Mass Cholera Vaccination Campaign Launched

In early October 2021, Shivaraj Hospital in Kapilvastu District, Lumbini Province, received over 100 cases of acute diarrhea from nearby Krishnanagar municipality in a single day. By the end of the month, five out of ten municipalities in the district had reported over 1300 acute diarrhea cases including six deaths. Selected samples tested at the National Public Health Laboratory came positive for Vibrio cholera, the causative agent for cholera.

The Ministry of Health and Population (MoHP), with support from WHO, Country Office for Nepal, UNICEF, and other partner agencies then launched a mass cholera vaccination campaign in response to the outbreak. Led by the District Health Office, Kapilvastu, the first phase of the campaign began on 21 November 2021 and was carried out in the five affected municipalities in the district: Yashodhara, Maharajgunj, Shivraj, Bijaynagar, and Krishnanagar.

With technical support from WHO, the Department of Health Services, MoHP, had submitted a proposal to *The International Coordinating Group (ICG) on Oral Cholera Vaccine Provision for Cholera Control requesting support for Oral Cholera Vaccine (OCV) from the global stockpile. The proposal which included a request for vaccine support and campaign operations cost support was fully approved, and in November, Nepal received a total of 483,408 doses of OCV.

“We were able to receive the vaccines on time, and within a week of its arrival in the country, we started the vaccination campaign. The campaign has been running smoothly and we have been able to contain the spread of the disease. Generous support from agencies including WHO has made this possible” said Dr Bikash Devkota, Secretary, Ministry of Health, Population and Family Welfare, Lumbini Province.

The first dose of the vaccine, made possible through the support of Gavi, the Vaccine Alliance, and the ICG, was provided to the target population of over 250,000 people achieving high coverage of more than 90 percent. The second dose vaccination is planned in early January 2022.

WHO, Country Office for Nepal, provided technical assistance to the government in planning, preparation, and implementation of the vaccination campaign, including training of over 500 health care workers on vaccine handling and cold chain management. In addition, WHO has been supporting with case investigations, logistics management, sample collection, and shipment in collaboration with the provincial government of Lumbini Province. Following the completion of the vaccination campaign, WHO will support the post-campaign coverage survey as per the requirement of the ICG. WHO along with other partner agencies is continuing to monitor the situation. 

Cholera is characterized by acute, profuse watery diarrhea usually with vomiting, leading to rapid dehydration, and affects both children and adults. If untreated, it can lead to fatal outcomes within hours.

Nepal is endemic for cholera with the potential for outbreaks due to an inadequate supply of safe drinking water and improved sanitation. In recent years, the country has seen diarrheal outbreaks in several districts. Adoption of a long-term approach by prioritizing WASH measures as well as the implementation of a multisectoral cholera prevention and control strategy is crucial to minimizing the risk of future outbreaks.

“While vaccination provides life-saving protection against cholera, we must remember that it does not replace other measures such as ensuring access to clean water, sanitation, and good hygiene which are crucial to prevent this dangerous disease. A multisectoral collaboration and coordination among all tiers of the government is key to prevention of occurrence of outbreaks,” said WHO Representative to Nepal, Dr Rajesh Sambhajirao Pandav.

As the cholera outbreak has been confirmed in other municipalities of the district, the Department of Health Services further submitted a proposal for oral cholera vaccination in the remaining five municipalities of the district. ICG has approved this proposal including 703,104 doses of OCV, which will be received by the country in early January 2022.

The first dose vaccination in these five remaining municipalities is planned to commence in January and the second dose in February 2022. WHO is continuing its technical support for the OCV campaign and outbreak response and is conducting review and coordination meetings with the local government to enhance micro planning to make the campaign a success.

*The International Coordinating Group (ICG) on Oral Cholera Vaccine Provision for Cholera Control is a partnership between UNICEF, MSF, IFRC, and WHO. The ICG's objective is to ensure rapid and equitable access to vaccines and emergency supplies for outbreak response.