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Experts Call for International Cholera Vaccine Stockpile



PAHO/WHO urged to design a pilot project to use available vaccine in Haiti



Washington D.C., 17 December 2010 (PAHO) -- A group of experts convened by the Pan American Health Organization/World Health Organization (PAHO/WHO) today urged the creation of an international stockpile of cholera vaccine and called for the use of current vaccines in a pilot project in Haiti that would be expanded as more vaccine becomes available.

The recommendations were based on considerations including the limited supplies of available vaccine, studies of the vaccines' safety and efficacy, and WHO recommendations on cholera vaccination, as well as conditions on the ground in Haiti. 

"In the short term, we should make use of the limited amount of vaccine we have," said Dr. Roger Glass, director of the Fogarty International Center and associate director for international research at the U.S. National Institutes of Health. "In the long term, we need to make sure we have adequate supplies to respond to cholera in Haiti, in the Americas, and around the world."

PAHO/WHO convened today's meeting in response to renewed interest in cholera vaccination following reports that more vaccine might be available than previously believed.

Information shared during the meeting indicated that 100,000 doses of cholera vaccine are currently ready for shipment, but an additional 200,000 doses could become available in the next three months and up to 1 million doses in the second half of 2011. Two doses of vaccine are needed to confer protection against cholera.

Experts
Dr. Jon Andrus, Dr. Ciro de Quadros and Dr. Roger Glass

"While the increased availability of a vaccine is certainly good news, it should be recognized that over 10 million people live in Haiti and over 10 million live in the Dominican Republic," said Dr. Jon K. Andrus, PAHO's deputy director and a leading vaccine expert. "Under no circumstances could there be enough vaccine-over 40 million doses-to vaccinate all the inhabitants of the island of Hispaniola over the next year."

Participants said the situation in Haiti clearly demonstrates the need for an international stockpile of cholera vaccine, which would stimulate vaccine production and guarantee vaccine supplies.

Toward that end, "We have asked PAHO/WHO to dialogue with suppliers to see how much more vaccine they can produce and to dialogue with organizations who would be willing to finance the purchase of vaccine," said Dr. Ciro de Quadros, executive vice-president of the Sabin Vaccine Institute. Dr. de Quadros, who chaired the meeting, also heads the Technical Advisory Group of PAHO's immunization program.

At the same time, the experts urged the development of a pilot project in Haiti that would utilize the immediately available vaccine and also provide lessons on how to introduce cholera vaccine effectively in a country that not only has an ongoing epidemic but also is recovering from a major earthquake. The group urged PAHO/WHO to design such a project and to seek funding for it.

Since mid-October, Haiti's cholera epidemic has sickened at least 112,000 people and claimed at least 2,400 lives.

PAHO/WHO experts believe the true toll of the epidemic is probably significantly higher than these official numbers, because of gaps in surveillance.

PAHO/WHO and other U.N. agencies as well as nongovernmental organizations have been supporting Haiti's Ministry of Health in the response to the epidemic. Their efforts have focused on ensuring treatment and prevention, with an emphasis on prompt administration of oral rehydration salts or, for severe cases, intravenous fluids and antibiotics. Prevention efforts have focused on ensuring access to safe drinking water, improving sanitation and waste disposal, and promoting safe food handling and personal hygiene practices.

While these efforts continue to be critical to minimizing the spread of the disease and the number of deaths, Andrus noted that it was important to consider vaccination as well.

"As we go along and new opportunities arise, it behooves us to consider those if they can help us save more lives," said Andrus. "This is a disease that has a foothold in Haiti and will be causing disease in Haiti for some years to come."

Other participants in today's meeting included Matthew Waldor of Harvard University, Peter Hotez of the Sabin Vaccine Institute, Eric Mintz of the U.S. Centers for Disease Control and Prevention (CDC), Myron Levine of the University of Maryland, John Clemens of the International Vaccine Institute, Bruce Gellin of the U.S. Department of Health and Human Services, and William Pape of GHESKIO in Haiti.

 
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