PLoS Medicine
(Accessed 6 September 2014)
http://www.plosmedicine.org/

Oral Cholera Vaccine Development and Use in Vietnam
Dang Duc Anh, Anna Lena Lopez mail, Hung Thi Mai Tran, Nguyen Van Cuong, Vu Dinh Thiem,
Mohammad Ali, Jacqueline L. Deen, Lorenz von Seidlein, David A. Sack
Published: September 02, 2014
DOI: 10.1371/journal.pmed.1001712
Summary Points
:: Vietnam is the first and only country in the world to regularly use oral cholera vaccines (OCVs) in their cholera control program.
:: From 1998 to 2012, more than 10.9 million doses of the locally produced OCV were deployed in the country through its public health system.
:: We present an overview of cholera epidemiology in Vietnam and the development and deployment of the OCV.
:: Since 1997, the number of cholera cases in Vietnam has declined, in association with increased OCV use as well as improvements in socioeconomic and water and sanitation conditions. It is not possible to establish the relative contributions of each of these to the reduction in cholera rates.
:: Hue, the only province to use OCVs consistently every year, has not reported any cholera case since 2003.
:: As WHO organizes a stockpile of OCV for use in emergencies and recommends the use of OCVs together with traditional means of control, the experience in Vietnam will be helpful to other at-risk countries as they look towards adopting the vaccine in their cholera control programs.

Cholera: A Continuing Public Health Threat
The emergence of cholera in Haiti highlighted the difficulties in containing cholera outbreaks with only safe water, sanitation, hygiene, and appropriate case management. In less developed settings where cholera occurs, these basic needs are often not met or are rapidly overwhelmed during man-made or natural disasters. Prior to the Haitian outbreak, countries in Africa and Asia had borne most of the cholera burden, with an estimated 1.4 billion people at risk, 2.8 million cases, and 100,000 to 200,000 deaths occurring annually [1],[2]; however, because of difficulties in surveillance and differences in reporting systems, only 245,393 cases with 3,034 deaths were reported to the World Health Organization (WHO) in 2012 [1]. This figure does not include the large number of acute watery diarrhoea cases reported in Asia, of which a significant proportion is caused by Vibrio cholerae. As cholera continues to be a global public health problem, in 2011, the World Health Assembly called for an integrated and comprehensive approach to cholera control, including oral cholera vaccines (OCVs) [3].
OCVs have been available for more than 20 years, but public health use has been limited. Vietnam is the first and currently the only country in the world to use killed OCVs routinely in its public health program. This article describes the cholera problem in Vietnam and how an oral cholera vaccine was developed and used as a component of a public health strategy against the disease…