title: Towards elimination of cholera in Bangladesh by 2030
Creators: name: Islam, Md. Taufiqul
Publisher: name: Griffith University
Year: 2023
Subjects: subject: Bangladesh
subject: cholera
subject: Vibrio cholerae
subject: elimination
subject: public health

description: Cholera, an epidemic-prone diarrhoeal disease, is considered a major public health problem, particularly in low and middle-income countries in Asia and Africa. The global burden of cholera remains high, with an estimated 2.9 million cases and 100,000 deaths annually. The establishment of surveillance systems is an important tool to detect hotspots and monitor the impact of the interventions in order to implement plans for elimination of cholera. Nationwide cholera surveillance in Bangladesh has been carried out by collaborative efforts between the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) and the Institute of Epidemiology Disease Control And Research (IEDCR) since 2014. Vibrio cholerae was confirmed in ~6% of suspected cases by microbiological culture. It was found that the risk of cholera was higher among suspected cases aged 5-45 years compared to those &lt;5 years of age. In addition, seasonality, profession, level of education, and a history of diarrhoea among neighbours were found to be risk factors for cholera. The displaced Rohingya people, termed as "Forcibly Displaced Myanmar Nationals" (FDMNs), fled to Cox's Bazar, south east of Bangladesh due to their internal conflict in late 2017. A total of 11 sentinel surveillance sites were established around the makeshift camps. The proportion of V. cholerae positivity was 0.7% and 1.2% among the FDMNs and host community respectively. Vaccination is one of the important public health tools to combat epidemics of cholera. Vaccine co-administration has numerous advantages, such as a reduction in delivery costs and likely a reduction in the number of visits in routine immunisation schedules. An open-label, randomised, controlled, non-inferiority trial was conducted in Dhaka city, Bangladesh to examine the safety and immunogenicity of oral cholera vaccine (OCV) and bivalent oral poliovirus vaccines (bOPV) co-administration. The trial revealed that co-administration of bOPV and OCV is safe and immunogenic in children aged 1-3 years, which should be considered by policymakers. The Global Task Force on Cholera Control (GTFCC) has launched a strategy, entitled 'Ending Cholera: A Global Roadmap to 2030', with the ambitious goal of reducing mortality by 90% and eliminating cholera in 20 countries. It is understood that vaccination alone will not lead to elimination and that a multi-sectorial approach is required. Therefore, the national governments of these cholera-prone countries, along with their technical partners, and local donors need to use the best available evidence in a strategic and coordinated way at national, regional, and local levels to achieve this 2030 target. The package should include rapid diagnostics, real-time reporting, prompt home treatment of mild to moderate cases, and referral to local hospitals for severe cases. Different tiers of developing countries should have different control strategies based upon the endemicity and risk of disease. A blueprint for this control plan will be a helpful guide to consider the specific implementation plans.