{"_asset":{"@search.score":6.045455,"Name":"Oral cholera vaccine coverage in Goma, Democratic Republic of the Congo, 2022, following 2019–2020 targeted preventative mass campaigns","AlternateTitleCommaDelimited":"","Id":"8936","AssetLocationUri":null,"Abstract":"

BACKGROUND

In 2019–2020, preventative Oral Cholera Vaccine campaigns were conducted in 24/32 non-contiguous health areas of Goma, DR Congo. In August 2022, we measured coverage and factors potentially influencing success of the delivery strategy.

METHODS

We used random geo-sampled stratified cluster survey to estimate OCV coverage and assess population movement, diarrhea history, and reasons for non-vaccination.

RESULTS

603 households were visited. Coverage with at least one dose was 46.4 % (95 %CI: 41.8–51.0), and 50.1 % (95 %CI: 45.4–54.8) in areas targeted by vaccination compared to 26.3 % (95 %CI: 19.2–34.9) in non-targeted areas. Additionally, 7.0 % of participants reported moving from outside Goma since 2019, and 5.4 % reported history of severe diarrhea. Absence and unawareness were the main reasons for non-vaccination.

CONCLUSION

Results suggest that targeting non-contiguous urban areas had a coverage-diluting effect. Targeting entire geographically contiguous areas, adapted distribution, and regular catch-up campaigns are operational recommendations to reach higher coverages arising from the study.

","PublicationOrPresentationDate":"2024-10-01T00:00:00Z","LastModifiedDate":"2024-09-21T18:13:01.029Z","IsDeleted":false,"DigitalObjectIdentifier":"10.1016/j.jvacx.2024.100555","ContentTypeName":"Research","ParentContentTypeName":"Journal Article","JournalName":"Vaccine X","ContentType":"Journal Article > Research","AvailabilityTypeId":1,"AvailabilityType":"Full Text","JournalIssue":null,"JournalVolume":"20","JournalPages":"100555","JournalAbbreviation":"Vaccine: X","Conference":null,"ConferenceStartDate":null,"ConferenceEndDate":null,"content":"\nOral cholera vaccine coverage in Goma, Democratic Republic of the Congo,\n2022, following 2019–2020 targeted preventative mass campaigns\n\nEmily Briskin a, Stéphane Hans Bateyi Mustafa b,c, Rachel Mahamba d, Deka Kabunga c,\nJanvier Kubuya c, Klaudia Porten a, Epicentre-MSF DRC cholera working group,\nLaurent Akilimali e, Placide Okitayemba Welo e, Anaïs Broban a,*\n\na Epicentre, Paris, France\nb Programme Elargi de Vaccination, North Kivu, Democratic Republic of the Congo\nc Provincial Health Division, North Kivu, Democratic Republic of the Congo\nd Epicentre, Goma, Democratic Republic of the Congo\ne National Program for the Elimination of Cholera and the Control of Other Diarrheal Diseases (PNECHOL-MD), Democratic Republic of the Congo\n\nA R T I C L E I N F O\n\nKeywords:\nCholera\nTargeted vaccination\nOral cholera vaccine\nVaccine coverage survey\nDemocratic Republic of the Congo\n\nA B S T R A C T\n\nBackground: In 2019–2020, preventative Oral Cholera Vaccine campaigns were conducted in 24/32 non-\ncontiguous health areas of Goma, DR Congo. In August 2022, we measured coverage and factors potentially\ninfluencing success of the delivery strategy.\nMethods: We used random geo-sampled stratified cluster survey to estimate OCV coverage and assess population\nmovement, diarrhea history, and reasons for non-vaccination.\nResults: 603 households were visited. Coverage with at least one dose was 46.4 % (95 %CI: 41.8–51.0), and 50.1\n% (95 %CI: 45.4–54.8) in areas targeted by vaccination compared to 26.3 % (95 %CI: 19.2–34.9) in non-targeted\nareas. Additionally, 7.0 % of participants reported moving from outside Goma since 2019, and 5.4 % reported\nhistory of severe diarrhea. Absence and unawareness were the main reasons for non-vaccination.\nConclusion: Results suggest that targeting non-contiguous urban areas had a coverage-diluting effect. Targeting\nentire geographically contiguous areas, adapted distribution, and regular catch-up campaigns are operational\nrecommendations to reach higher coverages arising from the study.