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Crucell to move Dukoral® and rCTB bulk produc

56 Posts
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  1. forum rang 6 de tuinman 14 augustus 2010 13:34
    VN: cholera vastgesteld in Pakistan
    ISLAMABAD (ANP) - De Verenigde Naties hebben zaterdag bevestigd dat in Pakistan zeker één persoon aan cholera is gestorven. De overledene woonde in Mingora, de belangrijkste stad in het noordwestelijke district Swat.

    Omdat de volkerenorganisatie bezorgd is over uitbreiding van de gevaarlijke infectieziekte, onderzoekt zij niet meer of mensen aan de ziekte lijden, maar behandelt zij iedereen die aan acute diarree lijdt, alsof hij cholera onder de leden heeft, aldus een woordvoerder van de VN-hulporganisatie OCHA. Zeker 36.000 mensen lijden aan diarree. ,,Wij suggereren niet dat iedereen die aan acute diarree lijdt, cholera heeft, maar cholera is zeker een zorg en daarom voeren wij onze inspanningen om cholera te behandelen op'', aldus de woordvoerder.

    Pakistan schat dat mogelijk twintig miljoen mensen in meer of mindere mate door de overstromingen als gevolg van hevige moessonregens zijn getroffen.

    Trouw
  2. forum rang 6 de tuinman 16 augustus 2010 12:07
    Ik zou graag jullie meningen over Dukoral willen weten. Kan/gaat Cr profiteren van de tragische gebeurtenissen in Pakistan?
    Wordt dit produkt ook gebruikt om de bewoners van Pakistan te helpen of wordt het goedkopere produkt van Shanta al gebruikt?
    Het moet haas wel effect hebben onder de reizigers die gewaarschuwd zijn voor cholera.
    Of is de produktie-capaciteit van Cr te beperkt om nog veel meer te kunnen verkopen?
    Graag jullie mening!
  3. forum rang 4 aossa 16 augustus 2010 12:29
    Te duur !

    Moet vooraf ingenomen worden (2 doses) om effectief te zijn.

    Crucell heeft meerdere malen het medicijn gratis ter beschikking gesteld bij uitbraken (om de voorraden op te ruimen of als reclame, wie zal het zeggen).

    Imo zijn gezondheidswerkers (en journalisten, politici) hun doelgroep (zie vooraf innemen en prijs).
  4. flosz 30 september 2010 20:42
    Cholera in Africa spreading at 'alarming' rate
    September 30, 2010 By ARTIS HENDERSON , Associated Press Writer
    (AP) -- An alarming number of new cholera cases have been reported in the West African nations of Cameroon, Chad, Niger and Nigeria, an international aid agency said Thursday
    While cholera is endemic to the region, far more cases than usual have been reported, said the U.K.-based office of Doctors Without Borders.
    Nigeria experienced its worst cholera outbreak in 19 years earlier this month when 13,000 were sickened and nearly 800 died in two months. That outbreak then spread to neighboring Cameroon, Chad and Niger, where more than 300 people died.
    UNICEF has said that Cameroon is suffering the worst outbreak of cholera in 20 years.
    Cholera is a waterborne bacterial infection spread through contaminated water. It causes severe diarrhea and vomiting that can lead to dehydration and death within hours. Treatment involves administering a salt and sugar-based rehydration serum.
    Some experts worry that recent flooding in Nigeria might lead to a spread in cholera infections. Gautam Chatterjee, the aid group's head of mission in Nigeria, said isolated cases have been reported.

    www.physorg.com/news205072314.html

    *******************
    No Vaccines in the Time of Cholera
    Martin Enserink
    With millions of people homeless, clean drinking water in short supply, and the infrastructure in tatters, water-borne diseases are one of the biggest threats in the Pakistani regions ravaged by floods. Experts are particularly worried about cholera, a disease that can cause explosive and lethal outbreaks. The International Vaccine Institute is lobbying for production of an inexpensive new oral cholera vaccine to be ramped up. But so far, the Pakistani government has no plans for a mass vaccination campaign, and the World Health Organization does not advocate one. One key problem: The vaccine requires two doses, given 2 weeks apart, which is nearly impossible to do in a massive population on the move, experts say. The debate is just the latest in an ongoing tussle about exactly how useful the new vaccine, called Shanchol—and an older, more expensive vaccine called Dukoral—is.
    www.sciencemag.org/cgi/content/short/...
  5. flosz 5 november 2010 11:34
    Cholera Stricken Haiti Gets Help From Brazil

    A military plane left Rio de Janeiro Thursday with supplies to aid in the cholera outbreak in Haiti. The first shipment of the promised $2 million in aid contained sodium hypochlorite, IV fluids, oral rehydration therapy, and injecting equipments according to the World Health Organization (WHO).

