Dukoral Cholera Vaccine

WHO - Multi-country outbreak of cholera, External situation report #20 - 20 November 2024

Oral cholera vaccines (OCV) have been used for years to help prevent and control cholera outbreaks. Unfortunately, with limited supply, cholera cases and related deaths are impacting about 33 countries.

According to the World Health Organization (WHO) Edition #20, from January to late October 2024, a cumulative total of 486,760 cholera and acute watery diarrhea cases and 4,018 deaths were reported from 33 countries across five WHO regions.

While the number of cases reported in October 2024 was 42% lower than the same period in 2023, the number of deaths increased by 54%, reflecting severe response challenges in outbreak settings.

Cross-border dynamics have made cholera outbreaks increasingly complex.

For example, active cholera transmission is widespread in Haiti but is rare in visitors.

In the U.S., nearly all cholera infections are acquired during international travel. As of November 20224, week #45, six cholera cases were reported to the CDC this year. In 2023, there were 17 cases.

Since the last WHO report, new cholera outbreaks have been reported in Iraq (571 cases and one death), Lebanon (one case with no death), and South Sudan (49 cases and one death).

The WHO did report some very positive news on November 20, 2024.

In November, record production of Oral Cholera Vaccines (OCV) was achieved, the highest since 2013, driven by new formulations and production methods introduced and prequalified this year. As of late November 2024, the WHO has prequalified Dukoral®, Shanchol™, Euvichol®, and Euvichol-S vaccines.

Despite this progress, the OCV emergency stockpile averaged less than 600,000 doses in October 2024, far below the target of five million doses needed for an effective outbreak response at all times.

This persistent shortage continues to hinder efforts to control cholera outbreaks and respond promptly to the spread of the disease, says the WHO.

In partnership with the Global Task Force on Cholera Control, the U.S. CDC supports the implementation of the OCV component of Ending Cholera, A Global Roadmap to 2030.

Sub Title:

Cholera vaccine supply improves in 2024

References:

Roadmap 2030 A global strategy to reduce cholera deaths

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WHO Cholera Report #20 2024

Global Cholera Vaccine Stockpile is Depleted

Karen McClorey Hackett — Sat, 19 Oct 2024 17:29:04 +0000

Reviewer:

Multi-country outbreak of cholera, External situation report #19 - 18 October 2024

According to the World Health Organization (WHO), the global Oral Cholera Vaccine (OCV) stockpile is depleted, and no doses are available.

The WHO's External Situation Report #19 says this shortage poses significant challenges to Cholera outbreak response efforts for the rest of 2024 and early 2025.

This news is concerning since around 1.3 billion people are at risk of cholera worldwide.

The International Coordinating Group (ICG) for OCVs was created in 1997 to manage the global stockpile. Since its establishment, the WHO, UNICEF, and Médecins sans Frontières have facilitated about 73 million doses of OCV for 23 countries.

As of October 14, 2024, the ICG dashboard indicates the global production capacity for this year is 37-50 million doses, with about 26 million approved for distribution.

Over the past month, the ICG received six requests for OCV from five countries: Bangladesh, Sudan, Niger, Ethiopia, and Myanmar. Due to limited vaccine availability, only 7.6 million doses could be shipped to these countries.

Recently, the Republic of Nigeria received about 900,000 OCV doses.

The WHO wrote on October 18, 2024, 'The shortfall in supply highlights the ongoing challenges in meeting global demand, especially as cholera outbreaks continue to rise across multiple regions. Efforts to scale production are underway, but immediate vaccine access remains constrained.'

"According to a Global Task Force on Cholera Control, the true impact of cholera is underestimated. Although global reports indicate between 100,000 and 1.2 million cases annually in the past two decades, cholera's prevalence is likely much higher due to gaps in surveillance, social stigma, and concerns about economic repercussions," said Duellyn Pandis, DNP, APRN, FNP-C.

"Currently, the changing climate elevates the risk of its spread to new regions," added Pandis, President & CEO of Passport Health of Tampa Bay.

OCVs such as Dukoral and Euvichol-Plus/Euvichol have been approved by the WHO, but they are unavailable in the U.S.

Cholera is spread through water and food contaminated with cholera bacteria. It can cause life-threatening watery diarrhea and vomiting.