\n\nBackground\n\nCholera remains an important public health issue worldwide and is\nrecently resurging, including in countries that previously had gone\nmany years without outbreaks [1,2]. The Oral Cholera Vaccine (OCV) is\none of the cholera control tools, individuals aged 1 and older being\neligible, with two doses administered 14 days apart. Two doses have\nbeen shown to provide about 58 % protective efficacy and 76 % effec-\ntiveness over 2 years, starting to decline after about 2 years, with few\nreliable estimates of long-term protective effect available. Efficacy ap-\npears to be lower among children under five [3,4]. Previous mass\ncampaigns have shown good OCV safety and acceptability [5–7].\n\nThe World Health Organization (WHO), following Ending Cholera: A\nGlobal Roadmap to 2030, developed by the Global Task Force on\nCholera Control [3,8] recommends reactive and preventative cholera\ncontrol integrated strategies, including water and sanitation and OCV\n\nmass campaigns. However, limited availability has historically con-\nstrained OCV use for large-scale cholera control, and information on the\noptimal strategies for such vaccination campaigns remains limited [9].\n\nGoma, capital of the North-Kivu Province, is the fourth-largest city in\nDemocratic Republic of the Congo and is composed of health areas (HA)\nacross three health zones (Karisimbi, Goma, and Nyiragongo). The city is\naffected by recurrent natural disasters and population displacement\nrelated to armed conflict, and is considered a cholera hotspot with\nrecurrent outbreaks [10,11]. As part of the national Multi-Sectoral Plan\nfor Cholera Elimination [12], a number of cholera-endemic zones of the\ncountry, including Goma city, which is likely seeding cases across the\nregion, were selected for targeted preventative OCV mass campaigns.\nBased on routine surveillance data during pre-vaccination time, several\ngeographically non-contiguous HA were selected for two-dose cam-\npaigns in May/October 2019, then in January/June 2020, and one\nadditional HA was targeted for a single-dose campaign in June 2020. In\n\n* Corresponding author.\nE-mail address: anais.broban@epicentre.msf.org (A. Broban).\n\nContents lists available at ScienceDirect\n\nVaccine: X\n\njournal homepage: www.elsevier.com/locate/jvacx\n\nhttps://doi.org/10.1016/j.jvacx.2024.100555\nReceived 5 July 2024; Received in revised form 6 September 2024; Accepted 9 September 2024\n\nVaccine: X 20 (2024) 100555 \n\nAvailable online 12 September 2024 \n2590-1362/© 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ). \n\nmailto:anais.broban@epicentre.msf.org\nwww.sciencedirect.com/science/journal/25901362\nhttps://www.elsevier.com/locate/jvacx\nhttps://doi.org/10.1016/j.jvacx.2024.100555\nhttps://doi.org/10.1016/j.jvacx.2024.100555\nhttps://doi.org/10.1016/j.jvacx.2024.100555\nhttp://creativecommons.org/licenses/by/4.0/\n\n\nthis challenging context (population uncertainties, frequent movements,\nlimited resources, dense neighborhoods), the campaigns used a door-to-\ndoor strategy, targeting all people aged one year and above. Post-\ncampaigns coverage rapid random assessments in targeted areas resul-\nted in levels ranging from 73 % to 98 % (Supplementary Data) [13],\nthough post-campaign overall city coverage, as well as population-level\nprotection achieved by targeted OCV campaigns, remained unclear. In\nAugust 2022, as part of a larger project evaluating the impact of OCV\ncampaigns in endemic zones (Goma and Bukama, Haut-Lomami), and\nbefore large displacements of North-Kivu population to Goma occurred\n(late 2022), an urban survey was conducted to measure current overall\nOCV coverage levels and factors potentially affecting coverage.