Introduction of Cholera Vaccine in Bangladesh
Introduction of Cholera Vaccine in Bangladesh
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.
Inclusion Criteria:

 1. Apparently healthy residents of selected vaccination sites

 2. Aged 1 year and above

 3. Non-pregnant women

 4. Written informed consent

 Exclusion Criteria:

 1. Age less than 1 year

 2. Pregnant women