During 2024, a cumulative total of 439,724 cholera cases and 3,432 deaths were reported globally across five WHO regions. The 126% spike in deaths is deeply concerning, says the WHO.

In the United States, the single-dose Vaxchora is the only OCV approved for use by people ages 2 to 64 who are traveling to an area where cholera is present.

The U.S. CDC recommends future travelers to cholera-endemic areas speak with a vaccine expert about immunization options at least ten days before traveling abroad.

As of late October 2024, travel vaccine clinics and pharmacies in the U.S. generally have OCVs available.

Note: This article was updated in December 2024 to correct a typo.

Sub Title:

Cholera vaccines are available in the United States

References:

International Coordinating Group on Vaccine Provision

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International Coordinating Group OCV dashboard October 18, 2024

Cholera Pandemic Continues With Constrained Vaccine Supply

Karen McClorey Hackett — Wed, 18 Sep 2024 10:36:30 +0000

Reviewer:

GAVI - Forgotten pandemic: The cholera emergency in five charts

Since the 7th cholera pandemic began in Asia in 1961, about 45 countries have reported outbreaks this year. Unfortunately, this multi-decade pandemic is being contested without an ample supply of vaccines.

According to recent data from the World Health Organization (WHO), the number of cholera cases in 2024 may surpass the peak recorded five years ago. This projection is based on 2023 data showing a 13% increase in reported cholera cases compared to 2022.

On September 13, 2024, Linda Geddes from GAVI reported that not only had the number of countries affected by cholera outbreaks increased, but also the number experiencing large outbreaks. Nine countries reported 10,000 or more cases: Afghanistan, Bangladesh, the Democratic Republic of the Congo, Ethiopia, Haiti, Malawi, Mozambique, Somalia, and Zimbabwe.

Fortunately, most cholera cases reported in the United States are acquired during international travel. As of August 17, 2024, just six cholera cases were reported this year. In 2023, there were 10 cases.

Although oral cholera vaccine (OCV) supplies have been strained, a record 35 million doses were shipped to 12 countries in 2023.

To appropriately manage access to the limited OCV supply, the International Coordinating Group for OCVs was created in 1997. As of May 2024, the global vaccine production capacity is forecast to be 37-50 million doses, short of demand.

Since January 2023, 18 countries have requested 105 million OCV doses, nearly double the 55 million doses produced in that period.

The WHO says all OCVs require two doses to ensure protection for up to three years.

However, to streak the limited supply, GAVI says that during the current outbreak, only one OCV dose protocol has been implemented in reactive vaccination campaigns.

The WHO has recommended another OCV to address this global shortage. Euvichol-S is expected to be on the market at the end of 2024.

Currently, approved OCVs such as Dukoral® have increased production to alleviate the global inventory shortage.

Valneva SE’s global manufacturing network includes three in-house operations for the internal and external production of clinical and commercial products. In 2024, Valneva’s new manufacturing site in Sweden underwent regulatory evaluation and approval.

As of September 17, 2024, the Bavarian Nordic Vaxchora® single-dose vaccine is available in the U.S. and Canada.

Vaxchora (CVD 103-HgR) is indicated for active immunization against disease caused by Vibrio cholerae serogroup O1 in adults 18 through 64 years of age traveling to an active cholera-affected area.

In the U.S., Vaxchora is available in 2024 at specific travel clinics and pharmacies, such as Passport Health-Tampa.

Sub Title:

Cholera is a vaccine preventable disease in 2024

References:

International Coordinating Group on Vaccine Provision

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GAVI - WHO Cholera data trends

Cholera Deaths Increased 71%

Karen McClorey Hackett — Thu, 05 Sep 2024 16:04:47 +0000

Reviewer:

In its newly published report, the World Health Organization (WHO) has revealed a significant increase in global cholera outbreaks.

The WHO stated on September 4, 2024, that the number of reported cholera cases has risen by 13%, and fatalities have increased by 71% in 2023 compared to 2022.

Unfortunately, over 4,000 individuals succumbed to this vaccine-preventable and 38% of the reported cases affected children under the age of five last year.

Globally, cholera cases were reported in 45 countries, up from 35 in 2021.

The geographical distribution of cholera changed significantly, with a 32% decrease in cases reported from the Middle East and Asia and a 125% increase in Africa.