    Nine Brazilian professionals started training in the town of Carrefour earlier in the week, while two Brazilian epidemiologists were dispatched to Haiti with the shipment.

    Brazil's aid arrives in Haiti as the Pan American Health Organization (PAHO) makes a recommendation of not using cholera vaccination immediately in Haiti's outbreak. PAHO recommends that preventative measures of future cholera outbreaks spearhead the focus of aid at this stage of Haiti's outbreak.
    CHOLERA PREVENTION COMES FROM GOOD HYGIENE, THE WASHING OF HANDS, AND CLEAN WATER.

    PAHO ALSO RECOMMENDS AGAINST THE USE OF INJECTION VACCINES BASED UPON A WHO ADVISORY ON THE USE OF VACCINATIONS. USING INJECTION VACCINATIONS ON A CHOLERA OUTBREAK ARE LIMITED TO A SHORT-TERM FIX.

    THE VACCINES BEST FOR THE CURRENT OUTBREAK IN HAITI ARE ORAL VACCINATIONS. Two oral vaccinations, Dukoral and Shunchol, are available globally, but only one is authorized by WHO. DUKORAL IS AUTHORIZED AND WILL ONLY BE AVAILABLE IN A LIMITED AMOUNT OF DOSAGES.

    Currently, both Haiti's Ministry of Culture and Communication along with the Ministry of Public Health and Population work to release national public messages on cholera prevention.

    technorati.com/politics/article/chole...
  6. flosz 17 november 2010 17:13
    Cholera Vaccine In The Caribbean: A Hypothetical Lifesaver
    The official count of cholera deaths in Haiti has surpassed 1,000 and authorities predict the disease will spread to other Caribbean countries.

    There are two effective oral cholera vaccines that cost as little as $1 a dose. Could they prevent a lot of sickness and death in the coming months? Hypothetically. But don't bet the farm on it.
    The problem, experts tell Shots, is there are only something like 500,000 doses of the vaccine on the entire planet. You read that right. There are only 500,000 doses of vaccine for a disease that sickens up to five million people a year and kills around 120,000.

