title: Impact of oral cholera vaccines in cholera-endemic countries: A mathematical modeling study.
abstract: BACKGROUND
  Impact evaluation of vaccination programs is necessary for making decisions to introduce oral cholera vaccines (OCVs) in cholera-endemic countries.
  
  
  METHODS
  We analyzed data to forecast the future global burden of cholera. We developed a mathematical model of cholera transmission in three countries as examples: Nigeria, Uganda, and Indonesia. After fitting the model, we evaluated the impact of OCVs delivered in four vaccination strategies varying by target age group and frequency of vaccination over the period of 2015-2030.
  
  
  RESULTS
  Data suggest that the global annual incidence of cholera will increase from 3046238 in 2015 to 3787385 in 2030 with the highest burden in Asia and Africa where overall population size is large and the proportion of population with access to improved sanitation facilities is low. We estimate that OCV will reduce the cumulative incidence of cholera by half in Indonesia and >80% in Nigeria and Uganda when delivered to 1+ year olds every three years at a coverage rate of 50%, although cholera may persist through higher coverage rates (i.e., >90%). The proportion of person-to-person transmission compared to water-to-person transmission is positively correlated with higher vaccination impact in all three countries.
  
  
  CONCLUSIONS
  Periodic OCV vaccination every three or five years can significantly reduce the global burden of cholera although cholera may persist even with high OCV coverage. Vaccination impact will likely vary depending on local epidemiological conditions including age distribution of cases and relative contribution of different transmission routes.
authors.affiliation: International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, South Korea. Electronic address: jonghoon.kim@ivi.int.
authors.forename: Jong-Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul 151-742, South Korea. Electronic address: vmogasale@ivi.int.
authors.forename: Vittal
authors.initials: V
authors.lastname: Mogasale
authors.affiliation: MathEcology, LLC, 3120 West Carefree Hwy, Suite 1-642, Phoenix, AZ 85086, USA. Electronic address: Colleen.Burgess@mathecology.com.
authors.forename: Colleen
authors.initials: C
authors.lastname: Burgess
authors.affiliation: PATH, 455 Massachusetts Avenue NW, Suite 1000, Washington, DC 20001, USA. Electronic address: twierzba@path.org.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Wierzba
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000517:prevention & control* / Q000635:transmission; D022121:Cholera Vaccines / Q000627:therapeutic use*; D017281:Cost of Illness; D006801:Humans; D007214:Indonesia; D007223:Infant; D032541:Mass Vaccination; D008962:Models, Theoretical; D009549:Nigeria; D014454:Uganda
chemical_list: D022121:Cholera Vaccines
keywords: Mathematical model; Oral cholera vaccine; Water-to-person transmission