title: Use of Vibrio cholerae vaccine in an outbreak in Guinea.
abstract: BACKGROUND
  The use of vaccines to prevent and control cholera is currently under debate. Shanchol is one of the two oral cholera vaccines prequalified by the World Health Organization; however, its effectiveness under field conditions and the protection it confers in the first months after administration remain unknown. The main objective of this study was to estimate the short-term effectiveness of two doses of Shanchol used as a part of the integrated response to a cholera outbreak in Africa.
  
  
  METHODS
  We conducted a matched case-control study in Guinea between May 20 and October 19, 2012. Suspected cholera cases were confirmed by means of a rapid test, and controls were selected among neighbors of the same age and sex as the case patients. The odds of vaccination were compared between case patients and controls in bivariate and adjusted conditional logistic-regression models. Vaccine effectiveness was calculated as (1-odds ratio)×100.
  
  
  RESULTS
  Between June 8 and October 19, 2012, we enrolled 40 case patients and 160 controls in the study for the primary analysis. After adjustment for potentially confounding variables, vaccination with two complete doses was associated with significant protection against cholera (effectiveness, 86.6%; 95% confidence interval, 56.7 to 95.8; P=0.001).
  
  
  CONCLUSIONS
  In this study, Shanchol was effective when used in response to a cholera outbreak in Guinea. This study provides evidence supporting the addition of vaccination as part of the response to an outbreak. It also supports the ongoing efforts to establish a cholera vaccine stockpile for emergency use, which would enhance outbreak prevention and control strategies. (Funded by Médecins sans Frontières.).
authors.affiliation: From Epicentre (F.J.L., L.G., A.-L.P., R.F.G.), African Cholera Surveillance Network, Agence de Médicine Préventive (K.S., M.A.M.), and National Reference Center for Vibrios and Cholera, Enteric Bacterial Pathogens Research and Expertise Unit, Institut Pasteur (M.-L.Q.) - all in Paris; Médecins sans Frontières, Geneva (L.G., I.C., M.S., D.L.); Ministry of Health (K.S.), Direction Préfectorale de la Santé (B.T.) and Research and Documentation Service, Ministry of Health (A.A.D.), Médecins sans Frontières (M.H.), and World Health Organization (C.I.) - all in Conakry, Guinea; and the Department of Microbiology, University of Valladolid, Valladolid, Spain (J.M.E.).
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Luquero
authors.forename: Lise
authors.initials: L
authors.lastname: Grout
authors.forename: Iza
authors.initials: I
authors.lastname: Ciglenecki
authors.forename: Keita
authors.initials: K
authors.lastname: Sakoba
authors.forename: Bala
authors.initials: B
authors.lastname: Traore
authors.forename: Melat
authors.initials: M
authors.lastname: Heile
authors.forename: Alpha Amadou
authors.initials: AA
authors.lastname: Diallo
authors.forename: Christian
authors.initials: C
authors.lastname: Itama
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Page
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Quilici
authors.forename: Martin A
authors.initials: MA
authors.lastname: Mengel
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Eiros
authors.forename: Micaela
authors.initials: M
authors.lastname: Serafini
authors.forename: Dominique
authors.initials: D
authors.lastname: Legros
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Grais
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002771:Cholera / Q000453:epidemiology / Q000517:prevention & control*; D022121:Cholera Vaccines / Q000008:administration & dosage* / Q000191:economics; D015986:Confounding Factors, Epidemiologic; D004196:Disease Outbreaks / Q000517:prevention & control*; D004356:Drug Storage; D005260:Female; D016701:Guinea / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D011159:Population Surveillance; D014734:Vibrio cholerae; D055815:Young Adult
chemical_list: D022121:Cholera Vaccines; C000588783:shanchol