title: Mass vaccination with a new, less expensive oral cholera vaccine using public health infrastructure in India: the Odisha model.
abstract: BACKGROUND
  The substantial morbidity and mortality associated with recent cholera outbreaks in Haiti and Zimbabwe, as well as with cholera endemicity in countries throughout Asia and Africa, make a compelling case for supplementary cholera control measures in addition to existing interventions. Clinical trials conducted in Kolkata, India, have led to World Health Organization (WHO)-prequalification of Shanchol, an oral cholera vaccine (OCV) with a demonstrated 65% efficacy at 5 years post-vaccination. However, before this vaccine is widely used in endemic areas or in areas at risk of outbreaks, as recommended by the WHO, policymakers will require empirical evidence on its implementation and delivery costs in public health programs. The objective of the present report is to describe the organization, vaccine coverage, and delivery costs of mass vaccination with a new, less expensive OCV (Shanchol) using existing public health infrastructure in Odisha, India, as a model.
  
  
  METHODS
  All healthy, non-pregnant residents aged 1 year and above residing in selected villages of the Satyabadi block (Puri district, Odisha, India) were invited to participate in a mass vaccination campaign using two doses of OCV. Prior to the campaign, a de jure census, micro-planning for vaccination and social mobilization activities were implemented. Vaccine coverage for each dose was ascertained as a percentage of the censused population. The direct vaccine delivery costs were estimated by reviewing project expenditure records and by interviewing key personnel.
  
  
  RESULTS
  The mass vaccination was conducted during May and June, 2011, in two phases. In each phase, two vaccine doses were given 14 days apart. Sixty-two vaccination booths, staffed by 395 health workers/volunteers, were established in the community. For the censused population, 31,552 persons (61% of the target population) received the first dose and 23,751 (46%) of these completed their second dose, with a drop-out rate of 25% between the two doses. Higher coverage was observed among females and among 6-17 year-olds. Vaccine cost at market price (about US$1.85/dose) was the costliest item. The vaccine delivery cost was $0.49 per dose or $1.13 per fully vaccinated person.
  
  
  CONCLUSIONS
  This is the first undertaken project to collect empirical evidence on the use of Shanchol within a mass vaccination campaign using existing public health program resources. Our findings suggest that mass vaccination is feasible but requires detailed micro-planning. The vaccine and delivery cost is affordable for resource poor countries. Given that the vaccine is now WHO pre-qualified, evidence from this study should encourage oral cholera vaccine use in countries where cholera remains a public health problem.
authors: Regional Medical Research Center, Bhubaneswar, Odisha, India.
authors: Shantanu K
authors: SK
authors: Kar
authors: International Vaccine Institute, Seoul, Republic of Korea.
authors: Binod
authors: B
authors: Sah
authors: Directorate of Health Services, Odisha, India.
authors: Bikash
authors: B
authors: Patnaik
authors: International Vaccine Institute, Seoul, Republic of Korea.
authors: Yang Hee
authors: YH
authors: Kim
authors: Regional Medical Research Center, Bhubaneswar, Odisha, India.
authors: Anna S
authors: AS
authors: Kerketta
authors: International Vaccine Institute, Seoul, Republic of Korea.
authors: Sunheang
authors: S
authors: Shin
authors: Regional Medical Research Center, Bhubaneswar, Odisha, India.
authors: Shyam Bandhu
authors: SB
authors: Rath
authors: International Vaccine Institute, Seoul, Republic of Korea.
authors: Mohammad
authors: M
authors: Ali
authors: International Vaccine Institute, Seoul, Republic of Korea.
authors: Vittal
authors: V
authors: Mogasale
authors: Regional Medical Research Center, Bhubaneswar, Odisha, India.
authors: Hemant K
authors: HK
authors: Khuntia
authors: International Vaccine Institute, Seoul, Republic of Korea.
authors: Anuj
authors: A
authors: Bhattachan
authors: International Vaccine Institute, Seoul, Republic of Korea.
authors: Young Ae
authors: YA
authors: You
authors: International Vaccine Institute, Seoul, Republic of Korea.
authors: Mahesh K
authors: MK
authors: Puri
authors: International Vaccine Institute, Seoul, Republic of Korea ; University of the Philippines Manila, National Institutes of Health, Manila, Philippines.
authors: Anna Lena
authors: AL
authors: Lopez
authors: International Vaccine Institute, Seoul, Republic of Korea.
authors: Brian
authors: B
authors: Maskery
authors: Translational Health Science and Technology Institute, Department of Biotechnology, New Delhi, India.
authors: Gopinath B
authors: GB
authors: Nair
authors: International Vaccine Institute, Seoul, Republic of Korea ; University of California, Los Angeles School of Public Health, Los Angeles, California, United States of America.
authors: John D
authors: JD
authors: Clemens
authors: International Vaccine Institute, Seoul, Republic of Korea.
authors: Thomas F
authors: TF
authors: Wierzba
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000517:prevention & control; D022121:Cholera Vaccines / Q000008:administration & dosage* / Q000191:economics*; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D007194:India; D007223:Infant; D008297:Male; D032541:Mass Vaccination / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D011634:Public Health; D055815:Young Adult
chemical_list: D022121:Cholera Vaccines