The interplay between WASH practices and vaccination with oral cholera vaccines in protecting against cholera in urban Bangladesh: Reanalysis of a cluster-randomized trial.

Chowdhury, F; Aziz, AB; Ahmmed, F; Ahmed, T; Kang, SS; Im, J; Park, J; Tadesse, BT; Islam, MT; Kim, DR; Hoque, M; Pak, G; Khanam, F; McMillan, NAJ; Liu, X; Zaman, K; Khan, AI; Kim, JH; Marks, F; Qadri, F; Clemens, JD

The interplay between WASH practices and vaccination with oral cholera vaccines in protecting against cholera in urban Bangladesh: Reanalysis of a cluster-randomized trial.

Chowdhury, F Aziz, AB Ahmmed, F Ahmed, T Kang, SS Im, J Park, J Tadesse, BT Islam, MT Kim, DR Hoque, M

Pak, G Khanam, F McMillan, NAJ Liu, X Zaman, K Khan, AI Kim, JH Marks, F Qadri, F Clemens, JD

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Vaccine, 2023, 41, (14), pp. 2368-2375
Issue Date:: 2023-03-31

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Field	Value	Language
dc.contributor.author	Chowdhury, F
dc.contributor.author	Aziz, AB
dc.contributor.author	Ahmmed, F
dc.contributor.author	Ahmed, T
dc.contributor.author	Kang, SS
dc.contributor.author	Im, J
dc.contributor.author	Park, J
dc.contributor.author	Tadesse, BT
dc.contributor.author	Islam, MT
dc.contributor.author	Kim, DR
dc.contributor.author	Hoque, M https://orcid.org/0000-0002-6014-6955
dc.contributor.author	Pak, G
dc.contributor.author	Khanam, F
dc.contributor.author	McMillan, NAJ
dc.contributor.author	Liu, X
dc.contributor.author	Zaman, K
dc.contributor.author	Khan, AI
dc.contributor.author	Kim, JH
dc.contributor.author	Marks, F
dc.contributor.author	Qadri, F
dc.contributor.author	Clemens, JD
dc.date.accessioned	2024-01-11T00:20:06Z
dc.date.available	2023-02-16
dc.date.available	2024-01-11T00:20:06Z
dc.date.issued	2023-03-31
dc.identifier.citation	Vaccine, 2023, 41, (14), pp. 2368-2375
dc.identifier.issn	0264-410X
dc.identifier.issn	1873-2518
dc.identifier.uri	http://hdl.handle.net/10453/174255
dc.description.abstract	The current global initiative to end Cholera by 2030 emphasizes the use of oral cholera vaccine (OCV) combined with feasible household Water-Sanitation-Hygiene (WASH) interventions. However, little is known about how improved WASH practices and behaviors and OCV interact to reduce the risk of cholera. We reanalyzed two arms of a cluster-randomized trial in urban Bangladesh, to evaluate the effectiveness of OCV given as a 2-dose regimen. One arm (30 clusters, n = 94,675) was randomized to vaccination of persons aged one year and older with OCV, and the other arm (30 clusters, n = 80,056) to no intervention. We evaluated the prevention of cholera by household WASH, classified at baseline using a previously validated rule, and OCV over 2 years of follow-up. When analyzed by assignment to OCV clusters rather than receipt of OCV, in comparison to persons living in "Not Better WASH" households in the control clusters, reduction of severe cholera (the primary outcome) was similar for persons in "Not Better WASH" households in vaccine clusters (46%, 95% CI:24,62), for persons in "Better WASH" households in the control clusters (48%, 95% CI:25,64), and for persons in "Better WASH" households in the vaccine clusters (48%, 95% CI:16,67). In contrast, when analyzed by actual receipt of a complete OCV regimen, , in comparison to persons in "Not Better WASH" households in the control clusters, protection against severe cholera increased steadily from 39% (95% CI:13,58) in residents of "Better WASH" households in the control clusters to 57% (95% CI:35,72) in vaccinated persons in "Not Better WASH" households to 63% (95% CI:21,83) in vaccinated persons in "Better WASH" households. This analysis suggests that improved household WASH and OCV received may interact to provide greater protection against cholera. However, the divergence between findings related to intent to vaccinate versus those pertaining to actual receipt of OCV underscores the need for further research on this topic.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation.ispartof	Vaccine
dc.relation.isbasedon	10.1016/j.vaccine.2023.02.054
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	06 Biological Sciences, 07 Agricultural and Veterinary Sciences, 11 Medical and Health Sciences
dc.subject.classification	Virology
dc.subject.classification	32 Biomedical and clinical sciences
dc.subject.classification	42 Health sciences
dc.subject.mesh	Humans
dc.subject.mesh	Cholera Vaccines
dc.subject.mesh	Cholera
dc.subject.mesh	Water
dc.subject.mesh	Bangladesh
dc.subject.mesh	Sanitation
dc.subject.mesh	Vaccination
dc.subject.mesh	Hygiene
dc.subject.mesh	Administration, Oral
dc.subject.mesh	Humans
dc.subject.mesh	Cholera
dc.subject.mesh	Water
dc.subject.mesh	Cholera Vaccines
dc.subject.mesh	Vaccination
dc.subject.mesh	Hygiene
dc.subject.mesh	Administration, Oral
dc.subject.mesh	Sanitation
dc.subject.mesh	Bangladesh
dc.subject.mesh	Humans
dc.subject.mesh	Cholera Vaccines
dc.subject.mesh	Cholera
dc.subject.mesh	Water
dc.subject.mesh	Bangladesh
dc.subject.mesh	Sanitation
dc.subject.mesh	Vaccination
dc.subject.mesh	Hygiene
dc.subject.mesh	Administration, Oral
dc.title	The interplay between WASH practices and vaccination with oral cholera vaccines in protecting against cholera in urban Bangladesh: Reanalysis of a cluster-randomized trial.
dc.type	Journal Article
utslib.citation.volume	41
utslib.location.activity	Netherlands
utslib.for	06 Biological Sciences
utslib.for	07 Agricultural and Veterinary Sciences
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Science
utslib.copyright.status	open_access	*
dc.date.updated	2024-01-11T00:20:03Z
pubs.issue	14
pubs.publication-status	Published
pubs.volume	41
utslib.citation.issue	14

