Virtual Doctors Forums
Outbreak in Lusaka, Zambia-see attached
That is a sad notice. Currently I have seen 7 patient with a diagnosis of G/E in one night today. This mayb as a result of luck of hygiene. Though in summer, Zambia get to be worm and that’s the kind of weather bacteria will tend to grow and spread well especially Food left uncovered will attract flies.
Usually here I see more than 20 cases of G/E daily.
Jonathan I saw this article and thought it was very interesting. I don’t know if you are able to get these kOCVs but this meta-analysis suggests in an outbreak they can be very useful to give short term protection.
If you want to see the whole article I’ll see if I can get it onto the forum
Are killed whole-cell oral cholera vaccines effective for cholera?
10 Oct 2017
The Lancet Infectious Diseases
UK Medical News
Meta-analysis backs the potential of inactivated oral cholera vaccines
Oral cholera vaccine is effective, trial shows
Global Clinical Summaries from Am J Infect Control
Varicella vaccine: meta-analysis confirms efficacy of 2-dose strategy in healthy children
Global Clinical Summaries from Lancet Infect Dis
Influenza vaccine effectiveness varies by subtype: meta-analysis
Killed whole-cell oral cholera vaccines (kOCVs) are becoming a standard cholera control and prevention tool. However, vaccine efficacy and direct effectiveness estimates have varied, with differences in study design, location, follow-up duration, and vaccine composition posing challenges for public health decision making. We did a systematic review and meta-analysis to generate average estimates of kOCV efficacy and direct effectiveness from the available literature.
For this systematic review and meta-analysis, we searched PubMed, Embase, Scopus, and the Cochrane Review Library on July 9, 2016, and ISI Web of Science on July 11, 2016, for randomised controlled trials and observational studies that reported estimates of direct protection against medically attended confirmed cholera conferred by kOCVs. We included studies published on any date in English, Spanish, French, or Chinese. We extracted from the published reports the primary efficacy and effectiveness estimates from each study and also estimates according to number of vaccine doses, duration, and age group. The main study outcome was average efficacy and direct effectiveness of two kOCV doses, which we estimated with random-effect models. This study is registered with PROSPERO, number CRD42016048232.
Seven trials (with 695 patients with cholera) and six observational studies (217 patients with cholera) met the inclusion criteria, with an average two-dose efficacy of 58% (95% CI 42–69, I²=58%) and effectiveness of 76% (62–85, I²=0). Average two-dose efficacy in children younger than 5 years (30% [95% CI 15–42], I²=0%) was lower than in those 5 years or older (64% [58–70], I²=0%; p<0·0001). Two-dose efficacy estimates of kOCV were similar during the first 2 years after vaccination, with estimates of 56% (95% CI 42–66, I²=45%) in the first year and 59% (49–67, I²=0) in the second year. The efficacy reduced to 39% (13 to 57, I²=48%) in the third year, and 26% (–46 to 63, I²=74%) in the fourth year.
Two kOCV doses provide protection against cholera for at least 3 years. One kOCV dose provides at least short-term protection, which has important implications for outbreak management. kOCVs are effective tools for cholera control.
The Bill & Melinda Gates Foundation.
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Bi Q, Ferreras E, Pezzoli L, et al. Protection against cholera from killed whole-cell oral cholera vaccines: a systematic review and meta-analysis. Lancet Infect Dis 2017; 17: 1080–88. doi:10.1016/S1473-3099(17) 30359-6.
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