Strategies to Prevent Cholera Introduction during International Personnel Deployments: A Computational Modeling Analysis Based on the 2010 Haiti Outbreak

PLoS Medicine
Joseph A LewnardVirginia E Pitzer

Abstract

Introduction of Vibrio cholerae to Haiti during the deployment of United Nations (UN) peacekeepers in 2010 resulted in one of the largest cholera epidemics of the modern era. Following the outbreak, a UN-commissioned independent panel recommended three pre-deployment intervention strategies to minimize the risk of cholera introduction in future peacekeeping operations: screening for V. cholerae carriage, administering prophylactic antimicrobial chemotherapies, or immunizing with oral cholera vaccines. However, uncertainty regarding the effectiveness of these approaches has forestalled their implementation by the UN. We assessed how the interventions would have impacted the likelihood of the Haiti cholera epidemic. We developed a stochastic model for cholera importation and transmission, fitted to reported cases during the first weeks of the 2010 outbreak in Haiti. Using this model, we estimated that diagnostic screening reduces the probability of cases occurring by 82% (95% credible interval: 75%, 85%); however, false-positive test outcomes may hamper this approach. Antimicrobial chemoprophylaxis at time of departure and oral cholera vaccination reduce the probability of cases by 50% (41%, 57%) and by up to 61% (58%, 63%), resp...Continue Reading

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Citations

Nov 28, 2017·PLoS Neglected Tropical Diseases·Matthew D PhelpsVirginia E Pitzer
May 24, 2017·Antimicrobial Agents and Chemotherapy·Amber KunkelTed Cohen
Jul 26, 2019·Tropical Medicine & International Health : TM & IH·Matthew D PhelpsPeter K M Jensen
Jun 22, 2019·BMC Complementary and Alternative Medicine·Magdalena KomiazykPatrick Groves
Nov 23, 2017·The Journal of Infectious Diseases·Matthew PhelpsLone Simonsen
Aug 14, 2018·American Journal of Epidemiology·Joseph A LewnardMarc Lipsitch
Jun 24, 2018·Frontiers of Medicine·Ali A Rabaan
Oct 24, 2020·The Lancet Infectious Diseases·Ruwan RatnayakeFrancesco Checchi

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