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Vaccine Protection of Bangladeshi infants and young children against cholera: implications for vaccine deployment and person-to-person transmission.

Magazine article
Authors Mohammad Ali
Michael Emch
Mohammad Yunus
David Sack
Anna Lena Lopez
Jan Holmgren
John Clemens
Published in The Pediatric infectious disease journal
Volume 27
Issue 1
Pages 33-7
ISSN 0891-3668
Publication year 2008
Published at Institute of Biomedicine, Department of Microbiology and Immunology
Pages 33-7
Language en
Keywords Adolescent, Adult, Bangladesh, epidemiology, Child, Child, Preschool, Cholera, epidemiology, immunology, prevention & control, Cholera Vaccines, immunology, Female, Humans, Immunity, Herd, Incidence, Infant, Vaccines, Inactivated, immunology
Subject categories Microbiology in the medical area


BACKGROUND: Killed oral cholera vaccines are internationally licensed for older children and adults, but not for infants and young children. We investigated whether mass immunization of older children and adults can confer herd protection to children too young to be vaccinated. METHODS: We analyzed the first year of surveillance of an individually randomized, placebo-controlled trial of killed oral cholera vaccines in 89,596 older Bangladeshi children and adult women. Vaccine herd protection of children less than 2 years of age, who were too young to participate in the trial, was evaluated by determining whether the incidence of cholera during the first year of follow-up of this age group was lower in residential clusters with higher levels of vaccine coverage than in clusters with lower levels of vaccine coverage. RESULTS: Vaccine coverage of the targeted population ranged from 4% to 65% in different clusters. The incidence (cases per 1000) of cholera among children less than 2 years of age ranged from 18.9 in clusters in the lowest quintile of vaccine coverage to 8.6 in clusters in the highest quintile (P = 0.004 for the inverse association between vaccine coverage and risk of cholera) Vaccine coverage of adult women (relative risk of cholera = 0.95 for each percent increase in vaccine coverage; 95% confidence interval: 0.92-0.99; P < 0.01), but not of older children, was independently associated with a lower risk of cholera in children less than 2 years of age. CONCLUSIONS: Vaccination of older age groups was associated with protection of children too young to be vaccinated. The pronounced herd protection of young children associated with vaccination of adult women suggests that adult women may play a prominent role in the transmission of cholera to young children in this setting.

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