Risk Map of Cholera Infection for Vaccine Deployment

The Eastern Kolkata Case

Youngae You, Mohammad Ali, Suman Kanungo, Binod Sah, Byomkesh Manna, Mahesh K Puri, G Balakrish Nair, S K Bhattacharya, Matteo Convertino, Jacqueline Deen, Anna Lopez, Thomas Wierzba, John David Clemens, Dipika Sur

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Despite advancement of our knowledge, cholera remains a public health concern. During March-April 2010, a large cholera outbreak afflicted the eastern part of Kolkata, India. The quantification of importance of socio-environmental factors in the risk of cholera, and the calculation of the risk is fundamental for deploying vaccination strategies. Here we investigate socio-environmental characteristics between high and low risk areas as well as the potential impact of vaccination on the spatial occurrence of the disease.

    Methods and Findings: The study area comprised three wards of Kolkata Municipal Corporation. A mass cholera vaccination campaign was conducted in mid-2006 as the part of a clinical trial. Cholera cases and data of the trial to identify high risk areas for cholera were analyzed. We used a generalized additive model (GAM) to detect risk areas, and to evaluate the importance of socio-environmental characteristics between high and low risk areas. During the one-year pre-vaccination and two-year post-vaccination periods, 95 and 183 cholera cases were detected in 111,882 and 121,827 study participants, respectively. The GAM model predicts that high risk areas in the west part of the study area where the outbreak largely occurred. High risk areas in both periods were characterized by poor people, use of unsafe water, and proximity to canals used as the main drainage for rain and waste water. Cholera vaccine uptake was significantly lower in the high risk areas compared to low risk areas.

    Conclusion:
    The study shows that even a parsimonious model like GAM predicts high risk areas where cholera outbreaks largely occurred. This is useful for indicating where interventions would be effective in controlling the disease risk. Data showed that vaccination decreased the risk of infection. Overall, the GAM-based risk map is useful for policymakers, especially those from countries where cholera remains to be endemic with periodic outbreaks. � 2013 You et al.
    Original languageEnglish
    Article numbere71173
    Pages (from-to)1-7
    Number of pages7
    JournalPLoS One
    Volume8
    Issue number8
    DOIs
    Publication statusPublished - 2 Aug 2013

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    Cholera Vaccines
    cholera
    Cholera
    Vaccines
    vaccines
    Infection
    infection
    vaccination
    Vaccination
    Disease Outbreaks
    Mass Vaccination
    Immunization Programs
    disease occurrence
    Rain
    corporations
    risk reduction
    Waste Water
    Public health
    Canals

    Cite this

    You, Y., Ali, M., Kanungo, S., Sah, B., Manna, B., Puri, M. K., ... Sur, D. (2013). Risk Map of Cholera Infection for Vaccine Deployment: The Eastern Kolkata Case. PLoS One, 8(8), 1-7. [e71173]. https://doi.org/10.1371/journal.pone.0071173
    You, Youngae ; Ali, Mohammad ; Kanungo, Suman ; Sah, Binod ; Manna, Byomkesh ; Puri, Mahesh K ; Nair, G Balakrish ; Bhattacharya, S K ; Convertino, Matteo ; Deen, Jacqueline ; Lopez, Anna ; Wierzba, Thomas ; Clemens, John David ; Sur, Dipika. / Risk Map of Cholera Infection for Vaccine Deployment : The Eastern Kolkata Case. In: PLoS One. 2013 ; Vol. 8, No. 8. pp. 1-7.
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    abstract = "Background: Despite advancement of our knowledge, cholera remains a public health concern. During March-April 2010, a large cholera outbreak afflicted the eastern part of Kolkata, India. The quantification of importance of socio-environmental factors in the risk of cholera, and the calculation of the risk is fundamental for deploying vaccination strategies. Here we investigate socio-environmental characteristics between high and low risk areas as well as the potential impact of vaccination on the spatial occurrence of the disease. Methods and Findings: The study area comprised three wards of Kolkata Municipal Corporation. A mass cholera vaccination campaign was conducted in mid-2006 as the part of a clinical trial. Cholera cases and data of the trial to identify high risk areas for cholera were analyzed. We used a generalized additive model (GAM) to detect risk areas, and to evaluate the importance of socio-environmental characteristics between high and low risk areas. During the one-year pre-vaccination and two-year post-vaccination periods, 95 and 183 cholera cases were detected in 111,882 and 121,827 study participants, respectively. The GAM model predicts that high risk areas in the west part of the study area where the outbreak largely occurred. High risk areas in both periods were characterized by poor people, use of unsafe water, and proximity to canals used as the main drainage for rain and waste water. Cholera vaccine uptake was significantly lower in the high risk areas compared to low risk areas. Conclusion: The study shows that even a parsimonious model like GAM predicts high risk areas where cholera outbreaks largely occurred. This is useful for indicating where interventions would be effective in controlling the disease risk. Data showed that vaccination decreased the risk of infection. Overall, the GAM-based risk map is useful for policymakers, especially those from countries where cholera remains to be endemic with periodic outbreaks. � 2013 You et al.",
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    author = "Youngae You and Mohammad Ali and Suman Kanungo and Binod Sah and Byomkesh Manna and Puri, {Mahesh K} and Nair, {G Balakrish} and Bhattacharya, {S K} and Matteo Convertino and Jacqueline Deen and Anna Lopez and Thomas Wierzba and Clemens, {John David} and Dipika Sur",
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    You, Y, Ali, M, Kanungo, S, Sah, B, Manna, B, Puri, MK, Nair, GB, Bhattacharya, SK, Convertino, M, Deen, J, Lopez, A, Wierzba, T, Clemens, JD & Sur, D 2013, 'Risk Map of Cholera Infection for Vaccine Deployment: The Eastern Kolkata Case', PLoS One, vol. 8, no. 8, e71173, pp. 1-7. https://doi.org/10.1371/journal.pone.0071173

    Risk Map of Cholera Infection for Vaccine Deployment : The Eastern Kolkata Case. / You, Youngae; Ali, Mohammad; Kanungo, Suman; Sah, Binod; Manna, Byomkesh; Puri, Mahesh K; Nair, G Balakrish; Bhattacharya, S K; Convertino, Matteo; Deen, Jacqueline; Lopez, Anna; Wierzba, Thomas; Clemens, John David; Sur, Dipika.

