title: Feasibility and acceptability of oral cholera vaccine mass vaccination campaign in response to an outbreak and floods in Malawi.
abstract: BACKGROUND
  Despite some improvement in provision of safe drinking water, proper sanitation and hygiene promotion, cholera still remains a major public health problem in Malawi with outbreaks occurring almost every year since 1998. In response to 2014/2015 cholera outbreak, ministry of health and partners made a decision to assess the feasibility and acceptability of conducting a mass oral cholera vaccine (OCV) as an additional public health measure. This paper highlights the burden of the 2014/15 cholera outbreak, successes and challenges of OCV campaign conducted in March and April 2015.
  
  
  METHODS
  This was a documentation of the first OCV campaign conducted in Malawi. The campaign targeted over 160,000 people aged one year or more living in 19 camps of people internally displaced by floods and their surrounding communities in Nsanje district. It was a reactive campaign as additional measure to improved water, sanitation and hygiene in response to the laboratory confirmed cholera outbreak.
  
  
  RESULTS
  During the first round of the OCV campaign conducted from 30 March to 4 April 2015, a total of 156,592 (97.6%) people out of 160,482 target population received OCV. During the second round (20 to 25 April 2015), a total of 137,629 (85.8%) people received OCV. Of these, 108,247 (67.6%) people received their second dose while 29,382 (18.3%) were their first dose. Of the 134,836 people with known gender and sex who received 1 or 2 doses, 54.4% were females and over half (55.4%) were children under the age of 15 years. Among 108,237 people who received 2 doses (fully immunized), 54.4% were females and 51.9% were children under 15 years of age. No severe adverse event following immunization was reported. The main reason for non-vaccination or failure to take the 2 doses was absence during the period of the campaign.
  
  
  CONCLUSIONS
  This documentation has demonstrated that it was feasible, acceptable by the community to conduct a large-scale mass OCV campaign in Malawi within five weeks. Of 320,000 OCV doses received, Malawi managed to administer at least 294,221 (91.9%) of the doses. OCV could therefore be considered to be introduced as additional measure in cholera hot spot areas in Malawi.
authors.affiliation: World Health Organization, Malawi Country Office, Lilongwe, Malawi; University of Malawi, College of Medicine, Blantyre, Malawi.
authors.forename: Kelias Phiri
authors.initials: KP
authors.lastname: Msyamboza
authors.affiliation: Ministry of Health, Epidemiology Unit, Lilongwe, Malawi.
authors.forename: Maurice
authors.initials: M
authors.lastname: M'bang'ombe
authors.affiliation: John Snow Institute.
authors.forename: Hannah
authors.initials: H
authors.lastname: Hausi
authors.affiliation: Ministry of Health, Nsanje District Hospital, Nsanje, Malawi.
authors.forename: Alexander
authors.initials: A
authors.lastname: Chijuwa
authors.affiliation: Ministry of Health, Nsanje District Hospital, Nsanje, Malawi.
authors.forename: Veronica
authors.initials: V
authors.lastname: Nkukumila
authors.affiliation: World Health Organization, Malawi Country Office, Lilongwe, Malawi.
authors.forename: Hudson Wenji
authors.initials: HW
authors.lastname: Kubwalo
authors.affiliation: International Vaccine Institute, Saul, South Korea.
authors.forename: Sachin
authors.initials: S
authors.lastname: Desai
authors.affiliation: Global Task Force for Cholera Control, Geneva, Switzerland.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pezzoli
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Dominique
authors.initials: D
authors.lastname: Legros
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000453:epidemiology / Q000517:prevention & control*; D022121:Cholera Vaccines / Q000008:administration & dosage*; D004196:Disease Outbreaks; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008295:Malawi / Q000453:epidemiology; D008297:Male; D032541:Mass Vaccination / Q000379:methods*; D010342:Patient Acceptance of Health Care; D011634:Public Health; D012499:Sanitation
chemical_list: D022121:Cholera Vaccines
keywords: Cholera; Malawi; oral cholera vaccine; sub-Saharan Africa