.lastname: Sack
authors.forename: John D
authors.initials: JD
authors.lastname: Clemens
mesh_terms: D000328:Adult; D001459:Bangladesh; D002771:Cholera / Q000276:immunology* / Q000517:prevention & control* / Q000635:transmission; D022121:Cholera Vaccines / Q000008:administration & dosage*; D004463:Ecology; D005500:Follow-Up Studies; D006801:Humans; D032521:Immunity, Herd; D016014:Linear Models; D016032:Randomized Controlled Trials as Topic; D012111:Residence Characteristics; D012424:Rural Population; D019371:Topography, Medical; D015164:Vaccines, Inactivated / Q000008:administration & dosage*
chemical_list: D022121:Cholera Vaccines; D015164:Vaccines, Inactivated