Effect of Oral Cholera Vaccine on the Geographical …regist2.virology-education.com/presentations/2019/2...Effect of Oral Cholera Vaccine on the Geographical Spread of Cholera Epidemic

NIGERIA FIELD EPIDEMIOLOGY AND LABORATORY TRAINING PROGRAMMENIGERIA FIELD EPIDEMIOLOGY AND LABORATORY TRAINING PROGRAMMENIGERIA FIELD EPIDEMIOLOGY AND LABORATORY TRAINING PROGRAMME

Dr. Kumshida Yakubu Balami1, Dr. Muawiyyah Babale Sufiyan2, Dr. Lawi Auta

Mshelia3, Dr. Collins Owili4, Dr. Sulaiman Saidu Bashir2, Dr. Muhammad Shakir

Balogun1, Prof. Kabir Sabitu2, Dr. Patrick Nguku1, Dr. Chikwe Ihekweazu5

1Nigeria Field Epidemiology And Laboratory Training Program

2Department of Community Medicine, Ahmadu Bello University, Zaria

3Borno State Ministry Of Health

4World Health Organisation, Borno State Office

5Nigeria Centre For Disease Control

Effect of Oral Cholera Vaccine on the

Geographical Spread of Cholera Epidemic in

Borno State, North-eastern Nigeria, 2017 - 2018

1


Introduction (1/3)

• Oral Cholera Vaccine (OCV) plays an important role

– prevention and control measure in epidemics

• Cholera is an acute enteric infection

– caused by the bacterium Vibrio cholerae

– epidemics are associated with two serogroups 01 or 0139

• Transmission mainly faecal-oral route

– via ingestion of contaminated food or water 2


Introduction (2/3)

• National Epidemiological bulletin, globally yearly1

– Cholera case-patients: 1.3 - 4.0 million

– Cholera deaths: 2,000 -143,000

– Africa - 55%

– Nigeria - 20.9%

– case fatality rates (CFR): 1.9% - 6.1%

• There has been a resurgence of cholera in Africa since in the

mid-1980s

– > 80% of the world‘s cases occurred in 19993


Introduction (3/3)

• Cholera Epidemic is a global health problem

– internally displaced persons (IDPs)

– complex emergencies

• Insurgency in North-eastern Nigeria

– disrupted social services and displaced thousands

• IDPs camps are overcrowded

– with inadequate water, sanitation and hygiene (WASH)4


Objectives

• Confirm

• Characterise

• Institute control measures

– first ever use of Oral Cholera Vaccine (OCV) in Nigeria

• Determine the effect of OCV on the geographical spread of

the cholera epidemic in Borno State 5


Methods

6


7

Map of Nigeria

Highlighting three (3)

