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Cholera vaccinations

Nicole Scherschun / jlw
August 13, 2012

A cholera epidemic first broke out in the West African country of Guinea in February. In order to contain the spread of the disease, aid organization "Doctors Without Borders" is leading a major vaccination campaign.

Men, women and children waiting in line for cholera vaccinations (photo: David Di Lorenzo/MSF)
Image: David Di Lorenzo/MSF

"Doctors Without Borders" project head Charles Gaudry starts his day at 5 in the morning. He is in charge of coordinating Guinea's inoculation campaign against cholera. Members of the 10 teams are up early, too. They load the vaccines and take them to the town where they'll be giving the potentially life-saving vaccine.

This, the largest immunization program of any African country, is being conducted in collaboration with the Guinean Ministery of Health mainly in the Boffa region, northwest of the capital Conakry.

"We have 30 teams going around who do an average of 1,000 people per day," said Gaudry. "That's up to 30,000 people being vaccinated per day."

For Doctors Without Borders, this is a type of pilot project to see if a large-scale vaccination campaign can effectively curb cholera in the worst-affected areas, said Gaudry. In order to get a conclusive evaluation, surveys and data need to be evaluated - Doctors Without Borders will track and monitor the long-term epidemiological development. The results will then be analyzed to develop a strategy for the containment of future epidemics.

The dangers of dehydration

Cholera is still a very serious infectious disease. It's transmitted by the "Vibrio cholerae" bacterium. One main symptom of infection is extreme diarrhea.

Vibrio cholerae bacteria (photo:
Cholera is spread by the "Vibrio cholerae" bacterial strainImage: picture-alliance/OKAPIA KG Germany/Dr.Gary Gaugler/OKAPIA

"Cholera can be very dangerous," Professor Klaus Stark from the Robert Koch Institute in Berlin told DW. "Especially people with a weak nutritional and immune status are rather susceptible, and can develop severe symptoms when infected. They can die in a relatively short amount of time if appropriate care is not received quickly."

Those infected with cholera need plenty of fluids and electrolytes immediately after the onset of the virus, because the body loses large amounts of water. "For some people that can be 10 to 20 liters a day," said Dr. Sebastian Dietrich from Doctors Without Borders in Berlin. "The time from infection until the first signs show is quite short, it may be a couple of hours, or at most a few days, then everything goes very fast: massive amounts of diarrhea, sometimes vomiting and in the end, the diarrhea only consists of water."

Poor hygiene and contaminated water

Cholera is extremely contagious, and is mainly transmitted through contaminated water. Areas with poor sanitation, where there is no reliable supply of water pose high risks. "That means, people getting water from ponds or lakes, and often wells can become infected," Dietrich said.

A woman takes the oral vaccine. (photo: David Di Lorenzo/MSF)
The oral vaccine is administered in two dosesImage: David Di Lorenzo/MSF

But there are other means of transmission as well. "When someone is infected with cholera and they shake someone's hand, and then they go and prepare food, the disease can be transmitted that way," Dietrich said. Lack of hygiene particularly affects some countries in Asia and Africa, as well as conflict zones. Refugee camps often struggle with cholera epidemics, and regions that have been hit by an earthquake - for instance Haiti - are prone to outbreaks as well.

Cholera outbreak infografic (photo: DW)

Vaccination to contain the epidemic

Approximately 143,000 in the Boffa and Forecariah regions of Guinea were vaccinated in April and May. Inoculations are administered orally and swallowed with plenty of water, so the drug is well absorbed and tolerated by the human body. It is pivotal people follow up with a booster, or second vaccination, funded by Doctors Without Borders, in order to ensure sufficient protection.

"In the large studies, effectiveness was shown to be between 60 and 80 percent," Stark said. Mass vaccinations, like those in Guinea, have to be carried out immediately in key outbreak areas to contain the disease from spreading. Teams are also put to task, disinfecting the homes of cholera-infected people. They look for the root causes of the outbreak, contaminated water sources, for example, and provide clean water. They explain protection methods against the disease, and distribute packages of toiletries.

Volunteer helping administer vaccines (photo: David Di Lorenzo/MSF)
Volunteers help with handing out vaccinesImage: David Di Lorenzo/MSF

A big call

First though, Guineans need to be encouraged to have the vaccinations. Two days beforehand, said Gaudry, staff are sent to the village. "The teams travel to the area by car, telling villagers with a megaphone that they will be in a particular area in two days time to give inoculations." The vaccination centers are usually set up in central locations, so they are easily accessible. "In the areas where we have vaccinated, which were really the epicenters of the epidemic, the number of infected cases has dropped significantly," commented Gaudry. "These trends are encouraging."

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