\n\nMethods\n\nWe conducted a stratified cluster survey based on standard MSF\nprotocol (Supplementary Data) [14,15]. Goma city’s HA and sur-\nrounding peri-urban area were divided into eight strata, according to\nnumber of OCV doses received, population density and geographical\ncontinuity (Supplementary Table 1). Assuming a coverage of 50 %,\nprecision of 8 %, α = 5 %, and a design effect of 2, we surveyed 20\nclusters of 4 households by strata. For security reasons, the survey was\nrestricted to urban areas, cutting out some unstable sub-urban zones\n(Fig. 1). Random geo-spatial points were identified using GIS software\nwithin each stratum. Only geo-points with a roof within a 50 m radius\nwere kept (using satellite images checks), and other points selected if\nnecessary. Clusters were interviewed around each geo-point, systemat-\nically selecting the fifth house on the left of the first included house, until\ncluster was complete. When several households lived under the same\nroof, one was randomly selected among eligible ones. All individuals\naged one and above at survey time and living in the survey area were\n\neligible for inclusion. Heads of households or their representative were\ninterviewed about the vaccination status of all household members\n(people who slept under the same roof the previous night). Unavailable\nhouseholds were replaced and not revisited.\n\nWe used KoboCollect software to collect data on demographic\ncharacteristics, history of vaccination, migration and severe watery\ndiarrhea (3 watery stools in 24 h) since January 2019 (Supplementary\nTable 2). Using R software (version 4.1.3, R4EPI/epikit package) we\ncalculated population-weighted proportion of the participants’ accord-\ning to demographic profiles, and calculated vaccination coverage levels\nand confidence intervals. Participants were considered moving from\noutside Goma city when they moved from other HA than included in the\nsurvey strata (Fig. 1). After excluding participants with unknown\nvaccination status, we assessed vaccination status’ association with age\ngroup and sex using univariate logistic regression. Association with\nother variables was assessed using multivariate logistic regression,\nadjusting on age group and sex.\n\nThis survey was conducted in accordance with the ethical guidelines\nof the Council for International Organizations of Medical Sciences [16].\nThe protocol was reviewed and approved by the Ethical Committee of\nthe University of Kinshasa School of Public Health (ESP/CE/106/2022,\n11/08/2022), and by the MSF Ethics Review Board (ID 2070, 20/07/\n2022).\n\nResults\n\nThe survey was carried out between 22 and 26 August 2022. Sur-\nveyors visited 603 households (3,352 individuals, of which 94 had un-\nknown vaccination status). Among respondents, 52.0 % were female,\nand the median age was 20 years (IQR 10–31). Seven households refused\nparticipation.\n\nFig. 1. History of Oral Cholera Vaccination Campaigns, 2019–2020 by number of does (hashing), and strata (colors) used for vaccination coverage survey, 2022,\nGoma, Democratic Republic of the Congo.\n\nE. Briskin et al. Vaccine: X 20 (2024) 100555 \n\n2 \n\n\n\nVaccine coverage\n\nOverall coverage with at least one dose was 50.1 % (95 %CI:\n45.1–55.0)) in vaccinated areas, compared to 26.3 % (95 %CI:\n19.2–34.9) in non-vaccinated areas (Table 1, Fig. 2). Two-dose coverage\nin vaccinated areas was 13.5 % (95 %CI: 10.2–17.5). Among partici-\npants reporting being vaccinated, only 1.2 % presented the physical\nvaccination card. The main reported reasons for non-vaccination among\nunvaccinated participants were unawareness (36 %) and absence (24 %)\n(Supplementary Table 3).