    What's more, since each person requires two doses, there's only enough cholera vaccine to immunize, at most, 250,000 people. And if you're also trying to protect young kids, who need three doses, then even fewer people can get protected.
    And anyway, meeting the immediate threat assumes the entire world's stockpile could be airlifted in the foreseeable future to island of Hispaniola, shared by Haiti and Dominican Republic. Together their population is around 18 million.
    Dr. Jon Andrus, deputy director of the Pan American Health Organization and an immunization expert, says PAHO recently "spent a lot of time discussing with some of the best experts in the world" whether to deploy cholera vaccine in Haiti and the Dominican Republic. There is a public health rationale for it, they decided.
    But when they found out how pitiful the world's cholera vaccine stocks are, Andrus told Shots, "we dropped that discussion and didn't feel we needed to pursue it. There just wouldn't have been the supply. The question is: Who would you vaccinate?"
    Or rather: Who would you deny the vaccine? It's not far-fetched to imagine vaccine riots.
    Many public health experts say you can't use cholera vaccine during an epidemic to contain it. It moves too fast, they say. There are three infected-but-asymptomatic people for every obviously sick person, so you can't tell whom it's too late to vaccinate. It takes several weeks to vaccinate susceptible people and achieve effective immunity.
    "If you're in the middle of a rip-roaring outbreak, the person you vaccinate would already have been exposed and the marginal gain from vaccination is not there," Andrus says.
    Dr. John Clemens doesn't buy that. He's director-general of the International Vaccine Institute in Seoul, which developed one of the oral cholera vaccines with support from the Bill and Melinda Gates Foundation.
    "THERE ARE A LOT OF ASSUMPTIONS MADE BY PEOPLE WHO SAY YOU CAN'T REALLY CONTAIN CHOLERA WITH A VACCINE," CLEMENS TOLD SHOTS. "IN FACT, IT'S NEVER BEEN TRIED SO WE REALLY DON'T KNOW." HE POINTS OUT THAT CURRENT VACCINES GIVE CONSIDERABLE PROTECTION AFTER THE FIRST DOSE.
    However you come down on this debate, most would acknowledge there's a difference between containment and control. Containment means acting in the short term to keep a disease within a confined area. Controlling it means reducing the toll of illness and death over a longer period of time.
    HAITI WILL SOON TRANSITION FROM THE ACUTE OUTBREAK PHASE TO LONGER-TERM SPREAD, WITHIN ITS BORDERS AND BEYOND. THAT'S WHEN CHOLERA VACCINE COULD REALLY MAKE A DIFFERENCE.
    "There have been some studies to show that if you're in a community outside the outbreak and you have time to vaccinate, there might be a benefit," Andrus says, cautiously.
    Although cholera is spreading rapidly in Haiti – so far six of the country's 10 provinces have been affected to greater or lesser degree — there are still communities that have been relatively unaffected. And there will be time to make a difference for many.
    COMPUTER MODELS "PROJECT ABOUT 200,000 CASES OVER THE NEXT SIX TO 12 MONTHS," Andrus said during a media teleconference Tuesday. Unless Haiti does a lot better at preventing death from cholera in the near term, we can predict that something like 10,000 people will die.
    Moreover, Latin America's experience with a major cholera pandemic beginning in 1991 makes it "likely that cholera will spread to other countries in the hemisphere" in the foreseeable future, Andrus adds.
    THE UNIVERSITY OF WASHINGTON'S IRA LONGINI SAYS YOU DON'T HAVE TO VACCINATE EVERYBODY TO HAVE A BIG EFFECT. "ONCE YOU GET 60 TO 70 PERCENT COVERAGE, YOU SHUT OFF TRANSMISSION OF CHOLERA," LONGINI TOLD SHOTS. IT'S A WELL-KNOWN PHENOMENON CALLED HERD IMMUNITY.
    BUT USING VACCINES TO LIMIT THE DISASTER WOULD REQUIRE A MASSIVE INCREASE IN PRODUCTION OF THE TWO VACCINES – DUKORAL, MADE BY A DUTCH COMPANY, AND SHANCHOL, a newer vaccine made by an Indian firm, Shantha, that last year announced it was ready to turn out five million doses.
    Even though there are only 250,000 or so doses of Shanchol that are ready to ship, Clemens of the International Vaccine Institute says there are many times that number available in bulk form. That vaccine could be shipped out if somebody stepped up and said we're going to do something big and bold to mitigate the Caribbean outbreak.
    That would also take uncharacteristically fast footwork by THE WORLD HEALTH ORGANIZATION, WHICH HAS NOT YET "PREQUALIFIED" SHANCHOL – a seal of approval that clears the vaccine's purchase by agencies like PAHO.
    CLEMENS SAYS SHANCHOL "HAS BEEN AT THE ABSOLUTE BACK OF THE QUEUE" FOR PREQUALIFICATION. "IT'S NOT EVEN ON THE PRIORITY LIST FOR CONSIDERATION, SO CERTAINLY ONE THING WHO COULD DO IS MOVE SHANCHOL UP IN THE QUEUE SO IT COULD BE PREQUALIFIED."
    But the fundamental question is: Why is cholera vaccine in such short supply?
    When Shots put that to Andrus he said: "It's hard to mobilize a commitment to produce medicines or vaccines to tackle diseases of poverty, disease of developing countries, where there might not be the profit you see with other diseases."
    Longini was more blunt: "It's because of who's affected. CHOLERA IS IGNORED BECAUSE IT'S A DISEASE OF THE POOREST OF THE POOR."
    www.npr.org/blogs/health/2010/11/17/1...

    PAHO Press Briefing on the Cholera Outbreak in Haiti, Tuesday, 16 November 2010 : www.youtube.com/watch?v=SfCBoHakc34

    Photographing Cholera’s Awful Toll in Haiti
    lens.blogs.nytimes.com/2010/11/16/pho...
    (The A.P. makes vaccinations with Dukoral available to its staff members, Mr. Lyon said.)
  7. flosz 17 november 2010 17:17
    by JurgenBrul November 15, 2010 5:39 PM EST
    Hello CBS friends, We Need CHOLERA VACCINATION and HEALTHY SANITATION NOW, otherwise we all will be Diseased! President Barack Obama and Secretary of Health and Human Services Kathleen Sebelius Must Immediately Improve the Health, Safety and Well-being of ALL People(included Haitians and Africans)! Conclusion: OUR HEALTH IS IMPORTANT! For More Information about CHOLERA VACCINATION go to: www.crucell.com/Products/Dukoral
    AND
    www.youtube.com/watch?v=fG0FFqYofuM
    Greetings, Jurgen R. Brul
    www.cbsnews.com/video/watch/?id=7051428n
    ***********
    Cholera Vaccine for Haiti Relief Workers

