Appendix 10. Practical tips for cholera mass vaccination campaigns

10.1 Needs estimation

Number of vaccines required

• Two-dose strategy:

To calculate the number of vaccines required, multiply the total population in the area targeted for vaccination by 2 (for 2 doses).
It is unnecessary to include a wastage factor or a buffer stock, even though there may be a small loss of vaccines (around 1%) or more people than anticipated to vaccinate. The quantity of vaccines should still be sufficient as infants under 1 year of age will not be vaccinated and the dropout rate between the 2 rounds is estimated at 10-15% [1] Citation 1. Word Health Organization. Oral cholera vaccines in mass immunization campaigns guidance for planning and use, 2010, Geneva.
http://apps.who.int/iris/bitstream/10665/44448/1/9789241500432_eng.pdf .

• Single dose strategy:

The number of vaccines is equal to the size of the total population in the area targeted for vaccination + 10% buffer stock.

Vaccine storage capacity

The single dose vaccine vial requires a large storage volume:

• The SHANCHOL^® vaccine is currently packaged in boxes of 35 monodose vials. Each 35-dose box has a volume of approximately 590 cm³ and measures 14 cm x 10.5 cm x 4 cm. The storage volume per vial is significantly greater (16.8 cm³/packaged vial) than the storage volume per measles vaccine (1.3-2.6 cm³).
• The EUVICHOL^® vaccine is currently packaged in boxes of 10 monodose vials. Each 10-dose box has a volume of approximately 110 cm³ and measures 9 cm x 3.5 cm x 3.5 cm. The volume of one vial is 11 cm³.
• The EUVICHOL-PLUS^® vaccine is currently packaged in boxes of 50 monodose vials. Each 50-dose box has a volume of approximately 392 cm³ and measures 11.1 cm x 4.7 cm x 6.2 cm. The volume of one vial is 7.85 cm³.

Other needs

• Potable water and cups should be provided a Citation a. Use reusable cups (wash cups with washing-up liquid and water after each use) rather than disposable plastic or paper cups (more hygienic and practical but not always available, more expensive, large quantity of waste).  :
  • to give a sip of water (particularly to children) after administering the vaccine that has an unpleasant taste (does not have to be given to each person vaccinated);
  • so that people in the queue can drink if there is a long wait.
• Make sure pliers are available to take the metallic caps off the vaccine vials.

10.2 Transport and storage of vaccines

During international transport and central storage in the country of use, the vaccine should be stored under cold chain conditions between +2 °C and +8 °C. As the volume of vaccines needed during mass vaccination campaigns is very large, in addition to refrigerators, cold rooms and refrigerated lorries or containers should be used for storing vaccines.

SHANCHOL^® vaccine has been prequalified by the WHO for use in "controlled temperature chain". It may be kept for a single period of time of up to 14 days at temperatures up to 40 °C. This excursion outside the usual cold chain (+2 to +8 °C) is permitted immediately prior to administration, provided the vaccine has not reached its expiry date and the vaccine vial monitor has not reached discard point. In practice, this means that the vaccine can be transported and stored at the site of vaccination in passive cold chain conditions without icepacks.

Vaccines used in controlled temperature chain must not be returned to the cold chain at the end of the day and must be discarded after 14 days. As per usual practice, vaccines that have been in the controlled temperature chain the longest are used first.

OCVs are cold-sensitive vaccines. They must never be stored in a freezer, even for long-term storage. In a refrigerator, always use the storage baskets provided, keeping vaccines away from the walls and floor of the refrigerator. Do not put frozen ice packs in the isotherm boxes or vaccines carriers when sending vaccines to vaccination sites.

10.3 Composition and performance of vaccination teams

As OCVs are administered orally (not injected) and do not usually cause serious adverse effects, mass cholera vaccination campaigns do not require a large number of medical staff.

Fixed teams

A core team consists of one vaccinator, one (or two) vaccine preparer(s) and one tally keeper.
The number of staff can be doubled, depending on the number of people expected.
People (“support staff”) are also needed for social mobilization, crowd control, setting up the site, waste management, etc.
A medical supervisor can supervise one or more sites and assess anyone with immediate adverse reactions to the vaccine.
Experience has shown that a core team can vaccinate around 150 people per hour (1000 people per day) and up to 250 people per hour during particularly busy periods.

Mobile teams

A core team of one vaccinator, one vaccine preparer, one tally keeper, and one logistician is sufficient if support staff can be hired on-site.
A single mobile team can vaccinate more than one site per day.

Door-to-door

A core team is composed of one vaccinator and one tally keeper.
A medical supervisor can manage 3 to 6 teams.
Depending on the context, a core team can vaccinate 150 to 600 people per day.

10.4 Team member tasks

10.5 Data recording

Vaccination cards

Vaccination cards should be used wherever feasible. They provide information for vaccination coverage surveys and vaccine effectiveness studies (Section 4.7.7).
Note: individuals presenting during the second round with no vaccination card (not vaccinated during the first round or card lost) should receive a dose of vaccine.

Tally sheets and daily summary reports

Tally sheets are used for recording the number of people vaccinated per day, by age group (< 5 years and ≥ 5 years, or 1-4 years, 5-15 years, and > 15 years depending on monitoring/ evaluation needs) and gender, in each vaccination site and per team. The data compiled from tally sheets are sent to the higher level every day to be analysed and to adapt the vaccination strategy if required.

10.6 Waste management

The volume of waste generated for a cholera mass vaccination campaign is higher than for other vaccination campaigns as the vaccines come as single dose-vials.

Waste should be collected in plastic containers with lids and treated separately.

Packaging and vaccine vial rubber stoppers should be burnt in an open pit, a drum burner, or an incinerator depending on the situation. Ashes should be covered with back filling if using an open pit or disposed of in an ash pit.

Metallic caps should be either discarded directly into a temporary pit which is later encapsulated or discarded into a sharps pit in an existing waste area.

Empty vials should be either discarded directly into a temporary pit which is later encapsulated or crushed with a glass crusher for final disposal in a sharps pit in an existing waste area.

Alternatively, waste can be transported to an existing facility for treatment and final disposal.