Effectiveness of a reactive oral cholera vaccination during a cholera outbreak at the Douala New-Bell Central Prison in Cameroon

Résumé

BACKGROUND: Research on cholera vaccine effectiveness in prison populations is scarce, despite evidence of OCV benefits in general outbreak settings. During a major cholera outbreak in Douala's overcrowded central prison, Cameroon deployed the Euvichol oral cholera vaccine. This study assessed the vaccine's association with reduced cholera-related hospitalisation among inmates. METHODS: A retrospective secondary data analysis was conducted in 2024 on inmates who were targeted for reactive vaccination during a cholera outbreak in 2022. A stratified sampling strategy based on gender and housing type was used to select eligible inmates. Vaccine status was ascertained from the prison's vaccination register. Our outcome variable of interest was cholera-related hospitalisation. Logistic regression was used to assess the likelihood of hospitalisation for severe cholera among vaccinated and unvaccinated inmates. Adjusted odds ratios (aOR) and associated 95% confidence intervals (CI) were obtained. RESULTS: A total of 323 inmates were included for analysis, of whom 110 (34.9%) were vaccinated. Cholera-related hospitalisations occurred in 147/213(57.3%) unvaccinated inmates compared to 45/110(41.7%) vaccinated inmates. For inmates who received one dose of OCV, hospitalisation was associated with an adjusted odds ratio of 0.39 (95% CI: 0.21-0.70; p = 0.002), while those who received two doses showed an adjusted OR of 0.37 (95% CI: 0.19-0.72; p = 0.003). In subgroup analyses, severe cholera was found to be associated with lower odds among female prisoners [aOR = 0.24, 95% CI: 0.08-0.70, p = 0.009] and among inmates in 'VIP' cells [aOR = 0.31, 95% CI: 0.11-0.84, p = 0.022]. CONCLUSION: Vaccination was associated with a reduction in hospitalisation during the prison cholera outbreak, confirming its emergency value. However, OCV alone may not be sufficient if overcrowding and poor water, sanitation, and hygiene (WASH) conditions persist. Improved living standards, as seen in the female and VIP sections, must be extended to all inmates.

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