Vaccination Against Cholera in Juba Stanislas Rebaudet, Jean Gaudart, Renaud Piarroux
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Vaccination against cholera in Juba Stanislas Rebaudet, Jean Gaudart, Renaud Piarroux To cite this version: Stanislas Rebaudet, Jean Gaudart, Renaud Piarroux. Vaccination against cholera in Juba. The Lancet Infectious Diseases, New York, NY : Elsevier Science ; The Lancet Pub. Group, 2001-, 2017, 15 (5), pp.479-480. 10.1016/S1473-3099(17)30189-5. hal-01527527 HAL Id: hal-01527527 https://hal-amu.archives-ouvertes.fr/hal-01527527 Submitted on 24 May 2017 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Distributed under a Creative Commons Attribution - NonCommercial - NoDerivatives| 4.0 International License Correspondence promoted, at least partly, by fluoro- are not directly modelled, despite Disease Epidemiology, and NIHR Imperial Health quinolone resistance itself. But symptoms of C difficile infection being Protection Research Unit on Healthcare Associated Infection and Antimicrobial Resistance, Imperial why community transmission a key determinant of transmission College, London, UK (XD); and Department of 4 of fluoroquinolone-susceptible (in contrast with those of MRSA). Microbiology, Leeds General Infirmary, Leeds strains should be more efficient Instead, the model assumes one in ten Teaching Hospitals NHS Trust, Leeds, UK (MHW) is unclear, particularly since most colonisations result in symptomatic 1 Dingle KE, Didelot X, Quan TP, et al. Effects of control interventions on Clostridium difficile fluoroquinolone use in our study infections; these would be treated, and infection in England: an observational study. was in the community. Additionally, most fluoroquinolone-susceptible and Lancet Infect Dis 2017; 17: 411–21. if fluoroquinolone resistance itself fluoroquinolone-resistant isolates are 2 Eyre DW, Walker AS, Griffiths D, et al. Clostridium difficile mixed infection and confers hospital adaptation, reduction equally susceptible to first-line therapy reinfection. J Clin Microbiol 2012; 50: 142–44. of its use would be expected to for C difficile infection (metronidazole 3 Loo VG, Bourgault A-M, Poirier L, et al. Host reduce hospital adaptation; this is not or vancomycin), giving no advantage and pathogen factors for Clostridium difficile infection and colonization. N Engl J Med 2011; considered in the model. to either. 365: 1693–703. The second assumption is The authors raise an intriguing 4 Mawer DP, Eyre DW, Griffiths D, et al. Contribution to Clostridium difficile com petition between fluoro- question that merits careful transmission of symptomatic patients with quinolone-resistant and fluoro- consideration across a range of health- toxigenic strains who are fecal toxin negative. quinolone-susceptible C difficile (ie, care-associated infections. We would Clin Infect Dis 2017; published online Feb 3. DOI:10.1093/cid/cix079. infection by one precludes infection welcome the opportunity to work 5 Valiquette L, Cossette B, Garant M-P, Diab H, by the other). This is required for the with them to explore the performance Pepin J. Impact of a reduction in the use of high-risk antibiotics on the course of an incidence of susceptible strains to of their model under realistic epidemic of Clostridium difficile-associated remain unchanged despite hospital assumptions for C difficile, particularly disease caused by the hypervirulent NAP1/027 infection control interventions. to explore why stewardship inter- strain. Clin Infect Dis 2007; 45 (suppl 2): S112–21. However, as acknowledged by van Kleef ventions could achieve C difficile and colleagues, this assumption is a control despite previous multifactorial simplification; rates of C difficile infection hospital infection control measures Vaccination against with multiple genotypes are about not doing so,5 and why reductions cholera in Juba 7%.2 Third, the model’s parameters in C difficile infection have not produce implausibly high C difficile occurred in the USA and Canada, In an interesting Personal View, Lucy prevalence (>20% in the hospital, and despite similar hospital infection Parker and colleagues1 reported the 10% in the community), contradicting control interventions but without difficulties regarding implementation empirical observations (typically fluoroquinolone restriction. of a reactive oral cholera vaccination ≤10% in the hospital and about 4% in MHW reports grants and personal fees from (OCV) campaign during the 2015 the community).3 Both assumptions Actelion, Cubist, Astellas, Optimer, Sanofi-Pasteur, cholera epidemic in Juba, South exaggerate competition in the model. Summit, Biomerieux, and Qiagen during the Sudan.1 They support the choice to conduct of the study; personal fees from Merck, Fourth, the model assumes that Seres, Valneva, and Alere, and grants from address the global shortage of vaccines bacteria are transmitted in hospitals Da Volterra