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Do oral cholera vaccine and water, sanitation, and hygiene combine to provide greater protection against Cholera?: results from a Cluster-Randomized Trial of Oral Cholera Vaccine in Kolkata, India

Oral cholera vaccine (OCV) and incremental improvements in household water, sanitation, and hygiene (WASH) within cholera-endemic areas can reduce cholera risk. However, we lack empiric evaluation of their combined impact.We evaluated a cluster-randomized, placebo-controlled trial of OCV (Shanchol)...

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Main Authors: Im, Justin (Author) , Islam, Md Taufiqul (Author) , Ahmmed, Faisal (Author) , Kim, Deok Ryun (Author) , Tadesse, Birkneh Tilahun (Author) , Kang, Sophie (Author) , Khanam, Farhana (Author) , Chowdhury, Fahima (Author) , Ahmed, Tasnuva (Author) , Firoj, Md Golam (Author) , Aziz, Asma Binte (Author) , Hoque, Masuma (Author) , Jeon, Hyon Jin (Author) , Kanungo, Suman (Author) , Dutta, Shanta (Author) , Zaman, Khalequ (Author) , Khan, Ashraful Islam (Author) , Marks, Florian (Author) , Kim, Jerome H (Author) , Qadri, Firdausi (Author) , Clemens, John D (Author)
Format: Article (Journal)
Language:English
Published: January 2024
In: Open Forum Infectious Diseases
Year: 2024, Volume: 11, Issue: 1, Pages: 1-8
ISSN:2328-8957
DOI:10.1093/ofid/ofad701
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1093/ofid/ofad701
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Author Notes:Justin Im, Md Taufiqul Islam, Faisal Ahmmed, Deok Ryun Kim, Birkneh Tilahun Tadesse, Sophie Kang, Farhana Khanam, Fahima Chowdhury, Tasnuva Ahmed, Md Golam Firoj, Asma Binte Aziz, Masuma Hoque, Hyon Jin Jeon, Suman Kanungo, Shanta Dutta, Khalequ Zaman, Ashraful Islam Khan, Florian Marks, Jerome H Kim, Firdausi Qadri, and John D. Clemens
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Summary:Oral cholera vaccine (OCV) and incremental improvements in household water, sanitation, and hygiene (WASH) within cholera-endemic areas can reduce cholera risk. However, we lack empiric evaluation of their combined impact.We evaluated a cluster-randomized, placebo-controlled trial of OCV (Shanchol) in Kolkata, India. The study population included 108 777 individuals, and 106 879 nonpregnant individuals >1 year of age were eligible to receive 2 doses of OCV or placebo. We measured cholera risk in all household members assigned to OCV vs placebo and in all members of households with “Better” vs “Not Better” WASH, where WASH was classified according to validated criteria. Protection was measured by Cox proportional hazard models.Residence in an OCV household was associated with protective effectiveness (PE) of 54% (95% CI, 42%-64%; P < .001) and was similar regardless of Better (PE, 57%; 95% CI, 26%-75%; P = .002) or Not Better (PE, 53%; 95% CI, 40%-64%; P < .001) household WASH. Better WASH household residence was associated with PE of 30% (95% CI, 5%-48%; P = .023) and was similar in OCV (PE, 24%; 95% CI, −26% to 54%; P = .293) and placebo (PE, 29%; 95% CI, −3% to 51%; P = .069) households. When assessed conjointly, residence in OCV households with Better WASH was associated with the greatest PE against cholera at 69% (95% CI, 49%-81%; P < .001).These findings suggest that the combination of a vaccine policy and improved WASH reduces cholera risk more than either would alone, although the magnitude of either intervention was not affected by the other. Future randomized trials investigating OCV and WASH interventions separately and together are recommended to further understand the interaction between OCV and WASH.
Item Description:Veröffentlicht: 10. Januar 2024
Gesehen am 25.06.2024
Physical Description:Online Resource
ISSN:2328-8957
DOI:10.1093/ofid/ofad701

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