Afghanistan, the Democratic Republic of the Congo, Malawi, and Somalia reported large outbreaks of over 10,000 suspected or confirmed cases, with Ethiopia, Haiti, Mozambique, and Zimbabwe adding to the tally in 2023.

Currently, the U.S. has not issued a Travel Health Notice regarding the global cholera outbreak. However, the CDC says active cholera transmission is widespread in Haiti.

Fortunately, only six cholera cases have been reported in the United States so far in 2024.

As of Fall 2024, the WHO has prequalified four oral cholera vaccines (OCV).

For example, Valneva SE's DUKORAL® prevents diarrhea caused by Vibrio cholerae and/or heat-labile toxin-producing enterotoxigenic Escherichia coli. DUKORAL contains four inactivated strains of V. cholerae serotype O1 and part of a toxin from one of these strains as active substances.

Despite the low stockpile of OCV, a record 35 million doses were shipped last year, with the one-dose strategy in effect.

The WHO recommends international travelers speak with a vaccine expert one month before visiting a cholera-endemic country this year.

Sub Title:

Cholera vaccines are available in 2024

References:

WHO cholera cases 2024

2023 cholera data

US CDC cholera alert

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WHO Cholera case map September 2024

Can Increasing Cholera Vaccine Supply Save Lives

Donald Hackett — Thu, 18 Apr 2024 18:42:35 +0000

Reviewer:

Multi-country outbreak of cholera, External situation report #13 - 17 April 2024

Many countries are facing devastating outbreaks of cholera in 2024 due to inadequate supplies of oral cholera vaccines (OCV).

The World Health Organization (WHO) has classified the global resurgence of cholera outbreaks as a grade 3 emergency, its highest alert level.

The WHO reported in their multi-country outbreak of cholera, External Situation Report #13, that since the beginning of 2023, and as of March data, there have been a cumulative total of 824,479 cholera cases and approximately 5,900 deaths reported from 31 countries.

Around the same time, in 2023, 62,199 cases and 326 cholera-related deaths were reported from 22 countries.

Over 20% of suspected cholera cases are in young children.

Based on the number of outbreaks and their geographic expansion, alongside the shortage of vaccines and other resources, WHO re-assed the risk at the global level as very high, and the event remains classified as a grade 3 emergency as of April 17, 2024.

"Cholera's true toll often remains obscured by underreporting, masking the full extent of its impact on communities worldwide," stated Duellyn Pandis, DNP, MS, APRN, FNP-C. "Underreporting hampers efforts to allocate resources, implement timely interventions, and prevent the further spread of the disease."

"Cholera vaccines provide a crucial line of defense against the devastating effects of the disease, offering protection to individuals and communities at risk. By stimulating the immune system to recognize and combat the cholera bacterium, vaccines reduce the likelihood of infection and the severity of outbreaks."

"Access to cholera vaccines not only saves lives but also helps prevent the spread of the disease, contributing to healthier populations and stronger public health systems," added Pandis, President & CEO of Passport Health of Tampa Bay.

The WHO recommends cholera vaccination in areas where local transmission of cholera occurs. However, the response in five WHO regions continues to be affected by a critical shortage of OCVs.

Since January 2023, OCV requests have surged, with 79 million doses requested by 14 countries, double the 40 million doses available during this period.

The global stockpile of vaccines was depleted until the beginning of March 2024.

As of April, the stockpile has 2.3 million doses, below the global target of five million.

According to the WHO, there are four OCVs: Vaxchora, Dukoral, ShanChol, and Euvichol-Plus/Euvichol.

On April 17, 2024, EuBiologics and the International Vaccine Institute (IVI) announced that Euvichol-S®, an improved OCV, achieved WHO prequalification. EuBiologics is currently the only OCV supplier to the global stockpile.

Euvichol-S is a new OCV that has improved productivity by about 40% over the existing Euvichol-Plus® by modifying the formulation and manufacturing method of the material.

According to a press release, EuBiologics can now supply three oral cholera vaccines, including Euvichol® (in glass vials) and Euvichol-Plus®.

After the scale-up process, Euvichol-S will be mass-produced in the Republic of Korea.

Dr. Julia Lynch, Director of IVI's Cholera program, stated, "The addition of Euvichol-S to the global health market will contribute to easing the shortage of OCV supply amid a dire global cholera situation."

"IVI will continue efforts to enhance the availability of OCV worldwide and develop new and improved vaccines that are equally safe, effective, and affordable."