    The Cholera outbreak currently ravaging Haiti is prompting aid workers to try to get vaccinated prior to travel. Unfortunately, there is not a vaccine that is licensed for use in America. Canada does offer the Dukoral vaccine for protection against Cholera. The Dukoral cholera vaccine is produced by Crucell Sweden and their website can be visited at www.SBLVaccines.se/en/ . Currently, no country in the world requires the cholera vaccine for entry requirements.
    The Cholera Vaccine:
    The Dukoral cholera vaccine contains a mixture of inactivated Vibrio cholera bacteria and a non-toxic component of the toxin secreted by the cholera bacteria. The goal of the vaccine is to stimulate the body’s immune response to the infection without actually make the recipient ill. The granules containing the vaccine are to be dissolved into a glass of water, then drank.
    Cholera Basics:
    Cholera is a bacterial infection that causes profuse, watery diarrhea. Vomiting is also common. The massive water loss caused by the diarrhea can lead to electrolyte abnormalities and eventually death from dehydration, if left untreated. The bacteria secretes a “cholera toxin” which is responsible for the majority of symptoms.
    Cause:
    Vibrio Cholerae groups O-1 or O-139; many other serogroups of Vibrio Cholerae exist with or without the cholera toxin gene and can cause similar presenting illness. Vibrio O-1 has two biotypes: Classical and El Tor. Each of these biotypes has two different serotypes: Inaba and Ogawa. The symptoms of these variations is indistinguishable and identical.
    Transmission:
    V. Cholerae is a free-living organism that is found living in both fresh and brackish wasters, often associated with plankton, shellfish and aquatic plants. Cholera infections is most commonly acquired from drinking water that is naturally infected with V. Cholerea or has been previously infected with the feces of a previously infected person. Other common routes of infection include contaminated fish/shellfish, produce or cooked grains that have not been properly heated/cooked. Person to person transmission, even with healthcare workers is rare. www.wellsphere.com/general-medicine-a...
  8. flosz 17 november 2010 17:25
    Vaccine donations
    In addition to the donation of InflexalR V in Korea, Crucell
    donated 690,000 doses of MoRu-ViratenR vaccine against
    measles and rubella to Unicef to assist earthquake victims in
    Haiti. The donation was made as part of the emergency aid
    campaign organized by the International Federation of
    Pharmaceutical Manufacturers & Associations (IFPMA), of
    which Crucell is a member. Crucell also offered 879,000 doses of
    Hepavax-GeneR to the disaster relief campaign. The offer was
    under consideration when this report went to press.
    jaarverslag.info/annualreports/crucel...
  9. flosz 25 november 2010 07:40
    Cholera and vaccine experts urge United States to stockpile vaccine
    November 24, 2010
    As the cholera epidemic in Haiti continues to rage, public health workers are focusing their efforts on treating the tens of thousands who have already been hospitalized with cholera-like symptoms and providing clean water and adequate sanitation to control the disease's spread.
    Three different oral vaccines are commonly used to prevent cholera in parts of the world where the disease is endemic: Dukoral, manufactured by Crucell; Shanchol, made by Shantha Biotechnics; and mORC-VAX from VaBiotech. All are relatively inexpensive, easy to administer, and reduce the risk of infection by more than eighty percent for at least six months. In adults, maximum immunity is achieved after two doses of vaccine; children usually receive three doses.
    Dukoral is on the World Health Organization's list of prequalified medicines, which international agencies use to ensure quality, safety, and efficacy of the drugs they purchase for use in resource-limited areas; Shanchol is awaiting WHO prequalification. "Remarkably," the authors note in their editorial, "there are fewer than 400,000 total doses of oral cholera vaccines (either Dukoral or Shanchol) available at present for shipment from their manufacturers, making it impossible to consider large-scale vaccination of at-risk populations with the recommended two- or three-dose regimens of either product." In light of this global shortage of the vaccine, the authors urge the United States to establish its own stockpile of cholera vaccine that could be deployed to areas at high risk for major outbreaks.
    The risk for a cholera outbreak can rise rapidly in the wake of a man-made or natural disaster, when populations can be forced into overcrowded camps with poor sanitation – such as the 1.3 million people living in Haitian refugee camps as the country recovers from its January, 2010 earthquake. Flood-ravaged areas of Pakistan and the slums of Santo Domingo in Haiti's neighbor, the Dominican Republic, are similarly at risk, Waldor and his colleagues say. A ready supply of vaccine could limit the impact of an outbreak dramatically, they assert.
    Further, the scientists argue, the benefits of a vaccine would exceed its direct impact on public health. Disease outbreaks can impede recovery efforts to continue following natural or man-made disasters. Cholera outbreaks also destabilize poor communities, promoting poverty and potentially igniting or exacerbating conflict, they say.
    The costs of maintaining a stockpile of several million doses of cholera vaccine in the United States would be low but the humanitarian and diplomatic benefits would be enormous, the authors conclude.
    Provided by Howard Hughes Medical Institute
    www.physorg.com/news/2010-11-cholera-...

