Challenges with achieving and maintaining oral cholera vaccine coverage: insights from serial cross-sectional representative surveys in a cholera-endemic community in the Democratic Republic of the Congo
Background We conducted three serial cross-sectional representative surveys after a mass cholera vaccination campaign in Uvira, Democratic Republic of the Congo to (1) estimate the vaccination coverage and explore heterogeneity by geographic and demographic factors; (2) examine barriers and facilita...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/3/1/e001035.full |
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| author | Oliver Cumming Andrew S Azman Espoir Bwenge Malembaka Jackie Knee Placide Okitayemba Welo Aimé Cikomola Aybüke Koyuncu Patrick Musole Bugeme Juan Dent Chloe Hutchins Hanmeng Xu Karin Gallandat Joseph Matundanya Delphin Rukakiza Merveille Nkombo Jaime Saidi Mufitini Baron Bashige Rumedeka Laurent Akilimali Elizabeth C Lee |
| author_facet | Oliver Cumming Andrew S Azman Espoir Bwenge Malembaka Jackie Knee Placide Okitayemba Welo Aimé Cikomola Aybüke Koyuncu Patrick Musole Bugeme Juan Dent Chloe Hutchins Hanmeng Xu Karin Gallandat Joseph Matundanya Delphin Rukakiza Merveille Nkombo Jaime Saidi Mufitini Baron Bashige Rumedeka Laurent Akilimali Elizabeth C Lee |
| author_sort | Oliver Cumming |
| collection | DOAJ |
| description | Background We conducted three serial cross-sectional representative surveys after a mass cholera vaccination campaign in Uvira, Democratic Republic of the Congo to (1) estimate the vaccination coverage and explore heterogeneity by geographic and demographic factors; (2) examine barriers and facilitators of vaccine uptake and (3) describe the changes in coverage over time and predict future coverage.Methods We collected data on sociodemographics, self-reported vaccination status, population movement and knowledge, attitudes and behaviours related to killed oral cholera vaccines (kOCVs) in August 2021, April 2022 and April 2023, approximately 11, 19 and 30 months postvaccination. We compared the characteristics of participants by vaccination status and explored the potential role of population movement as a cause for low coverage. We used an exponential decay model to predict the proportion of the population vaccinated with ≥1 dose of kOCV over time based on age-specific coverage.Results We enrolled 8735 participants from 1433 households across all surveys. Coverage in survey 1 (August 2021) was 55% for ≥1 dose of kOCV (95% CI 51 to 60) and 23% for ≥2 doses (95% CI 20 to 27). Vaccine refusal was associated with a lack of confidence in the vaccine’s safety, and 29% of unvaccinated adults reported it was unlikely they would accept kOCVs if an additional mass vaccination campaign was conducted in their area. Coverage of ≥1 one dose of kOCV declined on average by 18% per year (95% credible interval 14 to 23) and was 39% (95% CI 36 to 43) by survey 3 (approx. 30 months after second dose campaign).Conclusions Our findings suggest that in settings like Uvira, efforts to strengthen vaccine confidence are needed to achieve higher campaign coverage, and vaccine coverage dilution may be reduced by more frequent and coordinated geographic vaccination efforts. |
| format | Article |
| id | doaj-art-6393ee775f6a4c64b0aa9345e52da4d1 |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Public Health |
| spelling | doaj-art-6393ee775f6a4c64b0aa9345e52da4d12025-01-20T08:00:12ZengBMJ Publishing GroupBMJ Public Health2753-42942025-01-013110.1136/bmjph-2024-001035Challenges with achieving and maintaining oral cholera vaccine coverage: insights from serial cross-sectional representative surveys in a cholera-endemic community in the Democratic Republic of the CongoOliver Cumming0Andrew S Azman1Espoir Bwenge Malembaka2Jackie Knee3Placide Okitayemba Welo4Aimé Cikomola5Aybüke Koyuncu6Patrick Musole Bugeme7Juan Dent8Chloe Hutchins9Hanmeng Xu10Karin Gallandat11Joseph Matundanya12Delphin Rukakiza13Merveille Nkombo14Jaime Saidi Mufitini15Baron Bashige Rumedeka16Laurent Akilimali17Elizabeth C Lee18London School of Hygiene & Tropical Medicine, London, UK3 Médecins Sans Frontières, Geneva, SwitzerlandDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA8 London School of Hygiene & Tropical Medicine, Faculty of Infectious Tropical Diseases, Disease Control Department, London, UKProgramme National d’Elimination du Choléra et de Lutte Contre les autres Maladies Diarrhéiques (PNECHOL-MD), Ministère de la Santé Publique, Hygiène et Prévention, Kinshasa, Congo (the Democratic Republic of the)Expanded Programme for Immunization, Ministry of Health, Democratic Republic of the Congo, Kinshasa, Congo (the Democratic Republic of the)Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USADepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USADepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USADepartment of Disease Control, London School