The Bill & Melinda Gates Foundation funded the development of Euvichol-S.

The U.S. CDC recommends that adults traveling to areas with active cholera transmission get vaccinated. Over the past two years, the CDC has issued various Travel Health Advisories identifying cholera outbreaks.

Before departing abroad, the CDC suggests discussing vaccination options with a travel vaccine expert in the U.S.

Sub Title:

Euvichol-S oral cholera vaccine developed by EuBiologics and IVI in South Korea

References:

EuBiologics’ simplified OCV achieves WHO PQ

US CDC Travel Health Notices Cholera 2024

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The Democratic Republic of the Congo Disease Outbreaks Continue Deteriorating

Donald Hackett — Fri, 29 Mar 2024 13:44:56 +0000

Reviewer:

UN GENEVA PRESS BRIEFING 22 March 2024

During a recent UN Geneva press briefing, two World Health Organization (WHO) leaders confirmed that the overall health situation in the Democratic Republic of the Congo (DRC) is worsening.

On March 22, 2024, Dr. Boureima Hama Sambo, the WHO Representative to the DRC, and Dr. Rosamund Lewis, the WHO Technical Lead for Mpox, highlighted that the country's challenges have reached alarming levels.

According to the WHO, close to 20 million people will require health assistance in 2024, yet the health response remains severely underfunded.

In addition to civil conflict-related challenges, severe flooding has recently ravaged communities, exacerbating the risk of diarrhoeal and water-borne diseases and compounding the strain on the already fragile health system.

Regarding disease outbreaks, these doctors shared their observations:

DRC is facing its worst cholera outbreak since 2017, with 50,000 suspected cases and 470 deaths recorded in 2023. The risk is exceptionally high in internally displaced people sites where living conditions are dire, with water supply, hygiene, and sanitation services inadequate – conditions that favor the spread of cholera.

DRC is also battling the largest epidemic of measles recorded since 2019, with close to 28,000 cases and 750 deaths so far in 2024. The combination of measles and malnutrition has a severe health impact on children under five years of age, and the lack of access to vaccines and vaccination services further exacerbates the situation.

In addition, the still-emerging mpox outbreak has been rising across the country over the last year. Close to 4,000 suspected cases and 27 deaths have been recorded so far in 2024, which represents a higher case fatality than what was seen during the global outbreak.

Over two-thirds of the mpox cases are reported in children.

There is the geographic expansion to previously unaffected provinces such that almost all provinces, including Kinshasa, are now reporting cases; this also represents a threat of expansion to neighboring countries and beyond.

Since 2023, there has been newly documented sexual transmission of mpox due to the more virulent clade I of the virus, with outbreaks among sex workers and among men who have sex with men.

The WHO supports the health authorities in responding to mpox hotspots in the country and implementing the national mpox response plan, including through integration and collaboration with the national HIV/AIDS control and immunization programs.

Despite all these compounding challenges, WHO continues to support the government and its health partners in responding to this complex crisis.

Seperately, the U.S. CDC has issued various Travel Health Notices for the DRC, alerting international visitors to their polio, measles, and mpox risks.

The CDC recommends several travel vaccinations, such as dengue and yellow fever, before visiting the DRC.

These vaccines are offered at travel clinics and pharmacies in the U.S.

Sub Title:

DRC outbreaks include cholera, measles, mpox, dengue, yellow fever in 2024.

References:

US CDC Democratic Republic of the Congo 2024

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US CDC DRC travel alert March 2024

Cholera Vaccine Shortage Puts Millions of Children At-Risk

Karen McClorey Hackett — Wed, 20 Mar 2024 17:55:15 +0000

Reviewer:

Millions at risk from cholera due to lack of clean water, soap and toilets, and shortage of cholera vaccine

The International Coordinating Group (ICG) on Vaccine Provision has urged the authorities to address the unprecedented increase in cholera cases worldwide.

Today's recommended actions include investing in safe water, sanitation, and hygiene, improving the quality of and access to healthcare, and detecting and responding to outbreaks quickly.

The World Health Organization (WHO) confirmed on March 20, 2024, that the current trends are tragic because cholera is a preventable and treatable disease.

The persistence of cholera is evident as 2024 began, with 40,900 cases and 775 deaths reported (Edition #11) in January from 17 countries across four WHO regions.