    Would cholera vaccines have helped in Haiti? - November 24, 2010
    Three leading researchers today called for the United States to create a national stockpile of cholera vaccines that could be quickly deployed worldwide whenever an outbreak occured, In an opinion article published online by the New England Journal of Medicine the researchers (pictured from left to right) – Matthew Waldor, a cholera researcher at Harvard Medical School in Boston, Peter Hotez president of the Sabin Vaccine Institute in Washington DC, and John Clemens, head of the International Vaccine Institute in Seoul – argue that vaccination could have an enormous impact in controlling cholera outbreaks, such as the current one raging in Haiti, and also serve US foreign policy interests, through "vaccine diplomacy."
    The question of whether vaccine could have helped in Haiti - or help in future outbreaks - is controverial, however. It's one issue that I've addressed in a long analysis on the Haiti outbreak published in this week's issue of Nature. I've excerpted the relevant part in full below, which describes how those working in the field remain highly sceptical of the utility of cholera vaccine in an outbreak situation.
    "When the cholera outbreak started in Haiti, health agencies briefly contemplated using vaccines to try to curb it. But they abandoned the idea once it became clear that the available global production was completely insufficient for an effective vaccination campaign — only a few hundred thousand doses would have been available, and even these would have taken weeks to manufacture, whereas millions of doses were needed.
    Only one cholera vaccine — Dukoral — is approved by the World Health Organization (WHO). Made by the small Dutch company Crucell, based in Leiden, it is aimed at people travelling to cholera-endemic areas, and as such is too expensive to be widely deployed in the developing world. A second vaccine called Shanchol, already licensed in India, is currently going through the WHO’s approval process. Developed by the International Vaccine Institute in Seoul, with support from the Bill & Melinda Gates Foundation, the vaccine is produced by Shantha in Hyderabad, India, and should cost less than US$1 a dose.
    Even if sufficient Dukoral or Shanchol had been available at the start of the Haitian outbreak, it might have had little impact. Two doses of the vaccines have to be given a fortnight apart, with protective immunity taking another week to form. Mounting a large vaccination campaign also causes inevitable delays. So it is by no means clear that vaccination would have made any major dent in the spread of the disease (such delays have been experienced in past reactive vaccination campaign during meningitis outbreaks in Africa -- see my recent article on this here).
    The logistics would have been daunting, says Claire-Lise Chaignat, coordinator of the WHO’s Global Task Force on Cholera Control. Just vaccinating the 2 million people in the Haitian capital Port-au-Prince would have required rapid deployment of some 4 million vaccine doses. That’s a huge logistical challenge in any situation, but in the dire conditions Haiti now finds itself in it would be “almost impossible”, she says.
    Had sufficient vaccine been available, Jon Andrus, deputy director of the Pan American Health Organization, says that he would have considered trying vaccination in case it had a positive impact. Pre-emptive vaccination of people in the neighbouring Dominican Republic could also have made sense, he says.
    In the longer term, vaccination for cholera deserves further study, says Robert Quick, an epidemiologist at the Enteric Diseases Epidemiology Branch of the Centers for Disease Control and Prevention in Atlanta, Georgia. If a longer-lasting and highly efficient single-dose vaccine could be developed it might make a significant impact on outbreaks such as Haiti’s. A single-dose vaccine called Orochol has been developed, but its manufacturer, the Swiss company Berna Biotech (acquired by Crucell, based in Berne, in 2006), stopped making it in 2004 after switching its limited production facilities to make another vaccine.
    But Quick emphasizes that a single-dose vaccine would not be a panacea, and stark choices would remain. Mounting a vaccine campaign during an outbreak takes away scarce resources and staff, he argues. “Do you want staff treating people, or vaccinating?” he asks. “The first priority is saving lives.”
    Posted by Declan Butler on November 24, 2010
    blogs.nature.com/news/thegreatbeyond/...
  10. flosz 25 november 2010 16:10
    A National Cholera Vaccine Stockpile — A New Humanitarian and Diplomatic Resource
    ….
    Efforts to create safe and effective vaccines for the prevention of cholera have a long history. Parenteral vaccines have not proved to be effective, but there are several oral vaccines for cholera that have proved to be safe and reasonably effective in parts of the world where cholera is endemic and that even provide some degree of herd immunity.1 Three oral cholera vaccines are the most widely used. One consists of killed V. cholerae cells formulated with recombinant cholera toxin B (Dukoral, Crucell). Since 1991, Dukoral has been licensed in more than 60 countries, and it is prequalified by the WHO for United Nations purchase and has been used previously in crisis or refugee situations in Indonesia, Sudan, and Uganda, as well as in densely populated urban slums in Mozambique
    …..
    dx.doi.org/10.1056/NEJMp1012300
  11. flosz 3 december 2010 17:03
    Cholera tightens grip on Haiti
    Those tackling the epidemic are struggling to keep pace with an escalating crisis.
    Declan Butler
    As cholera rampages through Haiti, some epidemiologists are warning that the country could face more than half a million cases over the coming year. Yet tracking and treating the disease is proving increasingly difficult as civil unrest grips the county.
    Roughly 20,000 clinical cases, and 1,100 deaths, have officially been reported since the outbreak was first detected on 21 October in the Artibonite region of Haiti — figures likely to be underestimates, say epidemiologists, given the many additional cases in the wider community. "It's spreading like wildfire," says Andrew Camilli, a cholera researcher at Tufts University School of Medicine in Boston, Massachusetts (see 'Epidemic proportions'). www.nature.com/news/2010/101123/full/...
    As the current Haitian population has never been exposed to cholera, they lack any immunity to the disease, which makes the toll even greater. Vaccination might have helped, but it has never been tested during a large cholera outbreak and was not an option in Haiti because of the vaccine's scarcity and the logistical difficulties in getting it to people in time (see 'Would cholera vaccines have helped in Haiti?'). www.nature.com/news/2010/101123/full/...