during the conduct of the study; grants by providing just one dose to twice exclusively via health-care workers. and personal fees from Cerexa, Abbott, and the the number of people. However, the European Tissue Symposium outside the submitted Although patient-to-patient trans- work; and personal fees from Astra Zeneca, Pfizer, epidemic curve provided by Parker mission is modelled in the community, Durata, Nabriva, Roche, The Medicine Company, and and colleagues suggests that the it is not modelled within hospitals and Basilea outside the submitted work. All other South Sudan epidemic was not hugely authors declare no competing interests. Funding no contribution from the environment acknowledgements are listed in the original article. affected by this campaign. Indeed, or other reservoirs is allowed. This The views expressed in this response are those of the the basic reproductive number (R0), substantially amplifies the effect of any authors and not necessarily those of the funders. which we calculated as previously health-care worker intervention. David W Eyre, *Kate E Dingle, described2 using data extracted from Fifth, the model considers only Xavier Didelot, T Phuong Quan, this curve with the Plot Digitizer tool asymptomatic colonisation, which is Timothy E A Peto, Mark H Wilcox, and R software, using the R0 package, never treated, so the mean 200-day A Sarah Walker, Derrick W Crook was not reduced after the campaign carriage duration of resistant bacteria, [email protected] was finally launched on July 31, 2015; regardless of location, might be Nuffield Department of Clinical Medicine, Oxford the R0 was already less than 1 between reasonable. However, for reasons that University, Oxford, UK (DWE, KED, TPQ, TEAP, the first peak on June 28 and the start are unclear, susceptible bacteria are ASW, DWC); NIHR Health Protection Unit in of the OCV campaign (0·94 [95% CI Healthcare Associated Infections and Antimicrobial assumed to be lost 3·3 times faster than Resistance, University of Oxford (in partnership 0·92–0·95]), only 0·72 (0·66–0·78) resistant bacteria in hospitals, but at the with Public Health England), Oxford, UK (KED, TPQ, between the second peak on July 19 same rate in the community. Infections TEAP, ASW, DWC); Department of Infectious and the start of OCV, and still 0·92 www.thelancet.com/infection Vol 17 May 2017 479 Correspondence (0·90–0·94) from the start of OCV *Stanislas Rebaudet, Jean Gaudart, this rough method provides similar until the last confirmed case on Renaud Piarroux estimates of vaccine effectiveness to Sept 12, 2015. [email protected] the 87% that we observed in our study Several complementary factors Assistance Publique–Hôpitaux de Marseille, Hôpital (appendix). might explain such a disappointing de la Timone, 13385 Marseille cedex 05, France Rebaudet and colleagues suggest (SR, JG, RP); Aix-Marseille University, IRD, INSERM, effect. First, vaccine effectiveness of SESSTIM, Marseille, France (JG); and Aix-Marseille that adaptations to water sanitation this one-dose campaign could have University, UMR MD3, Marseille, France and hygiene (WaSH) behaviour been lower than the 87·3% (95% CI 1 Parker LA, Rumunu J, Jamet C, et al. Adapting probably reduced cholera transmission, 70·2 – 100) calculated in a case-cohort to the global shortage of cholera vaccines: but provide no evidence, and we are targeted single dose cholera vaccine in observational study by the same response to an outbreak in South Sudan. not aware of any data supporting group of authors.3 Efficacy of one- Lancet Infect Dis 2017; 17: e123–27. this statement. We believe that the dose OCV was estimated to be about 2 Azman AS, Rumunu J, Abubakar A, et al. ultimate solution to cholera control Population-level effect of cholera vaccine on 40% (95% CI 11–60) in a double-blind displaced populations, South Sudan, 2014. is universal access to (and use of) placebo-controlled clinical trial.4 Using Emerg Infect Dis 2016; 22: 1067–70. safe water, sanitation, and hygiene. 5 3 Azman AS, Parker LA, Rumunu J, et al. the WHO screening method with Effectiveness of one dose of oral cholera The WaSH interventions used during provided data, we calculated that vaccine in response to an outbreak: a this outbreak primarily consisted of 36% of cholera cases were expected case-cohort study. Lancet Glob Health 2016; distribution of point-of-use water 4: e856–63. to occur in vaccinated individuals 4 Qadri F, Wierzba TF, Ali M, et al. Efficacy of a disinfectant and hygiene promotion, in Juba. The observed proportion single-dose, inactivated oral cholera vaccine which, although justified during an 3 in Bangladesh. N Engl J Med 2016; was only 6%, which suggests biases 374: 1723–32. emergency, are very different from that the authors could not address 5 Orenstein WA, Bernier RH, Dondero TJ, et al. making real gains towards universal despite their efforts to do so. Second, Field evaluation of vaccine efficacy.