Children under the age of five bear the brunt of this disease.

Preliminary data for 2023 reveal that over 700,000 cases were reported, and several of the outbreaks had high case fatality rates, exceeding the 1% threshold used as an indicator for early and adequate treatment of cholera patients.

The WHO has also recommended accelerating the production of oral cholera vaccines (OCVs) to prevent further cases.

Global production capacity in 2024 is forecast to be 37-50 million doses but will likely continue to be inadequate to serve the needs of millions of people directly affected by cholera.

The severe gap in the number of available vaccine doses, compared with the level of current need, puts unprecedented pressure on the global stockpile of vaccines. Between 2021 and 2023, more doses were requested for outbreak response than in the entire previous decade.

In October 2022, the ongoing vaccine shortage necessitated the ICG to recommend a single vaccine dose, down from a previous, long-standing two-dose regimen.

Approximately 36 million doses were produced in 2023, while 14 affected countries registered a need for 72 million doses for a one-dose reactive strategy.

These requests understate the actual need, says the WHO.

Preventive vaccination campaigns have had to be delayed to preserve doses for emergency outbreak control efforts, creating a vicious cycle.

The change in strategy enabled available vaccines to protect more people and respond to more cholera outbreaks amid the ongoing supply shortfall, but a return to a two-dose regimen and a resumption of preventive vaccination would provide more extended protection.

As of March 2024, the WHO has qualified Dukoral®, Shanchol™, and Euvichol® cholera vaccines.

New vaccine manufacturers are not expected to join the market before 2025; they must be fast-tracked, says the WHO.

Sub Title:

International Coordinating Group on Vaccine Provision calls for urgent fast-tracking of cholera vaccine production

References:

Multi-country outbreak of cholera, External situation report #11 - 12 February 2024

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by Ulrike Mai

Cholera Outbreaks Continue Without Ample Vaccine Supply

Donald Hackett — Mon, 25 Sep 2023 19:06:28 +0000

Reviewer:

ECDC - Cholera vaccines 2023

As September 2023 comes to a close, twenty-four countries are currently reporting active outbreaks. New data show over 472,000 cholera cases were reported in 2022, an increase of 47% in one year.

While cholera is a vaccine-preventable, severe disease, there is a global shortage of oral cholera vaccines (OCV), which, according to reports, may continue for years.

According to the World Health Organization (WHO), three WHO pre-qualified OCVs are Dukoral®, Shanchol™, and Euvichol®.

Since the start of 2023, about 50 million OCV doses have been requested, of which 19.3 million (40%) were approved for 11 countries, according to the WHO.

The OCV worldwide supply in 2022 was 36 million doses.

The International Coordinating Group was created in 1997 to manage the global stockpile of OCVs. The current production roadmap forecasts that OCV supply could meet global demand by 2026.

However, there are vaccination success stories in 2023.

For example, the Republic of Kenya surpassed its target of vaccinating 1.59 million people with OCVs in early August 2023.

GAVI recently reported the campaign is in response to a Kenyan cholera outbreak that began in October 2022 and has resulted in 11,872 cases and 196 deaths across the country.

"The case fatality rate of the cholera outbreak stands at 1.7%, underscoring the severity of the situation," said Health Ministry's Disease Surveillance and Response Unit Dr Emmanuel Okunga.

"The WHO is calling for access to adequate life-saving treatment to maintain case fatality rates below 1%, which is achievable when appropriate interventions are deployed."

The U.S. CDC recommends vaccination for people traveling to or living in areas of active cholera transmission. Check the CDC's Travel Health Notices website to identify areas with active cholera transmission.

Sub Title:

Cholera vaccine demand exceeds production in 2023

References:

WHO Cholera outbreak

U.S. CDC cholera vaccines 2023

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GAVI the vaccine alliance, August 2023

Cholera Outbreaks Confirmed in 24 Countries

Karen McClorey Hackett — Mon, 05 Jun 2023 19:21:26 +0000

Reviewer:

Cholera, External situation report #3

The World Health Organization (WHO) published External Situation Report #3 on June 1, 2023, confirming that cholera outbreaks are ongoing in 24 countries.

Since April 2023, further cholera spread has continued to be reported in the Horn of Africa, especially around the Mandera triangle, where the borders of Ethiopia, Kenya, and Somalia meet.

