Cholera Clinical Trial
Official title:
Introduction of Cholera Vaccine in Bangladesh: " Impact Evaluation of Cholera Vaccine and Behaviour Change Interventions in Urban Dhaka"
The purpose of this study is to conduct and evaluate the feasibility and effectiveness of a mass cholera vaccination program to reduce diarrhea due to Vibrio cholerae in a high incidence urban area. This study will also evaluate the feasibility of adding a household hand washing and safe drinking water promotion intervention to a cholera vaccine program and the overall impact of this combination on decreasing the incidence of diarrhea due to Vibrio cholerae.
Cholera continues to be a major cause of morbidity and mortality in low income countries
including Bangladesh. It is estimated that there are at least 300,000 severe cases and 1.2
million infections in people in Bangladesh each year. Deaths annually from cholera may have
decreased but overall morbidity remains high.
The project for "Introduction of Cholera Vaccine in Bangladesh" (ICVB) will examine the
effectiveness of intervention with an oral cholera vaccine in reducing incidence of cholera
in urban Dhaka, and the effectiveness of a handwashing and home water treatment behaviour
change intervention in reducing diarrhea due to cholera. The proposal involves evaluation of
a 2-dose regimen of an oral killed whole cell (WC) vaccine and a handwashing and home water
treatment behavior change program promoting improved hygiene and home drinking water
treatment in reducing dehydrating diarrhea in a low income area of Dhaka, Bangladesh. The
study population will include 90 clusters (neighborhoods) in an area of high cholera
incidence in Mirpur with a total study population of 240,000. Thirty clusters (approximately
80,000 people) will receive cholera vaccine alone, 30 clusters will receive both cholera
vaccine and behavior change and 30 neighborhoods will continue their standard habits and
practices. Surveillance for cholera and diarrhea will be carried out in all the three areas
during the whole project period. Following the GIS mapping and census of the target
populations, the cholera vaccine will be offered to all males and non-pregnant females aged
one year and above in the vaccination areas, and an aggressive hygiene and safe water
promotion program will be implemented in the 30 behavior change communication clusters.
Passive surveillance for cholera will be undertaken using the two ICDDR,B diarrhea treatment
facilities as well as 10 other health facilities that serve the study areas. Vaccine and
other public health coverage and costs effectiveness as well cost-benefit will be measured,
followed by surveillance and identical follow-up studies. The hygiene and safe water behavior
change program will also be continued for 4 years. The impact of interventions will be
assessed by following vaccination by directly comparing the incidence of cholera and diarrhea
in the intervention communities to the incidence in the standard habits and practices
communities.
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