of Hygiene and Tropical Medicine, London, UKDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USADepartment of Disease Control, London School of Hygiene and Tropical Medicine, London, UKProgramme Elargi de Vaccination, Ministère de la Santé Publique, Hygiène et Prévention, Bukavu, Congo (the Democratic Republic of the)Programme Elargi de Vaccination, Ministère de la Santé Publique, Hygiène et Prévention, Bukavu, Congo (the Democratic Republic of the)World Health Organization, Kinshasa, Congo (the Democratic Republic of the)Zone de Santé d`Uvira, Ministère de la Santé Publique, Hygiène et Prévention, Uvira, South Kivu, Congo (the Democratic Republic of the)Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USAProgramme National d’Elimination du Choléra et de Lutte Contre les autres Maladies Diarrhéiques (PNECHOL-MD), Ministère de la Santé Publique, Hygiène et Prévention, Kinshasa, Congo (the Democratic Republic of the)Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USABackground We conducted three serial cross-sectional representative surveys after a mass cholera vaccination campaign in Uvira, Democratic Republic of the Congo to (1) estimate the vaccination coverage and explore heterogeneity by geographic and demographic factors; (2) examine barriers and facilitators of vaccine uptake and (3) describe the changes in coverage over time and predict future coverage.Methods We collected data on sociodemographics, self-reported vaccination status, population movement and knowledge, attitudes and behaviours related to killed oral cholera vaccines (kOCVs) in August 2021, April 2022 and April 2023, approximately 11, 19 and 30 months postvaccination. We compared the characteristics of participants by vaccination status and explored the potential role of population movement as a cause for low coverage. We used an exponential decay model to predict the proportion of the population vaccinated with ≥1 dose of kOCV over time based on age-specific coverage.Results We enrolled 8735 participants from 1433 households across all surveys. Coverage in survey 1 (August 2021) was 55% for ≥1 dose of kOCV (95% CI 51 to 60) and 23% for ≥2 doses (95% CI 20 to 27). Vaccine refusal was associated with a lack of confidence in the vaccine’s safety, and 29% of unvaccinated adults reported it was unlikely they would accept kOCVs if an additional mass vaccination campaign was conducted in their area. Coverage of ≥1 one dose of kOCV declined on average by 18% per year (95% credible interval 14 to 23) and was 39% (95% CI 36 to 43) by survey 3 (approx. 30 months after second dose campaign).Conclusions Our findings suggest that in settings like Uvira, efforts to strengthen vaccine confidence are needed to achieve higher campaign coverage, and vaccine coverage dilution may be reduced by more frequent and coordinated geographic vaccination efforts.https://bmjpublichealth.bmj.com/content/3/1/e001035.full |
| spellingShingle | Oliver Cumming Andrew S Azman Espoir Bwenge Malembaka Jackie Knee Placide Okitayemba Welo Aimé Cikomola Aybüke Koyuncu Patrick Musole Bugeme Juan Dent Chloe Hutchins Hanmeng Xu Karin Gallandat Joseph Matundanya Delphin Rukakiza Merveille Nkombo Jaime Saidi Mufitini Baron Bashige Rumedeka Laurent Akilimali Elizabeth C Lee Challenges with achieving and maintaining oral cholera vaccine coverage: insights from serial cross-sectional representative surveys in a cholera-endemic community in the Democratic Republic of the Congo BMJ Public Health |
| title | Challenges with achieving and maintaining oral cholera vaccine coverage: insights from serial cross-sectional representative surveys in a cholera-endemic community in the Democratic Republic of the Congo |
| title_full | Challenges with achieving and maintaining oral cholera vaccine coverage: insights from serial cross-sectional representative surveys in a cholera-endemic community in the Democratic Republic of the Congo |
| title_fullStr | Challenges with achieving and maintaining oral cholera vaccine coverage: insights from serial cross-sectional representative surveys in a cholera-endemic community in the Democratic Republic of the Congo |
| title_full_unstemmed | Challenges with achieving and maintaining oral cholera vaccine coverage: insights from serial cross-sectional representative surveys in a cholera-endemic community in the Democratic Republic of the Congo |
| title_short | Challenges with achieving and maintaining oral cholera vaccine coverage: insights from serial cross-sectional representative surveys in a cholera-endemic community in the Democratic Republic of the Congo |
| title_sort | challenges with achieving and maintaining oral cholera vaccine coverage insights from serial cross sectional representative surveys in a cholera endemic community in the democratic republic of the congo |
| url | https://bmjpublichealth.bmj.com/content/3/1/e001035.full |
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