Oral cholera vaccination campaign among the Forcibly Displaced Myanmar Nationals (FDMNs) in Bangladesh and host community to assess the effectiveness

Cholera continues to be a major cause of morbidity and mortality in low-income countries including Bangladesh. It is estimated that over 2.9 million cases and over 95,000 deaths occurs annually in cholera endemic countries alone and frequent epidemics happened in other settings with poor water and sanitation infrastructure. (1) The overall morbidity for cholera remains high. A global stockpile of OCV has been created by WHO in 2013 for epidemic and outbreak settings. (2) The disease is characterized by acute onset of watery diarrhea leading to rapid dehydration and death, if not promptly treated. From August, 2017 Rohingya Myanmar Nationals (RMN) have been influxed to Bangladesh through Cox’s Bazar border of Bangladesh. They are staying at the camps of two different upazilas (Teknaf and Ukhiya) of Cox’s Bazar. According to the latest assessment, more than half (52%) of the total Rakhine state’s population has no access to the improved sanitation facility. Also, around 45% of the population has not access to or is not using improved water supply facility according to the SDG standards.(14) Considering this risk assessment international co-ordination group (ICG) of WHO allocate 900,000 oral cholera vaccines from WHO stockpile to deploy among the RMN.

The prevention of cholera has become a high priority in the global community . Immunization with OCV is the most effective means of preventing cholera infection and its consequence. The World Health Organization (WHO) has warned of a growing risk of a cholera epidemic at the Rohingya camps in Bangladesh where people are sheltered in dire conditions. The camps did not have safe drinking water and lacked sufficient sanitation and hygiene; filthy water and feces flowed openly through the camps. Risk of waterborne diseases is very high, especially there is increasingthe risk of cholera in these camp. Moreover, according to a total number of 782 cases with 11 deaths have been reported in 2016 from Myanmer when the case fatality rate was 1.4%.(9) Interventions like vaccination are being scaled-up as the situation remains critical and challenging. But information related to vaccine effectiveness under this humanitarian condition is lacking

Relevance

The study of Shanchol OCV on Rohingya Myanmar Nationals (RMN) in children and adults will be able to give information regarding the effectiveness of vaccine in RMN subjects. This information will be important for proceeding with the cholera vaccination in the refugee population of same socioeconomic structure in future.

Objectives

The objective of this study is to determine the effectiveness of OCV in a test-negative case control design among Rohingya Myanmar Nationals (RMN) in Bangladesh.

Methods

This study will be conducted in Ukhiya upazila of Cox’s Bazar district. Here we would like to conduct the study through a test-negative case-control design. The participants will be the RMN who will come to the treatment center for seeking management of acute watery diarrhea (AWD). The stool or rectal swab of all participants will be tested. The cholera positive participants will be considered as cases whereas the cholera negative will be considered as control. The vaccine effectiveness will be measured by comparing the ratio of odds of vaccination in the cholera positive patients and odds of vaccination in the cholera negative patients.

Outcome measures/variables

The vaccine effectiveness will be measured by comparing the ratio of odds of vaccination in the cholera positive patients and odds of vaccination in the cholera negative patients.

Cholera continues to be a major cause of morbidity and mortality in low-income countries including Bangladesh. It is estimated that over 2.9 million cases and over 95,000 deaths occurs annually in cholera endemic countries alone and frequent epidemics happened in other settings with poor water and sanitation infrastructure. The overall morbidity for cholera remains high. A global stockpile of OCV has been created by WHO in 2013 for epidemic and outbreak settings. The disease is characterized by acute onset of watery diarrhea leading to rapid dehydration and death, if not promptly treated. From August, 2017 Forcibly Displaced Myanmar Nationals (FDMN) have been influxed to Bangladesh through Cox’s Bazar border of Bangladesh. They are staying at the camps of two different upazilas (Teknaf and Ukhiya) of Cox’s Bazar. According to the latest assessment, more than half (52%) of the total Rakhine state’s population has no access to the improved sanitation facility. Also, around 45% of the population has not access to or is not using improved water supply facility according to the SDG standards. Considering this risk assessment international co-ordination group (ICG) of WHO allocate 900,000 oral cholera vaccines from WHO stockpile to deploy among the FDMN. Therefore the objective of this study is to determine the effectiveness of OCV in a test-negative case control design among Forcibly Displaced Myanmar Nationals (FDMN) in Bangladesh.

“The vaccine effectiveness will be measured by comparing the ratio of odds of vaccination in the cholera positive patients and odds of vaccination in the cholera negative patients.
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