    Cholera is caused by the bacterium Vibrio cholerae, transmitted through contaminated water supplies or by direct contact with infective faecal material. Haiti already lacked clean water and basic sanitation, and conditions have deteriorated further following January's huge earthquake (see Nature 467, 1018–1019; 2010) and Hurricane Tomas in early November. www.nature.com/news/2010/101025/full/...
    Some 80% of symptomatic cholera cases are mild or moderate, but 20% cause severe dehydration from watery diarrhoea that can kill within hours if untreated. Until the 1970s, when oral rehydration therapy was widely introduced, death rates during outbreaks often exceeded 50%. But cholera is eminently treatable if patients are promptly rehydrated, and public-health responses to cholera epidemics typically reduce mortality rates to below 1%.
    Experts think that conditions in Haiti are resulting in far higher death rates than this. At the beginning of the outbreak, mortality was estimated at around 9%, falling to an estimated 4–6% over the past few weeks as patients began to be treated.
    That gain, however, has been wiped out by riots that were fanned by rumours that Nepalese UN peacekeepers were the source of the outbreak. The row over the source has been self-defeating, says Jon Andrus, deputy director of the Pan American Health Organization (PAHO), the regional office of the World Health Organization. With many of the sick unable to get past roadblocks to reach treatment centres, and deliveries of supplies held up, death rates have again soared past 9%, he says. The precise death toll is uncertain, like everything else about the outbreak. PAHO relies partly on a vast network of humanitarian groups and non-governmental organizations, such as Doctors Without Borders and the UN Children's Fund, to collect and report data from the field. Many of these groups aren't coordinated well with each other, and Andrus says that it's a huge challenge to ensure data quality, adherence to a standardized cholera case definition, and timely reporting. "Coordinating these groups on a normal day in Haiti would be difficult enough, but in post-earthquake Haiti in the middle of a cholera outbreak, it becomes a huge challenge," he says.
    For every clinical case of cholera there will be several undetected asymptomatic carriers shedding bacteria and spreading disease, complicating predictions of how the epidemic will spread. But the data are often good enough for their key functions: pinpointing trends such as a rapid increase of cases in an area, or the appearance of geographical clusters. These hotspots can then be targeted for rapid intervention.
    Last week, PAHO announced that the epidemiology suggested that 200,000 more cases could be expected in Haiti over the next year, but Andrus says that more recent estimates are likely to raise that figure to more than 500,000. Having these numbers is crucial to making sure that enough lifesaving supplies and staff are on hand when and where they are needed. "We are doing everything possible to keep ahead of the game, to be weeks in advance, so that we don't get into a situation where we run out of supplies," he says.
    Health officials are also alert to the risk that the Haiti outbreak could spread further into the neighbouring Dominican Republic, where cases have been reported, and far beyond. Experts are mindful of how a 1991 outbreak in Peru — the first in the Americas in a century — led to a suite of entrenched large cholera outbreaks across the Americas in the ensuing decade (except the Caribbean). "We've put the whole hemisphere on alert," says Andrus.
    www.nature.com/news/2010/101123/full/...
  12. flosz 11 december 2010 12:11
    Experts call for vaccination, antibiotics in Haiti

