Murray J, McFarland D A, Waldman R J
BASICS (Basic Support for Institutionalizing Child Survival), Arlington, VA 22209, USA.
Bull World Health Organ. 1998;76(4):343-52.
Recent large epidemics of cholera with high incidence and associated mortality among refugees have raised the question of whether oral cholera vaccines should be considered as an additional preventive measure in high-risk populations. The potential impact of oral cholera vaccines on populations prone to seasonal endemic cholera has also been questioned. This article reviews the potential cost-effectiveness of B-subunit, killed whole-cell (BS-WC) oral cholera vaccine in a stable refugee population and in a population with endemic cholera. In the population at risk for endemic cholera, mass vaccination with BS-WC vaccine is the least cost-effective intervention compared with the provision of safe drinking-water and sanitation or with treatment of the disease. In a refugee population at risk for epidemic disease, the cost-effectiveness of vaccination is similar to that of providing safe drinking-water and sanitation alone, though less cost-effective than treatment alone or treatment combined with the provision of water and sanitation. The implications of these data for public health decision-makers and programme managers are discussed. There is a need for better information on the feasibility and costs of administering oral cholera vaccine in refugee populations and populations with endemic cholera.
近期，霍乱在难民中大规模流行，发病率和死亡率居高不下，这引发了一个问题：口服霍乱疫苗是否应被视为高危人群的一项额外预防措施。口服霍乱疫苗对易患季节性地方性霍乱人群的潜在影响也受到了质疑。本文回顾了B亚单位全细胞灭活（BS-WC）口服霍乱疫苗在稳定的难民群体和地方性霍乱流行人群中的潜在成本效益。在地方性霍乱高危人群中，与提供安全饮用水和卫生设施或治疗疾病相比，大规模接种BS-WC疫苗是成本效益最低的干预措施。在有疫病流行风险的难民群体中，接种疫苗的成本效益与仅提供安全饮用水和卫生设施相似，但比单独治疗或治疗与提供水和卫生设施相结合的成本效益要低。本文讨论了这些数据对公共卫生决策者和项目管理者的启示。需要更好地了解在难民群体和地方性霍乱流行人群中接种口服霍乱疫苗的可行性和成本。
