In refugee settings, the use of cholera vaccines is controversial since a mass vaccination campaign might disrupt other priority interventions. We therefore conducted a study to assess the feasibility of such a campaign using a two-dose oral cholera vaccine in a refugee camp. The campaign, using killed whole-cell/recombinant B-subunit cholera vaccine, was carried out in October 1997 among 44,000 south Sudanese refugees in Uganda. Outcome variables included the number of doses administered, the drop-out rate between the two rounds, the proportion of vaccine wasted, the speed of administration, the cost of the campaign, and the vaccine coverage. Overall, 63,220 doses of vaccine were administered. At best, 200 vaccine doses were administered per vaccination site and per hour. The direct cost of the campaign amounted to US$ 14,655, not including the vaccine itself. Vaccine coverage, based on vaccination cards, was 83.0% and 75.9% for the first and second rounds, respectively. Mass vaccination of a large refugee population with an oral cholera vaccine therefore proved to be feasible. A pre-emptive vaccination strategy could be considered in stable refugee settings and in urban slums in high-risk areas. However, the potential cost of the vaccine and the absence of quickly accessible stockpiles are major drawbacks for its large-scale use.
PIP: This study was undertaken to assess the feasibility of mass vaccination using a two-dose oral cholera vaccine in a refugee setting in Uganda. A total of 44,000 south Sudanese refugees were involved in the study. The campaign was conducted using killed whole-cell/recombinant B-subunit cholera vaccine. Measured outcomes include the total number of doses administered, the dropout rate between the two rounds, the amount of vaccine wasted, the cost of the campaign, and the vaccine coverage. Given the results of the study, the mass vaccination of a refugee population with a two-dose oral cholera vaccine proved to be feasible. A total of 63,220 vaccines were administered, with 200 vaccine doses given per vaccination area per hour. The campaign cost was US$14,655, excluding the cost of the vaccine. Vaccine coverage was 83% for the first round and 75.9% for the second round. A presumptive vaccination strategy could be taken into account in stable refugee settings and in urban slums in high-risk sites. However, the potential amount of the vaccine and the absence of immediately accessible stockpiles are major constraints for its large-scale implementation.