\n\nSocio-demographic factors\n\nCoverage with at least one dose in the 2019-vaccinated zone was\n52.4 % (95 %CI: 46.1–58.6), which was not significantly different from\nthat in the 2020-vaccinated zone (47.5 %, 95 %CI: 39.8–55.3). Men’s\nvaccination coverage was significantly lower than women’s: 43 % of\nmen reported vaccination versus 57 % of women (OR: 0.71, 95 %CI:\n0.62–0.81). Compared with participants over 15 years old, those aged\n5–14 were more likely to have received at least one dose (OR: 1.6, 95 %\nCI: 1.3–1.9). Those below 5 years were significantly less likely to have\nreceived at least one dose (OR: 0.28, 95 %CI: 0.21–0.37) (Table 2).\n\nPopulation movements\n\nFifteen percent of participants reported moving from a different HA\nsince 2019 (from 6.4 % in stratum 2 to 32.9 % in stratum 1), of which 45\n% (7 % of total) had arrived from outside Goma city. Among those who\nhad moved since January 2019, 31.7 % were vaccinated with at least\none dose, which is significantly lower than the proportion vaccinated\namong people with no history of moving (48.2 %). People who had\nmoved from a HA outside Goma had a lower probability of being\nvaccinated, with only 18.1 % (95 %CI: 13.6–23.5) of those moving from\na HA outside of Goma being vaccinated with at least one dose, compared\nto 47.9 % (95 %CI: 46.1–49.6) of those coming from a Goma HA.\n\nEpisodes of severe diarrhea\n\nAmong participants, 5.4 % reported to have experienced severe\ndiarrhea, of which 19.3 % reported a cholera diagnosis during this\ndiarrhea episode. The proportion of participants with a diarrhea history\nranged from 2.2 % (95 %CI: 1.1–4.1) in stratum 6 to 10.0 % in stratum 1\n(95 %CI: 7.4–13.6) and 13.3 % in stratum 8 (95 %CI: 9.6–18.1).\n\nDiscussion\n\nA key finding of the study relates to population movements being an\nimportant factor influencing Goma’s OCV coverage. People’s permanent\nrelocation in and out of Goma accelerates coverage waning, with some\nvaccinated persons leaving and unvaccinated ones arriving. Moreover,\nan important number of doses intended for targeted areas were received\nby people living in non-targeted areas, suggesting daily movement\nacross HA during campaigns for work or leisure activities probably\naffected coverage levels. This coverage dilution underscores the\nimportance of fully vaccinating geographically contiguous areas (e.g.\nentire health zones) during preventative OCV campaigns, especially in\nbig cities. This result was considered in designing future national\nvaccination strategies, through the recent development of the\n2023–2027 Multi-Sectoral Plan for Cholera Elimination.\n\nOther studies have shown that targeted OCV campaigns in African\nurban settings can reach about 80 % 1-dose initial coverage, [14,17,18]\nor even higher in Bangladesh [19]. Despite initial rapid assessments\nyielding high coverage estimates in vaccinated areas, the exact initial\noverall coverage after Goma campaigns remains unknown. The 2022-\nmeasured coverage of at least one dose (46.4 %) is lower than ex-\npected with over half of the population unvaccinated, leaving people\nvulnerable to cholera and far from reaching sufficient coverage levels for\nherd immunity.\n\nThe low 2-dose coverage of 13.5 % in targeted areas also suggests\nthat people vaccinated were different in both rounds of the campaigns.\nThis could relate to frequent population movements, though the 2020\n2nd dose campaign happening during Covid-19 pandemic times, or\nrecall bias, could also have played a role.\n\nMen were less likely to be vaccinated than women. A similar trend\nwas observed in other OCV coverage surveys in similar contexts, and\ncould be related to men more often working away from home and thus\nabsent when vaccinators pass door-to-door [17]. The campaign-to-\nsurvey time explains the lower coverage in children under 5, part of\nthem being born post-campaigns. Older children, on the other hand,\nwere more likely to be vaccinated than adults; as vaccines are rarely\nproposed to adults through mass campaigns; this could reflect a\nmisunderstanding on the vaccine target, or lower acceptance in adults.