Some thoughts on Dr. Sack's important question on OCV delivery - Part 3 of 6 part series

Now, it is always in the best interest of community that we talk of the best available options like vaccination early rather than saying "Well this will complicate the situation without understanding the scientific facts as well as merits of vaccinating the most vulnerable during crisis situation. However, we also should acknowledge and prioritize (and can't undermine) WASH measures, which should be employed extensively in the backdrop of disease surveillance, which should be robust in its functioning . Few days ago I read Dr. Sack's blog post in ( www.stopcholera.org ), the key message that I could get from the post is that efficient surveillance and rapid action are the two side of the same coin to stop cholera spreading in the community. This is what all of us emphasize during our conversation with public health colleague here in Nepal. When Dr. Sack says "efficient" surveillance, it also means that it should be equipped with stool sample collection, proper sample transportation, cold chain maintenance and  appropriate lab diagnostic test. In the field however we could use quick diagnostic test like modified rapid dipstick test. This can be supplemented with culture and sensitivity test. Therefore, this is one area, which interests me when assessing the risk of cholera outbreaks in the community and now especially in temporary shelters, where people directly or indirectly affected by Earthquake take refuge for safety. During this temporary stay, I would say children, senior citizens, pregnant women and weak / feeble are at high risk of exposure to various communicable diseases. 

This is so timely, therefore we discuss and put in place robust surveillance and use rapid diagnostic test in 14 affected districts. Once we assess the surveillance data along with risk assessment using appropriate tools available, we would be in a place to take evidence based informed decision. In this light, let me share recent experience of oral cholera vaccination in Malawi where thousands of people were displaced due to flooding. In collaboration with the International Vaccine Institute (IVI), the World Health Organization (WHO) implemented  Oral Cholera vaccination in response to reported and later lab confirmed cholera outbreaks in Psanje, southern part of Malawi . Specifically, WHO provided vaccines for 105000 people while the International Vaccine Institute provided vaccines for 55000 people. The World Health Organization is continuing to lead the monitoring, evaluation and documentation of the best practices in the introduction of the Oral Cholera Vaccine. Also, the mass preventive vaccination were carried out in Guinea, Ethiopia and Haiti.

These are exemplary collaborative efforts to address outbreak caused by neglected diseases that is related to water, sanitation and hygiene in the community. It is unfortunate that we are still lingering with basic necessity that a responsible state has to offer to its people. Because there is lack of such basic utility our people are victim to preventable diseases like cholera. This has become even more relevant when the globe has constricted with rapid transportation (both sea and land) within and outside our boundary. This is further compounded by changing population dynamics as well as climate changes, political instability and rising antibiotic resistance in the community.

While writing this blog, we felt another 7.4 Rector Scale Earthquake with epicenter in Everest region. We do not know as of now, how much it has damaged and loss of life / injuries. We therefore pray that we do not want another Haiti Situation, when cholera outbreak complicated the overall relief and rehabilitation of the state and its people, here in Nepal. We will work in that direction and we are united in this national endeavor. 

Links:

1.       http://www.afro.who.int/en/malawi/press-materials/item/7556-malawi-completes-round-one-of-the-oral-cholera-vaccination-campaign-in-nsanje-district.html

2.       http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0002465

3.       http://www.msf.ie/south-sudan-oral-cholera-vaccination-campaign-maban