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Critical success factors for implementing cholera vaccination campaigns in humanitarian emergencies: a DEMATEL-based approach

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EURO Journal on Decision Processes

Abstract

Cholera outbreaks are quite common in the aftermath of natural or man-made disasters. Population displacement and overcrowding in conjunction with increased prevalence of malnutrition and degradation of sanitary conditions present the main drivers favoring cholera outbreaks in these settings. Although cholera is a vaccine-preventable disease, the implementation of mass vaccination campaigns remains still a difficult task in humanitarian emergencies. In this paper an attempt is made for identifying critical success factors as well as the possible interrelationships among them for successfully implementing cholera vaccination campaigns in humanitarian emergencies. Such factors are identified through systematically surveying the literature. Based on this survey and following experts’ responses relevant priorities are identified and the description and analysis of the interrelationships among these factors are given through the usage of the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method. According to the results of the analysis, sound coordination among the key-players involved, establishment of surveillance systems and mobilization of the target communities present the three most important factors while security issues and the general political context in which an immunization campaign is implemented are considered the most influential factors. The findings could be of significant value to those drafting contingency plans or implementing immunization campaigns in humanitarian emergencies.

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References

  • Abubakar A, Azman AS, Rumunu J, Ciglenecki I, Helderman T, West H, Lessler J, Sack DA, Martin S, Perea W, Legros D, Luquero FJ (2015) The first use of the global oral cholera vaccine emergency stockpile: lessons from South Sudan. PLoS Med 12(11):e1001901

    Article  Google Scholar 

  • Adams P (2013) Cholera in Haiti takes a turn for the worse. Lancet 381(9874):1264

    Article  Google Scholar 

  • Adinolfi C, Bassiouni DS, Lauritzsen HF, Williams HR (2005) Humanitarian response review. An independent report commissioned by the United Nations Emergency Relief Coordinator and Under-Secretary-General for Humanitarian Affairs, Office for the Coordination of Humanitarian Affairs (OCHA). Retrieved August 10, 2016 from http://www.unicef.org/emerg/files/ocha_hrr.pdf

  • Azman AS, Luquero FJ, Ciglenecki I, Grais RF, Sack DA, Lessler J (2015) The impact of a one-dose versus two-dose oral cholera vaccine regimen in outbreak settings: a modeling study. PLoS Med 12(8):e1001867

    Article  Google Scholar 

  • Bruckner C, Checchi F (2011) Detection of infectious disease outbreaks in twenty-two fragile states, 2000–2010: a systematic review. Confl Health 5(1):13

    Article  Google Scholar 

  • Calain P, Chaine J-P, Johnson E, Hawley M-L, O’Leary MJ, Oshitani H, Chaignat C-L (2004) Can oral cholera vaccination play a role in controlling a cholera outbreak? Vaccine 22(19):2444–2451

    Article  Google Scholar 

  • Chaignat CL, Monti V (2007) Use of oral cholera vaccine in complex emergencies: what next? Summary report of an expert meeting and recommendations of WHO. J Health Popul Nutr 25(2):244–261

    Google Scholar 

  • Chaignat CL, Monti V, Soepardi J, Petersen G, Sorensen E, Narain J, Kieny MP (2008) Cholera in disasters: do vaccines prompt new hopes? Expert Rev Vaccines 7(4):431–435

    Article  Google Scholar 

  • Clemens J, Holmgren J (2014) When, How, and Where can oral cholera vaccines be used to interrupt cholera outbreaks? Curr Top Microbiol Immunol Springer 379:231–258

    Google Scholar 

  • Clemens J, Shin S, Sur D, Nair GB, Holmgren J (2011) New-generation vaccines against cholera. Nat Rev Gastroenterol Hepatol 8(12):701–710

    Article  Google Scholar 

  • Connolly MA, Gayer M, Ryan MJ, Salama P, Spiegel P, Heymann DL (2004) Communicable diseases in complex emergencies: impact and challenges. Lancet 364(9449):1974–1983

    Article  Google Scholar 

  • Date KA, Vicari A, Hyde TB, Mintz E, Danovaro-Holliday MC, Henry A, Tappero JW, Roels TH, Abrams J, Burkholder BT, Ruiz-Matus C, Andrus J, Dietz V (2011) Considerations for oral cholera vaccine use during outbreak after earthquake in Haiti, 2010–2011. Emerg Infect Dis 17(11):2105–2112

    Article  Google Scholar 

  • Desai SN, Clemens JD (2012) An overview of cholera vaccines and their public health implications. Curr Opin Pediatr 24(1):85–91

    Article  Google Scholar 

  • Dytczak M, Ginda G (2013) Is explicit processing of fuzzy direct influence evaluations in DEMATEL indispensable? Expert Syst Appl 40(12):5027–5032