Abstract:

The current global initiative to end Cholera by 2030 emphasizes the use of oral cholera vaccine (OCV) combined with feasible household Water-Sanitation-Hygiene (WASH) interventions. However, little is known about how improved WASH practices and behaviors and OCV interact to reduce the risk of cholera. We reanalyzed two arms of a cluster-randomized trial in urban Bangladesh, to evaluate the effectiveness of OCV given as a 2-dose regimen. One arm (30 clusters, n = 94,675) was randomized to vaccination of persons aged one year and older with OCV, and the other arm (30 clusters, n = 80,056) to no intervention. We evaluated the prevention of cholera by household WASH, classified at baseline using a previously validated rule, and OCV over 2 years of follow-up. When analyzed by assignment to OCV clusters rather than receipt of OCV, in comparison to persons living in "Not Better WASH" households in the control clusters, reduction of severe cholera (the primary outcome) was similar for persons in "Not Better WASH" households in vaccine clusters (46%, 95% CI:24,62), for persons in "Better WASH" households in the control clusters (48%, 95% CI:25,64), and for persons in "Better WASH" households in the vaccine clusters (48%, 95% CI:16,67). In contrast, when analyzed by actual receipt of a complete OCV regimen, , in comparison to persons in "Not Better WASH" households in the control clusters, protection against severe cholera increased steadily from 39% (95% CI:13,58) in residents of "Better WASH" households in the control clusters to 57% (95% CI:35,72) in vaccinated persons in "Not Better WASH" households to 63% (95% CI:21,83) in vaccinated persons in "Better WASH" households. This analysis suggests that improved household WASH and OCV received may interact to provide greater protection against cholera. However, the divergence between findings related to intent to vaccinate versus those pertaining to actual receipt of OCV underscores the need for further research on this topic.

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http://hdl.handle.net/10453/174255