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Letter to the Editor Questioning the Effectiveness of Oral Cholera Vaccine in Port-au-Prince Slums

Abstract : Oral cholera vaccination (OCV) has been validated by the World Health Organization (WHO) as a valuable tool to complement water, sanitation, and hygiene (WASH) activities in cholera prevention for high-risk areas and populations. We read with great interest the recent study published by Sévère and others, which evaluated the effectiveness of a mass OCV campaign targeting approximately 70,000 inhabitants in several slums of Port-au-Prince, Haiti, between April and June 2012. The authors reported a 75% vaccine coverage and, using a cohort design, a striking 97.5% vaccine effectiveness in the 37 months postvaccination, whereas controlled clinical trials have measured OCV vaccine efficacy around 57% [95% confidence interval, 44–67%] during the first 2 years. Although it was expected that 56% of cholera cases would occur among vaccinated individuals according to the WHO screening method, the same proportion was 5% in the Sévère and others cohort. A thorough analysis of this study shows that the authors did not evaluate the isolated effectiveness of OCV. They rather estimated its combined effectiveness together with WASH-associated measures. To assess the importance of such methodological bias, we computed provided data using a bias-indicator cohort analysis, as previously described in another OCV campaign, and found that their strategy exhibited a 95% effectiveness [93–97%] against noncholeric diarrheas as well. Pondering such bias would require adjusting the results on the observance of WASH prevention methods, which may have differed between nonvaccinated and vaccinated groups.
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Submitted on : Monday, September 19, 2016 - 5:33:44 PM
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Stanilas Rebaudet, Jean Gaudart, Aaron Aruna Abedi, Renaud Piarroux. Letter to the Editor Questioning the Effectiveness of Oral Cholera Vaccine in Port-au-Prince Slums. American Journal of Tropical Medicine and Hygiene, American Society of Tropical Medicine and Hygiene, 2016, 95 (2), pp.4932-494. ⟨10.4269/ajtmh.16-0314a⟩. ⟨hal-01368624⟩

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