    Article  Google Scholar 

  • Farmer P, Almazor CP, Bahnsen ET, Barry D, Bazile J, Bloom BR, Bose N, Brewer T, Calderwood SB, Clemens JD, Cravioto A, Eustache E, Jérôme G, Gupta N, Harris JB, Hiatt HH, Holstein C, Hotez PJ, Ivers LC, Kerry VB, Koenig SP, LaRocque RC, Léandre F, Lambert W, Lyon E, Mekalanos JJ, Mukherjee JS, Oswald C, Pape J-W, Gretchko Prosper A, Rabinovich R, Raymonville M, Réjouit J-R, Ronan LJ, Rosenberg ML, Ryan ET, Sachs JD, Sack DA, Surena C, Suri AA, Ternier R, Waldor MK, Walton D, Weigel JL (2011) Meeting Cholera’s Challenge to Haiti and the World: a Joint Statement on Cholera Prevention and Care. PLoS Negl Trop Dis 5(5):e1145

    Article  Google Scholar 

  • Fontela E, Gabus A (1974) The DEMATEL, innovative methods. Research report 2: structural analysis of the World Problematique. Battelle Institute, Geneva

  • Gayer M, Legros D, Formenty P, Connolly MA (2007) Conflict and emerging infectious diseases. Emerg Infect Dis 13(11):1625–1631

    Article  Google Scholar 

  • Global Task Force on Cholera Control (2004) Cholera outbreak: assessing the outbreak response and improving preparedness. Retrieved August 12, 2016 from http://whqlibdoc.who.int/hq/2004/WHO_CDS_CPE_ZFk_2004.4_eng.pdf

  • Global Task Force on Cholera Control (2006) World Health Organization. Oral cholera vaccine use in complex emergencies: what next? Retrieved August 14, 2016 from http://www.who.int/cholera/publications/cholera_vaccines_emergencies_2005.pdf

  • Holmgren J (2012) A case for control of cholera in Africa by vaccination. Lancet Infect Dis 12(11):818–819

    Article  Google Scholar 

  • Kelvin AA (2011) Cholera outbreak in the Republic of Congo, the Democratic Republic of Congo, and cholera worldwide. J Infect Dev Ctries 5(10):688–691

    Google Scholar 

  • Legros D, Paquet C, Perea W, Marty I, Kenya Mugisha N, Royer H, Neira M, Ivanoff B (1999) Mass vaccination with a two-dose oral cholera vaccine in a refugee camp. Bull World Health Organ 77(10):837–842

    Google Scholar 

  • Lopez AL, Clemens JD, Deen J, Jodar L (2008) Cholera vaccines for the developing world. Human Vaccines 4(2):165–169

    Article  Google Scholar 

  • Martin S, Lopez AL, Bellos A, Deen J, Ali M, Alberti K, Anh DD, Costa A, Grais RF, Legros D, Luquero FJ, Ghai MB, Perea W, Sack DA (2014) Post-licensure deployment of oral cholera vaccines: a systematic review. Bull World Health Organ 92(12):881–893

    Article  Google Scholar 

  • Mauch V, Weil D, Munim A, Boillot F, Coninx R, Huseynova S, Powell C, Seita A, Wembanyama H, van den Hof S (2010) Structure and management of tuberculosis control programs in fragile states—Afghanistan, DR Congo, Haiti, Somalia. Health Policy 96(2):118–127

    Article  Google Scholar 

  • Oladele DA, Oyedeji KS, Niemogha MT, Nwaokorie F, Bamidele M, Musa AZ, Adeneye AK, Bamidele TA, Ochoga M, Akinsinde KA, Brai BI, Omonigbehin EA, Fesobi TW, Smith SI, Ujah IA (2012) An assessment of the emergency response among health workers involved in the 2010 cholera outbreak in northern Nigeria. J Infect Public Health 5(5):346–353

    Article  Google Scholar 

  • Pastor M, Pedraz JL, Esquisabel A (2013) The state-of-the-art of approved and under-development cholera vaccines. Vaccine 31(38):4069–4078

    Article  Google Scholar 

  • Phares CR, Date K, Travers P, Déglise C, Wongjindanon N, Ortega L, Bhuket PRN (2016) Mass vaccination with a two-dose oral cholera vaccine in a long-standing refugee camp, Thailand. Vaccine 34(1):128–133

    Article  Google Scholar 

  • Pinto A, Saeed M, El Sakka H, Rashford A, Colombo A, Valenciano M, Sabatinelli G (2005) Setting up an early warning system for epidemic-prone diseases in Darfur: a participative approach. Disasters 29(4):310–322

  • Plotkin S, Shin S, Desai SN, Sah BK, Clemens JD (2011) Oral vaccines against cholera. Clin Infect Dis 52(11):1343–1349

    Article  Google Scholar 

  • Polonsky JA, Ronsse A, Ciglenecki I, Rull M, Porten K (2013) High levels of mortality, malnutrition, and measles, among recently-displaced Somali refugees in Dagahaley camp, Dadaab refugee camp complex, Kenya, 2011. Confl Health 7(1):1

