Center for Statistics and Quantitative Infectious Diseases, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA.
Proc Natl Acad Sci U S A. 2011 Apr 26;108(17):7081-5. doi: 10.1073/pnas.1102149108. Epub 2011 Apr 11.
In October 2010, a virulent South Asian strain of El Tor cholera began to spread in Haiti. Interventions have included treatment of cases and improved sanitation. Use of cholera vaccines would likely have further reduced morbidity and mortality, but such vaccines are in short supply and little is known about effective vaccination strategies for epidemic cholera. We use a mathematical cholera transmission model to assess different vaccination strategies. With limited vaccine quantities, concentrating vaccine in high-risk areas is always most efficient. We show that targeting one million doses of vaccine to areas with high exposure to Vibrio cholerae, enough for two doses for 5% of the population, would reduce the number of cases by 11%. The same strategy with enough vaccine for 30% of the population with modest hygienic improvement could reduce cases by 55% and save 3,320 lives. For epidemic cholera, we recommend a large mobile stockpile of enough vaccine to cover 30% of a country's population to be reactively targeted to populations at high risk of exposure.
2010 年 10 月，一种在南亚流行的 El Tor 霍乱菌株开始在海地传播。干预措施包括治疗病例和改善卫生条件。使用霍乱疫苗可能会进一步降低发病率和死亡率，但这种疫苗供应短缺，对于流行霍乱的有效疫苗接种策略知之甚少。我们使用一个霍乱传播的数学模型来评估不同的疫苗接种策略。在疫苗数量有限的情况下，将疫苗集中在高风险地区总是最有效的。我们表明，将 100 万剂疫苗针对接触霍乱弧菌风险高的地区，足以对 5%的人口进行两次接种，将减少 11%的病例数。如果有足够的疫苗覆盖 30%的人口，并辅以适度的卫生改善，同样的策略可以减少 55%的病例数，并挽救 3320 条生命。对于流行的霍乱，我们建议储备大量的移动疫苗库存，以覆盖一个国家 30%的人口，以便针对接触风险高的人群进行有针对性的反应。
