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N Engl J Med. 2014 May 29;370(22):2111-20. doi: 10.1056/NEJMoa1312680.

Use of Vibrio cholerae vaccine in an outbreak in Guinea.

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From Epicentre (F.J.L., L.G., A.-L.P., R.F.G.), African Cholera Surveillance Network, Agence de Médicine Préventive (K.S., M.A.M.), and National Reference Center for Vibrios and Cholera, Enteric Bacterial Pathogens Research and Expertise Unit, Institut Pasteur (M.-L.Q.) - all in Paris; Médecins sans Frontières, Geneva (L.G., I.C., M.S., D.L.); Ministry of Health (K.S.), Direction Préfectorale de la Santé (B.T.) and Research and Documentation Service, Ministry of Health (A.A.D.), Médecins sans Frontières (M.H.), and World Health Organization (C.I.) - all in Conakry, Guinea; and the Department of Microbiology, University of Valladolid, Valladolid, Spain (J.M.E.).



The use of vaccines to prevent and control cholera is currently under debate. Shanchol is one of the two oral cholera vaccines prequalified by the World Health Organization; however, its effectiveness under field conditions and the protection it confers in the first months after administration remain unknown. The main objective of this study was to estimate the short-term effectiveness of two doses of Shanchol used as a part of the integrated response to a cholera outbreak in Africa.


We conducted a matched case-control study in Guinea between May 20 and October 19, 2012. Suspected cholera cases were confirmed by means of a rapid test, and controls were selected among neighbors of the same age and sex as the case patients. The odds of vaccination were compared between case patients and controls in bivariate and adjusted conditional logistic-regression models. Vaccine effectiveness was calculated as (1-odds ratio)×100.


Between June 8 and October 19, 2012, we enrolled 40 case patients and 160 controls in the study for the primary analysis. After adjustment for potentially confounding variables, vaccination with two complete doses was associated with significant protection against cholera (effectiveness, 86.6%; 95% confidence interval, 56.7 to 95.8; P=0.001).


In this study, Shanchol was effective when used in response to a cholera outbreak in Guinea. This study provides evidence supporting the addition of vaccination as part of the response to an outbreak. It also supports the ongoing efforts to establish a cholera vaccine stockpile for emergency use, which would enhance outbreak prevention and control strategies. (Funded by Médecins sans Frontières.).

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