    Article  Google Scholar 

  • Porta MI, Lenglet A, de Weerdt S, Crestani R, Sinke R, Frawley MJ, Van Herp M, Zachariah R (2014) Feasibility of a preventive mass vaccination campaign with two doses of oral cholera vaccine during a humanitarian emergency in South Sudan. Trans R Soc Trop Med Hyg 108(12):810–815

    Article  Google Scholar 

  • Ratnayake R (2011) Training in epidemiology and disease control for humanitarian emergencies. J Epidemiol Community Health 65(2):98–99

    Article  Google Scholar 

  • R Development Core Team (2008) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. ISBN 3-900051-07-0. http://www.R-project.org

  • Salama P, Spiegel P, Talley L, Waldman R (2004) Lessons learned from complex emergencies over past decade. Lancet 364(9447):1801–1813

    Article  Google Scholar 

  • Tappero JW, Tauxe RV (2011) Lessons learned during public health response to cholera epidemic in Haiti and the Dominican Republic. Emerg Infect Dis 17(11):2087–2093

    Article  Google Scholar 

  • Thompson KM, Duintjer Tebbens RJ (2016) Framework for optimal global vaccine stockpile design for vaccine-preventable diseases: application to measles and cholera vaccines as contrasting examples. Risk Anal 36(7):1487–1509

    Article  Google Scholar 

  • Tong A, Flemming K, McInnes E, Oliver S, Craig J (2012) Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med Res Methodol 12:181

    Article  Google Scholar 

  • UNICEF (2012) Guidance note on the use of Oral Cholera Vaccines for UNICEF. Retrieved August 13, 2016 from http://www.unicef.org/immunization/files/UNICEF_OCV_Guidance_20_July2012_final.pdf

  • Valenciano M, Coulombier D, Cardozo BL, Colombo A, Alla MJ, Samson S, Connolly MA (2003) Challenges for communicable disease surveillance and control in Southern Iraq, April–June 2003. J Am Med Assoc 290(5):654–658

    Article  Google Scholar 

  • Von Seidlein L, Jiddawi M, Grais RF, Luquero F, Lucas M, Deen J (2013) The value of and challenges for cholera vaccines in Africa. J Infect Dis 208(SUPPL. 1):S8–S14

    Article  Google Scholar 

  • Waring SC, Brown BJ (2005) The threat of communicable diseases following natural disasters: a public health response. Disaster Manag Response 3(2):41–47

    Article  Google Scholar 

  • Waldor MK, Hotez PJ, Clemens JD (2010) A national cholera vaccine stockpile - A new humanitarian and diplomatic resource. New England J Medi 363(24):2279–2282

  • Weil AA, Ivers LC, Harris JB (2012) Cholera: lessons from Haiti and beyond. Curr Infect Dis Rep 14(1):1–8

    Article  Google Scholar 

  • World Health Organization (2005) Communicable disease control in emergencies: a field manual. Retrieved August 08, 2016 from http://www.who.int/infectious-disease-news/IDdocs/whocds200527/ISBN_9241546166.pdf

  • World Health Organization (2006) Use of the two-dose oral cholera vaccine in the context of a major natural disaster. Report of a mass vaccination campaign in Aceh Province, Indonesia, 2005. Retrieved August 17, 2016 from http://www.who.int/topics/cholera/publications/final_tsunami.pdf

  • World Health Organization (2007) WHO position paper on cholera vaccine use in Iraq, 05 October 2007

  • World Health Organization (2010) Cholera vaccines: WHO position paper. Wkly Epidemiol Rec 85(13):117–128. Retrieved August 17, 2016 from http://www.who.int/wer/2010/wer8513.pdf

  • World Health Organization (2012) Outbreak surveillance and response in humanitarian emergencies. WHO guidelines for EWARN implementation. Retrieved August 14, 2016 from http://whqlibdoc.who.int/hq/2012/WHO_HSE_GAR_DCE_2012_1_eng.pdf

  • World Health Organization (2012) WHO Consultation on oral cholera vaccine (OCV) stockpile strategic framework: potential objectives and possible policy options. Geneva: Department of Immunization, Vaccines and Biologicals, World Health Organization; (WHO/IVB/12.05). Retrieved August 7, 2016 from http://www.who.int/immunization/documents/innovation/WHO_IVB_12.05/en/

  • World Health Organization (2012) WHO Technical Working Group on creation of an oral cholera vaccine stockpile. Retrieved August 5, 2016 from http://www.who.int/iris/bitstream/10665/75240/1/WHO_HSE_PED_2012_2_eng.pdf

  • World Health Organization (2013) SAGE Working Group on Vaccination in Humanitarian Emergencies. Vaccination in acute humanitarian emergencies: a framework for decision-making. Retrieved August 14, 2016 from http://www.who.int/iris/bitstream/10665/92462/1/WHO_IVB_13.07_eng.pdf

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Correspondence to Thomas K. Dasaklis.

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Dasaklis, T.K., Pappis, C.P. Critical success factors for implementing cholera vaccination campaigns in humanitarian emergencies: a DEMATEL-based approach. EURO J Decis Process 6, 1–20 (2018). https://doi.org/10.1007/s40070-017-0062-3

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