    WASHINGTON, Dec 10 (Reuters) - Simply setting up clinics to treat Haitians with cholera is not doing anywhere near enough to tackle the epidemic there, health experts said on Friday, calling for intensive vaccination and more use of antibiotics.
    Their recommendation, published in the Lancet medical journal, adds to a growing chorus of voices speaking in support of a vaccination program.
    Health authorities, including the Pan-American Health Organization, had argued against vaccination, saying it would be too difficult and expensive.
    But Paul Farmer of Harvard Medical School and colleagues at his organization Partners In Health said current strategies are not working.
    "Rehydration alone without any antibiotics, in our view, is not a good idea, even for moderate cases of cholera," Farmer told reporters in a telephone briefing.
    Haiti's health ministry reports that more than 91,000 people have been sickened by cholera since the outbreak began in October, with more than 2,000 deaths. More than 3 percent of patients are dying -- a high death rate for cholera.
    Cholera is caused by a water-borne bacteria called Vibrio cholerae. It 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.
    Standard treatment is a rehydration fluid containing special sugars and salts but Farmer's team said this is not doing enough in Haiti.
    "Sometimes we are seeing them really late, when they are very ill and being carried in. Treatment needs to be much more aggressive," Farmer said.
    PAHO, the American division of the World Health Organization, has opposed vaccination. But earlier on Thursday PAHO's Dr. Jon Andrus told NPR that his organization had discovered more than 1 million doses of oral cholera vaccine stockpiled and was rethinking its stance.
    Sanofi Aventis' (SASY.PA) 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 (CRXL.O) makes another oral vaccine called Dukoral.

    "BOTH SHANCHOL AND DUKORAL ARE NEEDED HERE, AND PRODUCTION OF THESE VACCINES SHOULD BE RAMPED UP, AS CHOLERA EXPERTS HAVE ARGUED FOR THE PAST DECADE," FARMER'S TEAM(OF HARVARD MEDICAL SCHOOL) WROTE.
    www.reuters.com/article/idUSN10118681...

    Five complementary interventions to slow cholera: Haiti

    There are two vaccines on the market:
    one, Dukoral, costs US$6 per dose to manufacture;13 the
    second, Shanchol, costs $1 per dose to manufacture.9
    With economies of scale, the costs would drop further,
    as we have learned not only with other vaccines but also
    in following the costs of antiretroviral therapy and other
    large-scale treatment eff orts.14
    Further, cholera is unlikely to disappear from Haiti
    any time soon. The El Tor strain will probably become
    endemic in Haiti. Bangladesh is now in its fi fth decade
    of an El Tor epidemic; epidemics caused by other
    strains have trailed off within 20 years.9 But research in
    Bangladesh and India suggests that, when the effi cacy
    of the vaccine is added to a substantial herd eff ect,
    protection rates can climb over 90% and protection can
    last for up to 3 years.9 Although large-scale vaccination
    might not prevent cholera from becoming endemic in
    Haiti, it would save thousands of lives. Both Shanchol
    and Dukoral are needed here, and production of these
    vaccines should be ramped up, as cholera experts have
    argued for the past decade.
    download.thelancet.com/pdfs/journals/...
  14. flosz 20 december 2010 20:33
    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, Crucell and Sanofi could produce 2 to 3 million doses a year," de Quadros(SABIN vaccine Inst.) said.

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

    www.reuters.com/article/idUSN17244921...

    www.youtube.com/watch?v=sdKOLD6TQZs

    PAHO/WHO urged to design a pilot project to use available vaccine in Haiti


    Washington D.C., 17 December 2010 (PAHO) -- A group of experts convened by the Pan American Health Organization/World Health Organization (PAHO/WHO) today urged the creation of an international stockpile of cholera vaccine and called for the use of current vaccines in a pilot project in Haiti that would be expanded as more vaccine becomes available.
    The recommendations were based on considerations including the limited supplies of available vaccine, studies of the vaccines' safety and efficacy, and WHO recommendations on cholera vaccination, as well as conditions on the ground in Haiti.

    "In the short term, we should make use of the limited amount of vaccine we have," said Dr. Roger Glass, director of the Fogarty International Center and associate director for international research at the U.S. National Institutes of Health. "In the long term, we need to make sure we have adequate supplies to respond to cholera in Haiti, in the Americas, and around the world."

    PAHO/WHO convened today's meeting in response to renewed interest in cholera vaccination following reports that more vaccine might be available than previously believed.

