title: Use of Oral Cholera Vaccine and Knowledge, Attitudes, and Practices Regarding Safe Water, Sanitation and Hygiene in a Long-Standing Refugee Camp, Thailand, 2012-2014.
abstract: Oral cholera vaccines (OCVs) are relatively new public health interventions, and limited data exist on the potential impact of OCV use on traditional cholera prevention and control measures-safe water, sanitation and hygiene (WaSH). To assess OCV acceptability and knowledge, attitudes, and practices (KAPs) regarding cholera and WaSH, we conducted cross-sectional surveys, 1 month before (baseline) and 3 and 12 months after (first and second follow-up) a preemptive OCV campaign in Maela, a long-standing refugee camp on the Thailand-Burma border. We randomly selected households for the surveys, and administered questionnaires to female heads of households. In total, 271 (77%), 187 (81%), and 199 (85%) households were included in the baseline, first and second follow-up surveys, respectively. Anticipated OCV acceptability was 97% at baseline, and 91% and 85% of household members were reported to have received 1 and 2 OCV doses at first follow-up. Compared with baseline, statistically significant differences (95% Wald confidence interval not overlapping zero) were noted at first and second follow-up among the proportions of respondents who correctly identified two or more means of cholera prevention (62% versus 78% and 80%), reported boiling or treating drinking water (19% versus 44% and 69%), and washing hands with soap (66% versus 77% and 85%); a significant difference was also observed in the proportion of households with soap available at handwashing areas (84% versus 90% and 95%), consistent with reported behaviors. No significant difference was noted in the proportion of households testing positive for Escherichia coli in stored household drinking water at second follow-up (39% versus 49% and 34%). Overall, we observed some positive, and no negative changes in cholera- and WaSH-related KAPs after an OCV campaign in Maela refugee camp. OCV campaigns may provide opportunities to reinforce beneficial WaSH-related KAPs for comprehensive cholera prevention and control.
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.|Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Heather M
authors.identifier: 0000-0002-5448-6275
authors.initials: HM
authors.lastname: Scobie
authors.affiliation: Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.|Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Christina R
authors.initials: CR
authors.lastname: Phares
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Wannemuehler
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.|Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Edith
authors.initials: E
authors.lastname: Nyangoma
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.|Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Eboni M
authors.initials: EM
authors.lastname: Taylor
authors.affiliation: Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Anna
authors.initials: A
authors.lastname: Fulton
authors.affiliation: Thailand Ministry of Public Health - U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
authors.forename: Nuttapong
authors.initials: N
authors.lastname: Wongjindanon
authors.affiliation: Première Urgence-Aide Médicale Internationale, Mae Sot, Thailand.
authors.forename: Naw Rody
authors.initials: NR
authors.lastname: Aung
authors.affiliation: Première Urgence-Aide Médicale Internationale, Mae Sot, Thailand.
authors.forename: Phillipe
authors.initials: P
authors.lastname: Travers
authors.affiliation: Global Immunization Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
authors.forename: Kashmira
authors.initials: K
authors.lastname: Date
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D002771:Cholera / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D022121:Cholera Vaccines / Q000008:administration & dosage* / Q000276:immunology; D003430:Cross-Sectional Studies; D060766:Drinking Water / Q000382:microbiology / Q000592:standards; D004926:Escherichia coli / Q000302:isolation & purification; D005191:Family Characteristics; D005260:Female; D063373:Hand Hygiene / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D012036:Refugees; D012423:Rural Health; D012499:Sanitation / Q000592:standards; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
chemical_list: D022121:Cholera Vaccines; D060766:Drinking Water