Cholera vaccine shortage forces shift to one-dose regimen

The International Coordinating Group (ICG), is made up of members from the World Health Organization (WHO), UN Children’s Fund UNICEF, Médecins Sans Frontières, and the International Federation of Red Cross and Red Crescent Societies.

Unprecedented outbreaks

The switch to a single-dose approach will help conserve stocks, allowing the oral vaccine to combat the potentially fatal waterborne disease in more countries, amid an “unprecedented” rise in outbreaks, said WHO in a press release. 

Since January this year, 29 countries have reported cholera cases, including Haiti, Malawi and Syria which are facing a mounting caseload. In comparison, in the previous five years, fewer than 20 countries on average, reported outbreaks.

“The global trend is moving towards more numerous, more widespread and more severe outbreaks, due to floods, droughts, conflict, population movements and other factors that limit access to clean water and raise the risk of cholera outbreaks”, said the UN health agency.

Proven effectiveness

Although two is optimal, the one-dose strategy has proven to be effective to respond to outbreaks, even though evidence on the exact duration of protection is limited, and protection appears to be much lower in children, said WHO.

Immunity against infection lasts for three years under the two dose regimen, where the second dose is administrated within six months of the first.

“The benefit of supplying one dose still outweighs no doses: although the temporary interruption of the two-dose strategy will lead to a reduction and shortening of immunity, this decision will allow more people to be vaccinated and provide them protection in the near term, should the global cholera situation continue deteriorating”, WHO said.

‘Extremely limited’ supply

The supply of cholera vaccines right now, is extremely limited, said WHO, and has to be coordinated by the ICG which manages the global stockpile.

Of the total 36 million doses forecast to be produced in 2022, 24 million have already been shipped for preventive (17%) and reactive (83%) campaigns, and an additional eight million doses were approved by the ICG for the second round for emergency vaccination in four countries, illustrating the dire shortage of the vaccine.

With vaccine manufactures currently producing at their maximum capacity, there is no short-term solution to increase production, said the agency.

“To ease the problem in the longer term, urgent action is needed to increase global vaccine production”, said WHO.

The ICG will continue to monitor the global epidemiological trends, and will review this decision regularly.

UNHCR, the UN Refugee Agency, is concerned over a cholera outbreak in the Minawao refugee camp in Cameroon's Far North Region. Three people have died, and 39 cases have been identified in the camp.

Refugees in Cameroon succumb to cholera: UNHCR

The UN refugee agency, UNHCR, said on the Wednesday that it was deeply saddened by the death of three refugees in Minawao camp, Cameroon, from cholera.

“I present my heartfelt condolences to the bereaved families,” said Olivier Beer, the UNHCR Representative in the country. UNHCR is working with Cameroon's Government, UN agencies and other partners to ensure urgent care for those who have fallen ill and to break the chain of transmission.

To help contain the outbreak, UNHCR and partners are training community relays on identifying and reporting suspected cases, close monitoring of contact cases, as well as disinfecting the homes of suspected cases and public spaces in the camp.

Efforts are also underway to urgently ramp up existing awareness campaigns about cholera and good hygiene practices in the camp.

A first cholera alert was issued by UNHCR’s partner for health in Minawao, the International Medical Corps, IMC, after a rapid diagnostic test on samples collected from a patient, came back positive on 15 October.

As of 18 October, 24 out of 39 patients were receiving treatment at health facilities in Minawao. According to medical staff handling the cases, the patients are in serious but stable condition. Twelve people have recovered and returned home.