As of June 5, 2023, the WHO says the overall capacity to respond to the multiple and simultaneous cholera outbreaks continues to be strained due to the global lack of resources, including shortages of oral cholera vaccines.

Based on the increasing number of outbreaks and their geographic expansion, as well as a lack of vaccines and other resources, WHO continues to assess the risk at the global level as very high.

The WHO has recorded Seven distinct Cholera pandemics over the past two centuries. The seventh pandemic, which remains active in 2023, is considered to have started in 1961.

The global burden of Cholera is unknown mainly because most cases are not reported.

However, the WHO reported the average cholera fatality rate in 2021 was 1.9% (2.9% in Africa). Furthermore, preliminary WHO data suggest a similar unfortunate trend for 2022 and 2023.

Cholera, caused by the bacterium Vibrio cholerae, is rare in the U.S.

Nearly all cholera cases reported in the U.S. are acquired during international travel.

For example, as of December 2022, the U.S. Centers for Disease Control and Prevention (CDC) confirmed (8) travelers infected with Cholera arrived from Pakistan, Iraq, and Bangladesh.

In December 2020, the maker of the cholera vaccine, CVD 103-HgR (Vaxchora), temporarily stopped making and selling it. As a result, this vaccine is currently unavailable in the U.S.

Other cholera vaccines, such as the oral DUKORAL® vaccine, are available in various countries.

Sub Title:

Cholera is a high level global health risk

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U.S. CDC - cholera cases

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WHO map of cholera outbreaks 2023

Where is Cholera a Health Risk

Karen McClorey Hackett — Sat, 15 Apr 2023 13:54:34 +0000

Reviewer:

JAMA: WHO Warns “Very High” Global Risk as Cholera Cases Spread

Cholera pandemics have accelerated since mid-2021, according to a recent World Health Organization (WHO) statement that noted the pandemic’s “alarmingly high mortality rates.”

Cholera can be a life-threatening disease caused by bacteria called Vibrio cholerae. People get Cholera from unsafe food or water, says the WHO.

As of April 15, 2023, 24 countries in Africa, Asia, and the Caribbean are reporting cholera outbreaks, with other African nations of Malawi, Tanzania, South Africa, Zimbabwe, Mozambique, and Zambia experiencing outbreaks since mid-February 2023, wrote Emily Harris in a news article published by The JAMA Network on April 5, 2023.

For example, in Mozambique, the first cholera case was reported from the Lago district in Niassa province in September 2022. As of February 19, 2023, a cumulative total of 5,237 suspected cases and 37 related fatalities (Case Fatality Ratio 0.7%) have been reported in 29 districts from six out of 11 provinces in Mozambique.

Furthermore, Malawi had among the highest total cholera cases and the most related fatalities, 54,841 and 1,684, respectively, as of March 20, 2023.

The shortages of oral cholera vaccines (OCV) have strained the worldwide response for months.

But a few countries have been able to launch OCV campaigns.

On March 8, 2023, the WHO, the Syria Immunization Group, and others announced a cholera vaccination campaign would focus on northwest Syria. During this campaign, 1.7 million doses of an OCV would be offered to Syrians above one year of age.

In the U.S., nearly all cholera cases were acquired during international travel.

For example, as of December 2022, the U.S. Centers for Disease Control and Prevention (CDC) confirmed (8) travelers infected with Cholera arrived from Pakistan, Iraq, and Bangladesh.

To prevent Cholera, the CDC says a single dose of the Vaxchora vaccine is advised for people traveling to areas of active cholera transmission.

However, Vaxchora is currently unavailable in the U.S.

Other oral cholera vaccines are approved by the WHO, such as DUKORAL®.

Unfortunately, Dukoral is not available in the U.S. but is available in various countries as of April 15, 2023.

The CDC’s Travel Health website helps identify areas with active cholera transmission.

Sub Title:

Cholera is a global risk in April 2023

References:

WHO: Cholera – Global situation

WHO: Cholera - Mozambique

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Cholera Risks Remains Very High for Travelers

Donald Hackett — Wed, 22 Mar 2023 20:16:07 +0000

Reviewer:

WHO Cholera Outbreak External situation report #1 2023

The World Health Organization (WHO) today reported the global cholera situation has deteriorated, with four new countries reporting outbreaks.

In total, 24 countries are reporting cases as of March 20, 2023.