    In: PLoS One, Vol. 8, No. 8, e71173, 02.08.2013, p. 1-7.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Risk Map of Cholera Infection for Vaccine Deployment

    T2 - The Eastern Kolkata Case

    AU - You, Youngae

    AU - Ali, Mohammad

    AU - Kanungo, Suman

    AU - Sah, Binod

    AU - Manna, Byomkesh

    AU - Puri, Mahesh K

    AU - Nair, G Balakrish

    AU - Bhattacharya, S K

    AU - Convertino, Matteo

    AU - Deen, Jacqueline

    AU - Lopez, Anna

    AU - Wierzba, Thomas

    AU - Clemens, John David

    AU - Sur, Dipika

    PY - 2013/8/2

    Y1 - 2013/8/2

    N2 - Background: Despite advancement of our knowledge, cholera remains a public health concern. During March-April 2010, a large cholera outbreak afflicted the eastern part of Kolkata, India. The quantification of importance of socio-environmental factors in the risk of cholera, and the calculation of the risk is fundamental for deploying vaccination strategies. Here we investigate socio-environmental characteristics between high and low risk areas as well as the potential impact of vaccination on the spatial occurrence of the disease. Methods and Findings: The study area comprised three wards of Kolkata Municipal Corporation. A mass cholera vaccination campaign was conducted in mid-2006 as the part of a clinical trial. Cholera cases and data of the trial to identify high risk areas for cholera were analyzed. We used a generalized additive model (GAM) to detect risk areas, and to evaluate the importance of socio-environmental characteristics between high and low risk areas. During the one-year pre-vaccination and two-year post-vaccination periods, 95 and 183 cholera cases were detected in 111,882 and 121,827 study participants, respectively. The GAM model predicts that high risk areas in the west part of the study area where the outbreak largely occurred. High risk areas in both periods were characterized by poor people, use of unsafe water, and proximity to canals used as the main drainage for rain and waste water. Cholera vaccine uptake was significantly lower in the high risk areas compared to low risk areas. Conclusion: The study shows that even a parsimonious model like GAM predicts high risk areas where cholera outbreaks largely occurred. This is useful for indicating where interventions would be effective in controlling the disease risk. Data showed that vaccination decreased the risk of infection. Overall, the GAM-based risk map is useful for policymakers, especially those from countries where cholera remains to be endemic with periodic outbreaks. � 2013 You et al.

    AB - Background: Despite advancement of our knowledge, cholera remains a public health concern. During March-April 2010, a large cholera outbreak afflicted the eastern part of Kolkata, India. The quantification of importance of socio-environmental factors in the risk of cholera, and the calculation of the risk is fundamental for deploying vaccination strategies. Here we investigate socio-environmental characteristics between high and low risk areas as well as the potential impact of vaccination on the spatial occurrence of the disease. Methods and Findings: The study area comprised three wards of Kolkata Municipal Corporation. A mass cholera vaccination campaign was conducted in mid-2006 as the part of a clinical trial. Cholera cases and data of the trial to identify high risk areas for cholera were analyzed. We used a generalized additive model (GAM) to detect risk areas, and to evaluate the importance of socio-environmental characteristics between high and low risk areas. During the one-year pre-vaccination and two-year post-vaccination periods, 95 and 183 cholera cases were detected in 111,882 and 121,827 study participants, respectively. The GAM model predicts that high risk areas in the west part of the study area where the outbreak largely occurred. High risk areas in both periods were characterized by poor people, use of unsafe water, and proximity to canals used as the main drainage for rain and waste water. Cholera vaccine uptake was significantly lower in the high risk areas compared to low risk areas. Conclusion: The study shows that even a parsimonious model like GAM predicts high risk areas where cholera outbreaks largely occurred. This is useful for indicating where interventions would be effective in controlling the disease risk. Data showed that vaccination decreased the risk of infection. Overall, the GAM-based risk map is useful for policymakers, especially those from countries where cholera remains to be endemic with periodic outbreaks. � 2013 You et al.

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    KW - geographic distribution

    KW - health promotion

    KW - high risk population

    KW - human

    KW - India

    KW - infection control

    KW - infection prevention

    KW - infection risk

    KW - low risk population

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    KW - mass immunization

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    KW - product safety

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    KW - risk reduction

    KW - social environment

    KW - social status

    KW - Administration, Oral

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    KW - Cholera Vaccines

    KW - Environmental Monitoring

    KW - Humans

    KW - Models, Statistical

    KW - Population Density

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    KW - Vibrio cholerae

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    You Y, Ali M, Kanungo S, Sah B, Manna B, Puri MK et al. Risk Map of Cholera Infection for Vaccine Deployment: The Eastern Kolkata Case. PLoS One. 2013 Aug 2;8(8):1-7. e71173. https://doi.org/10.1371/journal.pone.0071173