\n\nOperationally, all these elements need to be considered in planning\nmass campaigns, particularly population movements. For instance,\nvaccination strategies may be adapted to population’s schedule, espe-\ncially adult men, notably by reinforcing vaccination at work sites, shops,\nor streets in addition to visiting residences door-to-door. Modification of\nvaccination hours, or neighborhood-level community strategies could\nalso be considered. In addition to periodic mass campaigns, routine\ncampaigns to vaccinate new arrivals in migratory areas, younger\n\nTable 1\nOral cholera vaccine (OCV) coverage by strata among participants in the coverage survey, Goma, North Kivu, Democratic Republic of the Congo, 2022 (N = 3,258\nindividuals, n = 599 households).\n\nStratum N individuals (n households) Number of doses targeted 1 dose (95 % CI) 2 doses (95 % CI) At least 1 dose (95 % CI)\n\nAll strata 3,258 (599) 0, 1, or 2 33.2 (28.8–37.9) 11.8 (8.9–15.3) 46.4 (41.8–51.0)\nStrata targeted for at least one dose 1 or 2 35.9 (31.1–41.1) 13.5 (10.2–17.5) 50.1 (45.1–55.0)\n1 373 (63) 2 38.3 (31.7–41.3) 11.5 (3.8–33.3) 50.7 (40.1–61.2)\n2 470 (80) 2 31.8 (22.9–42.4) 11.5 (5.9–21.3) 43.3 (31.2–56.3)\n3 426 (86) 2 33.4 (20.6–49.3) 18.7 (10.5–31.2) 55.8 (44.9–66.2)\n4 519 (88) 0 (never targeted) 22.8 (16.1–31.2) 3.4 (1.2–9.4) 26.3 (19.2–34.9)\n5 425 (71) 2 43.4 (32.1–55.3) 13.8 (6.9–25.7) 57.3 (44.3–69.3)\n6 406 (76) 2 27.7 (14.4–46.6) 18.5 (8.5–35.7) 46.3 (31.1–62.1)\n7 386 (87) 2 35.9 (25.3–48.2) 6.8 (2.6–16.7) 42.8 (30.6–55.9)\n8 253 (48) 1 43.8 (22.5–67.7) 10.5 (4.4–23.2) 55.4 (30.8–77.5)\n\nE. Briskin et al. Vaccine: X 20 (2024) 100555 \n\n3 \n\n\n\nchildren and previously missed persons could be beneficial; however,\nsuch strategies require large and regular amounts of available OCV [9].\n\nCampaigns would also benefit from more awareness programs\nfocused on adults’ vaccine uptake, and education on vaccine schedule’s\nimportance. While delay between Goma campaigns reached 5–6 months\n\nboth years, shorter delays may also facilitate recall and awareness about\n2nd dose. In addition, systematic assessment of the post-campaign\ncoverage using WHO-recommended cluster methodology could also\nhelp evaluate the campaigns. Finally, using OCV in combination with\nother complimentary multi-sectoral interventions such as improvements\n\nFig. 2. Coverage with at least one dose of oral cholera vaccine (colored), by survey strata, Goma, Democratic Republic of the Congo, August 2022.\n\nTable 2\nOral Cholera Vaccine Coverage and covariates, Goma, Democratic Republic of the Congo, August 2022. Percentages are calculated by column.\n\nOverall**\n\nn (%), n = 3258\nVaccinated with at least 1 dose\nn (%), n = 1492\n\nUnvaccinated\nn (%)\nn = 1766\n\nOdds Ratio\n(95 %CI)\n\nSex\nFemale 1 693 (52.0) 844 (56.6) 849 (48.1) ref\nMale 1 541 (47.3) 640 (42.9) 901 (51.0) 0.71 (0.62–0.81)\nUnknown sex2 24 (0.7) 8 (0.5) 16 (0.9) −\n\nAge\n1–4 years 293 (9.0) 55 (3.7) 238 (13.5) 0.28 (0.21–0.37)\n5–14 years 854 (26.2) 483 (32.4) 371 (21.0) 1.6 (1.3–1.9)\n15 years and over 2 069 (63.5) 934 (62.6) 1135 (64.3) ref\nUnknown Age2 42 (1.3) 20 (1.3) 22 (1.2) −\n\nHistory of moving**,1\n\nRemained in same health area 2746 (84.3) 1324 (88.7) 1422 (80.5) ref\nMoved from other health area of Goma city 275 (8.4) 118 (7.9) 157 (8.9) 0.84 (0.65–1.1)\nMoved from other health area outside of Goma city 227 (7.0) 41 (2.8) 186 (10.5) 0.23 (0.16–0.32)\nMoved from any health area (within or outside Goma city combined) 502 (15.4) 159 (10.7) 343 (19.4) 0.50 (0.40–0.61)\nUnknown moving status 10 (0.3) 9 (0.6) 1 (0.1) −\n\nHistory of severe diarrhea**,1\n\nNo 3058 (93.9) 1413 (94.7) 1645 (93.1) ref\nYes 173 (5.3) 63 (4.2) 110 (6.3) 0.68 (0.48–0.93)\nUnknown history2 27 (0.8) 16 (1.1) 11 (0.6) −\n\n** Since January 2019.\n1 OR adjusted for age and sex.\n2 Participants with unknown values are excluded from Odds Ratio calculations.