image: Targeting vaccine and other interventions to those in the vicinity of people with cholera could be an effective way to control cholera outbreaks. view more
Credit: CDC Global, Flickr
Targeting vaccine and other interventions to those in the vicinity of people with cholera could be an effective way to control cholera outbreaks, which can have devastating effects after disasters and in other emergency settings, according to a research study by Flavio Finger, of the École Polytechnique Fédérale Lausanne, Lausanne, Switzerland and Andrew Azman, of the Johns Hopkins Bloomberg School of Public Health, Baltimore, USA and colleagues, published in PLOS Medicine.
Basing their study on a cholera outbreak in Chad in 2011, Finger, Azman and colleagues modelled the effects of different case-area targeted interventions--including oral cholera vaccine, prophylactic antibiotic administration, and water treatment--on simulated cholera epidemics. The results indicate that cholera vaccine is expected to be the most effective intervention, with 70-100 metres being the optimum radius around existing cholera cases for vaccine administration. Azman and colleagues estimate that targeted cholera vaccine could reduce the number of cholera cases by 81% as compared with an uncontrolled epidemic, and shorten an epidemic by 68%. Targeted campaigns are also expected to require much smaller quantities of vaccine and other interventions as compared with mass campaigns aiming to protect whole populations.
Regardless of whether vaccine, antibiotics or water treatment are used individually or in combinations, targeting interventions to areas around cases may provide a critical solution for stopping cholera outbreaks from expanding, and, where outbreaks have already grown into large-scale epidemics, targeted interventions may bring them to a quicker end. Further research will now be needed to test the predictions in actual disease outbreaks.
In an accompanying Perspective article discussing the research, Lorenz von Seidlein and Jacqueline Deen emphasize the importance of prompt action to achieve control of cholera outbreaks in emergency situations.
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Research Article
Funding:
FF, EB and AR acknowledge the support from the Swiss National Science Foundation (SNSF) through the project "Dynamics and controls of large-scale cholera outbreaks" (CR23I2 138104). FF also acknowledges support through the SNSF Early Postdoc Mobility Fellowship P2ELP3_175079. ASA and JL were funded through grants from The Bill and Melinda Gates Foundation (OPP1171700 to both and OPP1053556 to ASA). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests:
I have read the journal's policy and the authors of this manuscript have the following competing interests: JL is a paid statistical advisor for PLOS Medicine.
Citation:
Finger F, Bertuzzo E, Luquero FJ, Naibei N, Touré B, Allan M, et al. (2018) The potential impact of case-area targeted interventions in response to cholera outbreaks: A modeling study. PLoS Med 15(2): e1002509. https://doi.org/10.1371/journal.pmed.1002509
Author Affiliations:
Laboratory of Ecohydrology, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
Dipartimento di Scienze Ambientali, Informatica e Statistica, Università Ca' Foscari Venezia, Venice, Italy
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
Epicentre, Paris, France
Communauté des Amis de l'Informatique pour le Développement-Tchad, N'Djamena, Chad
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
Dipartimento di Ingegneria Civile, Edile ed Ambientale, Università di Padova, Padova, Italy
In your coverage please use this URL to provide access to the freely available paper:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002509
Perspective
Funding:
The authors received no specific funding for this work.
Competing Interests:
I have read the journal's policy and the authors of this manuscript have the following competing interests: LvS receives a stipend as a specialty consulting editor for PLOS Medicine and serves on the journal's editorial board. The authors declare no other competing interests exist.
Citation:
von Seidlein L, Deen JL (2018) Preventing cholera outbreaks through early targeted interventions. PLoS Med 15(2): e1002510. https://doi.org/10.1371/journal.pmed.1002510
Author Affiliations:
Mahidol-Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Institute of Child Health and Human Development, National Institutes of Health, University of the Philippines, Manila, Philippines
In your coverage please use this URL to provide access to the freely available paper:
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002510
Journal
PLoS Medicine