Monday, December 20, 2010


(Reuters) - By Jane Sutton

MIAMI - The Pan American Health Organization hopes to start a cholera vaccination program in Haiti by April but must first boost and fund production of the vaccine that is in short supply, the group said on Friday.

The diarrheal disease appeared in the poor Caribbean nation in October for the first time in decades and has sickened 105,000 people and killed more than 2,000, Haitian health officials have said.

PAHO, the American division of the World Health Organization, had previously opposed vaccination in Haiti on grounds that it would be too difficult and expensive.

It changed course on Friday and recommended using the vaccine in Haiti, partly because it has discovered a stockpile of additional vaccine and partly out of recognition that the outbreak would not be halted any time soon.

"This is a disease caused by a bacterium that has a foothold in Haiti and will be in Haiti causing endemic cholera for many years to come," Dr. Jon Andrus, deputy director of PAHO, said in a webcast from Washington. "So if we have options to better our response we really, really need to study those carefully."

Cholera is caused by a water-borne bacteria called Vibrio cholera and is transmitted when contaminated human fecal matter gets into water, food or onto someone's hands. Many people show no symptoms but can pass it along and cholera can cause extremely severe diarrhea and vomiting that will kill within hours by dehydrating victims.

There are only about 200,000 to 300,000 doses of cholera vaccine available in the world at present, and only two companies produce it, said Dr. Ciro de Quadros, executive vice president of the Sabin Vaccine Institute.

Sanofi Aventis' India-based division Shantha makes a vaccine called Shanchol for about $1 a dose, with up to three doses needed for protection, while Netherlands-based Crucell makes another called Dukoral.

PAHO recently discovered a stockpile of more than 1 million doses of Shanchol that would take several months to pack and label, de Quadros said. It has not been prequalified for purchase by the WHO, but that prequalification is expected in the first or second quarter of 2011, he said.

Doctors meeting on Friday under the auspices of PAHO recommended that it meet with the manufacturers to see if they could ramp up production and work with organizations that could help finance the purchase of the vaccines.

"If there would be a (financial) guarantee, both suppliers could produce 2 to 3 million doses a year," de Quadros said.

With that in place, PAHO could start a vaccine-demonstration project in Haiti in March or April, he said.

The doctors said they do not know how many doses would be needed in Haiti and that there were many logistical challenges to work out. Haiti is deeply impoverished and struggling to rebuild from a catastrophic January earthquake that killed more than 250,000 people.

Andrus said the vaccine must be considered "an extra tool in the toolkit" to fight cholera.

Health organizations have so far focused on treating cholera patients with a rehydration fluid containing special sugars and salts, and on educating people about how to halt its spread through hand-washing and sanitation measures.

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