North-eastern States

worst hit by Insurgency


8

Map of

Nigeria

Highlighting

Borno State


Case Definition

• A suspected cholera case is any person ≥ 2years in Borno

State presenting with acute watery diarrhoea with or

without vomiting and severe dehydration or died as a

result, between 16th August, 2017 – 13th January 2019

9


Results

10


First cholera epidemic,16th Aug., - 21st Dec., 2017

11

OCV 1OCV 2


Second cholera epidemic13th Feb., - 16th July 2018

12

0

5

10

15

20

25

30

35

4015

/03

/18

17

/03

/18

19

/03

/18

21

/01

/18

22

/03

/18

23

/4/2

018

24

/4/2

018

26

/02

/18

26

/04

/18

27

/03

/18

28

/03

/18

1/2

/20

18

1/1

8/2

018

1/2

2/2

018

1/2

4/2

018

1/2

6/2

018

1/2

8/2

018

1/3

0/2

018

2/1

/20

18

2/3

/20

18

2/5

/20

18

2/7

/20

18

2/9

/20

18

2/1

1/2

018

2/1

3/2

018

2/1

5/2

018

2/1

7/2

018

2/1

9/2

018

2/2

1/2

018

2/2

3/2

018

2/2

5/2

018

2/2

8/2

018

3/2

/20

18

3/4

/20

18

3/6

/20

18

3/8

/20

18

3/1

0/2

018

3/1

2/2

018

3/1

4/2

018

3/3

0/2

018

4/5

/20

18

4/8

/20

18

4/1

0/2

018

4/1

2/2

018

4/1

5/2

018

4/1

9/2

018

4/2

2/2

018

4/2

4/2

018

4/2

7/2

018

4/2

9/2

018

5/1

/20

18

5/3

/20

18

5/5

/20

18

5/7

/20

18

5/9

/20

18

5/1

1/2

018

5/1

4/2

018

5/1

6/2

018

5/1

8/2

018

5/2

0/2

018

5/2

2/2

018

5/2

4/2

018

5/2

7/2

018

5/3

1/2

018

6/2

/20

18

6/6

/20

18

6/1

4/2

018

6/1

6/2

018

6/1

8/2

018

6/2

0/2

018

6/2

2/2

018

6/2

4/2

018

6/2

6/2

018

6/2

8/2

018

6/3

0/2

018

9/5

/20

18

Nu

mb

er

of

Cases


Third cholera epidemic 5th Sept., 2018 - 13th Jan., 2019

13

0

20

40

60

80

100

120

140

160

180

200

17

-9-1

81

22

/09

/201

8

23

/09

/202

7

24

/8/2

018

26

/8/2

018

28

/8/2

018

3/1

O/2

018

7/3

0/2

018

8/2

/20

18

8/5

/20

18

8/7

/20

18

8/9

/20

18

8/1

1/2

018

8/1

3/2

018

8/1

5/2

018

8/1

7/2

018

8/1

9/2

018

8/2

1/2

018

8/2

3/2

018

8/2

5/2

018

8/2

7/2

018

8/2

9/2

018

8/3

1/2

018

9/2

/20

18

9/4

/20

18

9/6

/20

18

9/8

/20

18

9/1

0/2

018

9/1

2/2

018

9/1

4/2

018

9/1

6/2

018

9/1

8/2

018

9/2

0/2

018

9/2

2/2

018

9/2

4/2

018

9/2

6/2

018

9/2

8/2

018

9/3

0/2

018

10

/2/2

018

10

/4/2

018

10

/6/2

018

10

/8/2

018

10

/10

/201

8

10

/12

/201

8

10

/14

/201

8

10

/16

/201

8

10

/18

/201

8

10

/20

/201

8

10

/22

/201

8

10

/24

/201

8

10

/26

/201

8

10

/28

/201

8

10

/30

/201

8

11

/1/2

018

11

/3/2

018

11

/5/2

018

11

/7/2

018

11

/9/2

018

11

/11

/201

8

11

/13

/201

8

11

/15

/201

8

11

/17

/201

8

11

/19

/201

8

11

/21

/201

8

11

/23

/201

8

11

/25

/201

8

11

/27

/201

8

11

/29

/201

8

12

/1/2

018

12

/3/2

018

(bla

nk)

Nu

mb

er

of

Ca

se

s

Date seen at the Health Facility


OCV Status of third epidemic case-patients

14

OCV Status Number of Cases Percentage

No 6214 99.7%

YES 16 0.3%

YES 1 DOSE 6 38%

YES 2 DOSE 10 63%

Grand Total 6230 100%


15

Distribution of cholera cases

during the first epidemic

August - December 2017


Public Health Action

15


Oral Cholera Vaccination

• The first ever use of Oral Cholera Vaccine (OCV) in Nigeria

• Shanchol Cholera Vaccine was licenced for use

• Using the Polio vaccination structure

– we conducted an OCV campaign in two phases

▪ targeting all people >1yr of age

▪ affected communities

▪ IDP camps 17


• Vaccination coverage of at least 95%

• sensitize 100% of the population in the affected areas

• Intensify active surveillance for cholera

18

Objectives of OCV campaign


OCV Campaign Operations - Strategy

• Door-to-door delivery

– Polio Immunization Structure was engaged

– Vaccinated every person >1yr old with one dose of OCV

– Issued a vaccination card - OCV2 only

– Provided key messages on cholera

• Use of permanent facilities

• Outreach services 19


OCV Outcome

First Dose (Phase)

• OCV doses

– 914,565

• Total Target Population

– 855,492

• Total Number vaccinated

– 896,919

• Coverage rate

– 105%

Second Dose (Phase)

• OCV doses

– 914,565

• Total Target Population

– 896,919

• Total Number vaccinated

– 891,137

• Coverage rate

– 99%

20• Wastage rate - 0.4% No Adverse Event Following Immunisation was reported


21

Map of Borno

State highlighting

Two-dose OCV

campaign in

selected LGAs

and Wards


22

Geographical spread of second epidemic in relation to two-dose OCV areas

Distribution of cholera cases during the

second epidemic February - July 2018


23

Geographical spread of third cholera epidemic in relation to OCV areas

Distribution of cholera cases during the third

epidemic 23rd August 2018 - 13th January 2019


Successes during OCV Implementation

• High demand for the vaccine

• Full participation of the State Polio EOC

– Planning and monitoring

• Daily

– evening review meeting

– call in data

– revisit Plans

– In-process monitoring and household coverage survey

• Post implementation evaluation (coverage survey) 24


Conclusion

• High reactive OCV coverage

• With a two-dose OCV we controlled the protracted cholera

epidemic

• Second epidemic in an entirely different geographical location

• Most of the cases in the third epidemic were in wards not

previously vaccinated with OCV 25


Limitations• Inadequate vaccine cold chain storage system

• Insurgency

– Incomplete and late daily call - in data due to network challenges

– Non – commencement of implementation at the time

– External supervisors unable to access some LGAs

• Broken down Incinerators

• Non use of vaccination cards during the first dose (Phase 1) 25


Recommendations• Borno State Ministry of Health and Partners

– Intensify health promotion and education

– Provide adequate clean water supply

– Provide more cold chain capacity and additional vaccine carrier per team

– Undertake exhaustive repairs of all the broken down incinerators

• Federal Ministry of Health/NPHCDA

– Support Borno State to achieve above recommendations

– Plan for a preventive OCV Campaign

• NFELTP/NCDC

– A timely designed study to determine the vaccine efficacy, effect of OCV on

cholera rapid diagnostic test 26


Acknowledgements

33


[email protected]

34

Thank

you for

your

Attention

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=&url=https://guardian.ng/news/fg-deploys-oral-cholera-vaccine-to-borno-targets-900000-persons/&psig=AOvVaw3d7yQfwAGhouqFM8cjH5xR&ust=1541671094853535

Documents

Effect of Oral Cholera Vaccine on the Geographical …regist2.virology-education.com/presentations/2019/2...Effect of Oral Cholera Vaccine on the Geographical Spread of Cholera Epidemic