Since the beginning of 2023, cholera outbreaks have spread further in southeast Africa.

And the widespread outbreaks in Malawi and Mozambique remain active.

Additional outbreaks have been reported in Tanzania, South Africa, Zimbabwe, and Zambia since the start of the year.

In the greater Horn of Africa, outbreaks continue in Somalia, Ethiopia, Kenya, and South Sudan.

Cholera is an acute diarrheal infection characterized, in its severe form, by extreme watery diarrhea and potentially fatal dehydration. It is caused by ingesting food or water contaminated with the bacterium Vibrio cholerae.

The mortality associated with these outbreaks is of particular concern as many countries reported higher case-fatality ratios (CFR).

The average cholera CFR reported globally in 2021 was 1.9% (2.9% in Africa). Preliminary data suggests a similar trend for 2022 and 2023.

The overall capacity to respond to cholera outbreaks continues to be strained due to the global lack of resources, including shortages of the oral cholera vaccine (OCV), says the WHO.

From a prevention perspective, the global surge in cholera cases over the past two years has put unprecedented stress on the OCV supply chain, resulting recently in the decision to temporarily suspend the standard two-dose vaccination regimen in cholera outbreak response campaigns, using a single-dose approach instead.

As of March 22, 2023, this vaccine disruption continues to impact OCV availability in the U.S.

Based on the current situation as presented in External situation report #1, the WHO assesses the risk at the global level as very high.

Sub Title:

Cholera vaccine supply remains constrained in March 2023

References:

Cholera – Global situation 2022

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WHO map of Africa's cholera outbreaks March 2023

Syria Launches 1.7 Million Oral Cholera Vaccinations

Karen McClorey Hackett — Wed, 08 Mar 2023 19:20:56 +0000

Reviewer:

WHO and UNICEF launch cholera vaccination

The World Health Organization (WHO) today announced a ten-day Oral Cholera Vaccine (OCV) vaccination campaign was launched in northwest Syria.

The WHO confirmed on March 8, 2023, the United Nations Children's Fund (UNICEF), in coordination with health authorities, the Syria Immunization Group (SIG), and the Global Alliance for Vaccines (GAVI), kicked off this campaign with 1.7 million doses of cholera vaccine that will be used to protect Syrians above one year of age.

The vaccinations focus on Sarmada, Maaret Tamsrin, Dana, and Atmeh districts in Idleb and the A'zaz district in northern Aleppo.

Since the cholera outbreak was first declared in Syria on September 10, 2022, over 50 thousand suspected cases have been reported in both Idlib and Aleppo governorates.

"WHO warns against the increase of water-borne diseases for over 2.1 million Syrians living in the northwest of the country, with the risk increasing significantly in the aftermath of the devastating earthquake, especially in overcrowded camps and collective centers," says Dr. Richard Brennan, Regional Emergency Director for WHO's Regional Office for the Eastern Mediterranean, in a media release.

"WHO and partners have to act now to avoid further illness and death. As the cholera vaccines are orally administered (Valneva SE's DUKORAL®), it is crucial to ensure that targeted populations are reached before the beginning of the Holy month of Ramadan, as most adults will be fasting during this period".

Additionally, the WHO recently reported cholera outbreaks in 29 countries, such as Haiti.

UNICEF Deputy Regional Director programs for the Middle East and North Africa, Maddalena Bertolotti, commented, "This vaccination campaign is vital as it will provide much-needed protection for children and their families and help curb the spread of the disease, which can put millions of people at risk."

UNICEF continues to lead OCV procurement, cold chain, and vaccine management for safety.

And UNICEF co-leads in the planning and implementation of the social mobilization activities for the OCV campaign to create awareness of the importance of taking the vaccine to keep families safe and healthy from cholera disease

The devastating earthquakes that struck southern Türkiye and northern Syria have disrupted access to safe water, sanitation, and hygiene, exposing the population to an increased risk of water-borne diseases, including cholera.

Sub Title:

Cholera outbreak in Syria detected in September 2022

References:

Cholera outbreaks March 2023

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Syria, cholera, vaccinations

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Friday, March 17, 2023 - 15:15

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U.S. CDC map Feb. 2023

Türkiye Health Risks Increase Following Severe Earthquakes

Donald Hackett — Mon, 20 Feb 2023 16:22:40 +0000

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