Expert group reconsiders cholera vaccine for Haiti

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Dec 20, 2010 (CIDRAP News) – An expert group convened by the Pan American Health Organization (PAHO) at its headquarters in Washington, DC, on Dec 17 discussed a possible cholera vaccine for Haiti and suggested developing a global vaccine stockpile.

The cholera vaccine has not been an element of the outbreak response, because supplies were thought to be limited, patients need two doses, and vaccine supplies require refrigeration Experts also feared a vaccine campaign would slow disease treatment efforts. However, PAHO officials recently learned that companies may have more vaccine available than originally thought.

Vaccine company officials told PAHO that about 100,000 doses of cholera vaccine are ready for shipment and that 200,000 more could be produced over the next 3 months. They projected that 1 million doses could be available by the second half of 2011.

Dr Jon Andrus, PAHO's deputy director, said despite the expectation that cholera vaccine supply will grow relatively quickly, it's unrealistic to expect there will be enough for everyone in the outbreak region to receive it. "While the increased availability of a vaccine is certainly good news, it should be recognized that over 10 million people live in Haiti and over 10 million live in the Dominican Republic."

However, he said vaccine could play a role in long-term response effort, now that the disease has a foothold in the country and is expected to cause disease for years to come. "As we go along and new opportunities arise, it behooves us to consider [vaccines] if they can help us save more lives," he said.

In the meanwhile, the group suggested a pilot project for Haiti that would use current vaccine supplies and provide early lessons about how to introduce cholera vaccine in outbreak and natural disaster settings.

Dr Roger Glass, who participated in the meeting and is director of the National Institutes of Health Fogarty International Center, said in the statement that global health officials should use the limited supply of vaccine that is available, while balancing the longer term goal of ensuring that there is enough cholera vaccine to respond in Haiti, the Americas, and the rest of the world.

Participants at the conference said Haiti's cholera outbreak demonstrates a need for an international vaccine stockpile, which they said would help guarantee supplies. Dr Ciro de Quadros, chairman of the meeting and executive vice-president of the Sabin Institute in Washington, DC, said the group asked PAHO to connect with suppliers to see how much can be produced and with organizations that might be able to finance vaccine purchases.

In other developments, the United Nations Office for the Coordination of Human Affairs (UN OCHA) said in a Dec 17 update that Haiti's health ministry has reported 58,190 hospitalizations and 2,535 deaths. Two departments, Artibonite and West, have reported an increase in cases. Both areas are lacking sufficient water, sanitation, and hygiene outbreak response workers.

The case-fatality rate in rural areas is trending much higher than in Port-au-Prince, where people have better access to medical facilities. The UN said a more urgent focus is needed on rural areas in Grand Anse, Nippes, North, and Northeast departments, which are home to many rural people.

Health responders are bracing for further deterioration in Haiti's security situation in upcoming days when final results in the first round of the presidential elections are announced.

Dec 17 PAHO press release
Dec 17 UN OCHA report

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