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• W69378545 abstract "Sir -- Further to the mass cholera vaccination campaign in refugee camps in Adjumani district, Northern Region, Uganda, reported in the last issue of the Bulletin (1), we describe below the situation when a cholera outbreak occurred in the district one year after the campaign. Adjumani district has offered asylum to Sudanese refugees since 1989. The refugee population, which represents about 55% of the total district population (125 000 people), is spread over 35 different settlement camps. At the request of WHO, a pilot vaccination campaign with the WC/rBS oral cholera vaccine was conducted in October 1997 in six of these camps. The objective was to assess the feasibility and acceptability of mass vaccination in a large refugee setting (2). Vaccine coverage was 87.0%, a total of 27 607 persons being fully vaccinated. A cholera epidemic caused by Vibrio cholerae El Tor serotype Ogawa reached the north of Uganda in April 1998. In Adjumani district the first cases of cholera were reported in August, and the epidemic peaked in October 1998. Between 17 August and 8 November, 358 cases of cholera were reported from 60 different locations covering the entire district. The overall attack rate was 0.3% and the case-fatality ratio was 4.2% (15 deaths). The epidemic affected the entire district, and all the refugees, including those living in the vaccinated camps, were exposed to the risk of cholera. A total of 28 cases out of 358 (7.8%) occurred among refugees, but none of them came from a settlement that participated in the vaccination campaign in 1997. Attack rates were higher in the Ugandan population than in the refugee population (0.59% v 0.04%, relative risk: 14.4 (95% confidence interval, 9.8-21.2)). Water supplies and sanitation facilities were similar in the vaccinated and non-vaccinated settlements, but were better in the settlements than in the Ugandan villages. This fact might partly explain the lower attack rate observed in the refugee population. Since no case of cholera was reported from the vaccinated population, it was not possible to measure vaccine effectiveness using classic epidemiological studies (3). Therefore, in order to assess whether the cholera vaccination had had a protective effect, we compared the global incidences of common (non-bloody) diarrhoea between vaccinated and non-vaccinated refugee settlements for the month of October 1998. We also compiled the evolution of common diarrhoea incidences in four vaccinated settlements over the period October 1997 (vaccination) to October 1998 (outbreak). The median incidences of common diarrhoea in October 1998 were lower in the vaccinated settlements (2.8/1000) compared with non-vaccinated settlements (10.0/1000) and the Ugandan population (4.3/1000) attending the same health units, but the differences were not statistically significant. The trends in the common diarrhoea incidences since October 1997 in four vaccinated camps did not show any marked increase during the cholera epidemic period (Fig. …" @default.
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• W69378545 date "1999-01-01" @default.
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• W69378545 title "Effectiveness of mass vaccination with WC/rBS cholera vaccine during an epidemic in Adjumani district, Uganda." @default.
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