title: Coverage and cost of a large oral cholera vaccination program in a high-risk cholera endemic urban population in Dhaka, Bangladesh.
abstract: A feasibility study of an oral cholera vaccine was carried out to test strategies to reach high-risk populations in urban Mirpur, Dhaka, Bangladesh. The study was cluster randomized, with three arms: vaccine, vaccine plus safe water and hand washing practice, and no intervention. High risk people of age one year and above (except pregnant woman) from the two intervention arms received two doses of the oral cholera vaccine, Shanchol™. Vaccination was conducted between 17th February and 16th April 2011, with a minimum interval of fourteen days between two doses. Interpersonal communication preceded vaccination to raise awareness amongst the target population. The number of vaccine doses used, the population vaccinated, left-out, drop out, vaccine wastage and resources required were documented. Fixed outreach site vaccination strategy was adopted as the mode of vaccine delivery. Additionally, mobile vaccination sites and mop-up activities were carried out to reach the target communities. Of the 172,754 target population, 141,839 (82%) and 123,666 (72%) received complete first and second doses of the vaccine, respectively. Dropout rate from the first to the second dose was 13%. Two complete doses were received by 123,661 participants. Vaccine coverage in children was 81%. Coverage was significantly higher in females than in males (77% vs. 66%, P<0.001). Vaccine wastage for delivering the complete doses was 1.2%. The government provided cold-chain related support at no cost to the project. Costs for two doses of vaccine per-person were US$3.93, of which US$1.63 was spent on delivery. Cost for delivering a single dose was US$0.76. We observed no serious adverse events. Mass vaccination with oral cholera vaccine is feasible for reaching high risk endemic population through the existing national immunization delivery system employed by the government.
authors.affiliation: International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
authors.forename: Iqbal Ansary
authors.initials: IA
authors.lastname: Khan
authors.forename: Amit
authors.initials: A
authors.lastname: Saha
authors.forename: Fahima
authors.initials: F
authors.lastname: Chowdhury
authors.forename: Ashraful Islam
authors.initials: AI
authors.lastname: Khan
authors.forename: Md Jasim
authors.initials: MJ
authors.lastname: Uddin
authors.forename: Yasmin A
authors.initials: YA
authors.lastname: Begum
authors.forename: Baizid Khoorshid
authors.initials: BK
authors.lastname: Riaz
authors.forename: Sanjida
authors.initials: S
authors.lastname: Islam
authors.forename: Mohammad
authors.initials: M
authors.lastname: Ali
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Luby
authors.forename: John D
authors.initials: JD
authors.lastname: Clemens
authors.forename: Alejandro
authors.initials: A
authors.lastname: Cravioto
authors.forename: Firdausi
authors.initials: F
authors.lastname: Qadri
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001459:Bangladesh; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000517:prevention & control*; D022121:Cholera Vaccines / Q000008:administration & dosage* / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012034:Refrigeration / Q000191:economics; D014505:Urban Population; D014611:Vaccination / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D022121:Cholera Vaccines; C000588783:shanchol
keywords: Bangladesh; Cholera vaccine; Complete dose; Endemic high risk targeted population; Feasibility