Vaccines plus water, sanitation, and hygiene interventions in the fight against cholera
Authors: Yael Velleman, Megan Wilson-Jones
Journal: The Lancet Global Health (2017)

The Comment by Louise Ivers (November, 2016)1Ivers LC New strategies for cholera control.Lancet Glob Health. 2016; 4: e771-e772Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar references a supposed debate in cholera control between investing in universal access to water and sanitation and a multidisciplinary approach focused on cholera vaccination with specific evidence-based water, sanitation, and hygiene (WASH) interventions. As advocates for the importance of WASH, WaterAid is concerned to see this view being propagated. We strongly support WHO's recommendations2Global Task Force on Cholera ControlCholera outbreak: assessing the outbreak response and improving preparedness.http://www.who.int/cholera/publications/OutbreakAssessment/en/Date: 2010Google Scholar that controlling cholera and, importantly, preventing outbreaks requires a coordinated approach including improvements in WASH, immunisation with the oral cholera vaccine, improved disease surveillance, and strengthened health systems. To date, cholera control efforts have been mainly focused on reaction, with less focus on prevention and preparedness. Vaccines are clearly a crucial intervention in the prevention of cholera; however, vaccination strategies should be matched with investments in long-term prevention, including water and sanitation infrastructure and sustainable behaviours around hygiene. Apart from long-term interventions, immediate results can be had by accompanying the delivery of the oral cholera vaccine with hygiene promotion. Promoting safe water treatment and storage, safe disposal of faeces, handwashing with soap at key moments, and food hygiene are important and often neglected opportunities to strengthen the cholera response. Finally, growing evidence3Rodó X Pascual M Fuchs G Faruque ASG ENSO and cholera: a nonstationary link related to climate change?.PNAS. 2002; 99: 12901-12906Crossref PubMed Scopus (223) Google Scholar suggests that climate change is likely to play an increasing role in the global resurgence and redistribution of cholera. This change in the epidemiology of cholera increases the risk that global stockpiles of vaccine might not be sufficient to match demand in the future. Although vaccines are an essential weapon in the fight against cholera outbreaks, they need to be delivered alongside crucial preventative WASH interventions. Long-term investments in universal access to WASH will be essential in both the immediate response to this growing threat and in building up communities' resilience for the future. We declare no competing interests. Effectiveness of one dose of oral cholera vaccine in response to an outbreak: a case-cohort studyOne dose of Shanchol was effective in preventing medically attended cholera in this study. These results support the use of a single-dose strategy in outbreaks in similar epidemiological settings. Full-Text PDF Open AccessVaccines plus water, sanitation, and hygiene interventions in the fight against cholera – Authors' replyIn their correspondence, Yael Velleman and Megan Wilson-Jones agree that controlling and preventing cholera requires a multidisciplinary approach including vaccination and safe water, sanitation, and hygiene (WASH) interventions. The affirmation that colleagues at a prominent organisation known for working to improve access to WASH—WaterAid—strongly agree with a combined, integrated approach to prevention and control of this disease is welcome. We also agree on how to leverage cholera vaccination campaigns into positive public-health opportunities. Full-Text PDF Open Access