    Information shared during the meeting indicated that 100,000 doses of cholera vaccine are currently ready for shipment, but an additional 200,000 doses could become available in the next three months and up to 1 million doses in the second half of 2011. Two doses of vaccine are needed to confer protection against cholera.
    "While the increased availability of a vaccine is certainly good news, it should be recognized that over 10 million people live in Haiti and over 10 million live in the Dominican Republic," said Dr. Jon K. Andrus, PAHO's deputy director and a leading vaccine expert. "Under no circumstances could there be enough vaccine-over 40 million doses-to vaccinate all the inhabitants of the island of Hispaniola over the next year."

    Participants said the situation in Haiti clearly demonstrates the need for an international stockpile of cholera vaccine, which would stimulate vaccine production and guarantee vaccine supplies.

    Toward that end, "We have asked PAHO/WHO to dialogue with suppliers to see how much more vaccine they can produce and to dialogue with organizations who would be willing to finance the purchase of vaccine," said Dr. Ciro de Quadros, executive vice-president of the Sabin Vaccine Institute. Dr. de Quadros, who chaired the meeting, also heads the Technical Advisory Group of PAHO's immunization program.

    At the same time, the experts urged the development of a pilot project in Haiti that would utilize the immediately available vaccine and also provide lessons on how to introduce cholera vaccine effectively in a country that not only has an ongoing epidemic but also is recovering from a major earthquake. The group urged PAHO/WHO to design such a project and to seek funding for it.

    Since mid-October, Haiti's cholera epidemic has sickened at least 112,000 people and claimed at least 2,400 lives.

    PAHO/WHO experts believe the true toll of the epidemic is probably significantly higher than these official numbers, because of gaps in surveillance.
    PAHO/WHO and other U.N. agencies as well as nongovernmental organizations have been supporting Haiti's Ministry of Health in the response to the epidemic. Their efforts have focused on ensuring treatment and prevention, with an emphasis on prompt administration of oral rehydration salts or, for severe cases, intravenous fluids and antibiotics. Prevention efforts have focused on ensuring access to safe drinking water, improving sanitation and waste disposal, and promoting safe food handling and personal hygiene practices.

    While these efforts continue to be critical to minimizing the spread of the disease and the number of deaths, Andrus noted that it was important to consider vaccination as well.

    "As we go along and new opportunities arise, it behooves us to consider those if they can help us save more lives," said Andrus. "This is a disease that has a foothold in Haiti and will be causing disease in Haiti for some years to come."

    Other participants in today's meeting included Matthew Waldor of Harvard University, Peter Hotez of the Sabin Vaccine Institute, Eric Mintz of the U.S. Centers for Disease Control and Prevention (CDC), Myron Levine of the University of Maryland, John Clemens of the International Vaccine Institute, Bruce Gellin of the U.S. Department of Health and Human Services, and William Pape of GHESKIO in Haiti.
    new.paho.org/hq/index.php?option=com_...
  15. flosz 27 januari 2011 14:22
    Studies support reactive cholera vaccination

    ……
    ……
    Just one oral cholera vaccine, Dukoral, made by Crucell, is internationally licensed, the report notes. Vietnam, the only country to use oral cholera vaccine to control the disease, makes a Dukoral variant that contains killed whole cells, the authors say.
    ………….
    www.cidrap.umn.edu/cidrap/content/fs/...

    Cholera causing more deaths, experts urge vaccination in.reuters.com/article/idINTRE70P25V2...

    The Case for Reactive Mass Oral Cholera Vaccinations www.plosntds.org/article/info%3Adoi%2...

    Use of Oral Cholera Vaccines in an Outbreak in Vietnam www.plosntds.org/article/info%3Adoi%2...

    The Cholera Pandemic,Still With Us After Half a Century: Time To Rethink www.plosntds.org/article/info%3Adoi%2...
  16. flosz 24 oktober 2011 10:40
    No quick fix for Haiti cholera
    ....
    ......

    Shanchol, a vaccine approved by the WHO for worldwide use on 29 September, could brighten the outlook. It was developed by the International Vaccine Institute in Seoul with support from the Bill & Melinda Gates Foundation, and is produced by Shantha Biotechnics in Hyderabad, India, a subsidiary of vaccine company Sanofi Pasteur. Two groups of non-governmental organizations (NGOs) operating in Haiti now intend to include the vaccine in their own emergency responses to cholera.

    At US$1.85 a dose, Shanchol is cheaper than the only other currently available cholera vaccine — Dukoral, made by Crucell, based in Leiden, the Netherlands. Shanchol is also given orally, and requires fewer doses in children under six, who are among the most vulnerable to cholera. The vaccine's benefits "are really clear for the outbreak contexts in which MSF works", says Julia Hill, vaccines policy adviser at Médecins Sans Frontières (MSF), also called Doctors Without Borders, in Geneva, Switzerland.
    ....
    .....


    www.nature.com/news/2011/111018/full/...
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