\n\nE. Briskin et al. Vaccine: X 20 (2024) 100555 \n\n4 \n\n\n\nto hygiene and water supply systems, could help maximize results [20].\nFurther studies will be needed to investigate the impact of such mass\nOCV campaigns in urban endemic contexts, and qualitative investiga-\ntion could also help develop additional strategies and increase coverage\nin such contexts.\n\nPeople living along the periphery of the city (strata 1 and 8) had\nhigher self-report of diarrhea. These areas are known to welcome more\nnew arrivals, especially displaced people. Those with a history of diar-\nrhea were significantly less likely to have been vaccinated, which could\nsuggest some protective effect of the vaccine. Participants were more\nlikely to recall the episode only if a cholera diagnosis was made,\npotentially influencing these results. Moreover, other factors including\nsocioeconomic status or access to protective measures could be influ-\nencing this effect, meriting further investigation.\n\nOne key limitation of this study is recall bias, as participants may\nhave forgotten if or when they or their family members were vaccinated\n(and how many doses), and if they had diarrhea. This was mitigated by\ndescribing the cholera vaccination in detail during interviews, and the\nfact that OCV is the only oral vaccine also targeting adults, which may\nhave facilitated recall. Given that this study only included people living\nin Goma at the time of survey, we were unable to study population\nmovements from within Goma to outside of the city, in particular people\nwho were vaccinated but subsequently left.\n\nConclusion\n\nThese results give unique insights on OCV coverage in targeted urban\nsettings after an elapse of time, and illustrate that targeting non-\ncontiguous zones for vaccination in urban contexts with frequent pop-\nulation movements can result in diluted and suboptimal final coverage\nlevels. Thus, campaigns targeting larger geographic areas and entire\npopulation groups could result in higher vaccination coverage in such\ncontexts. Results also suggest the importance of adapted vaccinations\nstrategies, including adapting to adults’ schedule, planning for catch-up\ncampaigns, strengthening awareness programs or considering inte-\ngrated combined approaches for cholera.\n\nAuthors’ contributions\n\nThe following authors (alphabetical by last name) were part of the\nEpicentre-MSF DRC cholera Working Group and made valuable contri-\nbutions to investigation, data curation and interpretation of the results:\nIsabel Amoros-Quiles, Richard Safari Balegamire, Flavio Finger, Patient\nKamavu, Joseph Kasereka, Christopher Mambula, Germain Mweha,\nJohanne Sekkenes, Abdoul Kassim Toure.\n\nFunding\n\nThis work was supported by the Wellcome Trust grant number:\n[215689/Z/19/Z], co-financed by Wellcome Trust and Foreign\nCommonwealth Development Office (FCDO). The funder was not\ndirectly involved in the data collection, analysis, or decision to publish\nthese results.\n\nCRediT authorship contribution statement\n\nEmily Briskin:Writing – original draft, Visualization, Methodology,\nInvestigation, Formal analysis, Data curation, Conceptualization.\nStéphane Hans Bateyi Mustafa: Writing – review & editing, Concep-\ntualization. Rachel Mahamba: Writing – review & editing, Methodol-\nogy, Investigation, Data curation. Deka Kabunga: Writing – review &\nediting, Conceptualization. Janvier Kubuya: Writing – review & edit-\ning, Conceptualization. Klaudia Porten: Writing – review & editing,\nSupervision, Conceptualization. Laurent Akilimali:Writing – review &\nediting, Supervision, Conceptualization. Placide Okitayemba Welo:\nWriting – review & editing, Supervision, Conceptualization. Anaïs\n\nBroban: Writing – review & editing, Writing – original draft, Visuali-\nzation, Supervision, Project administration, Methodology,\nConceptualization.\n\nDeclaration of competing interest\n\nThe authors declare the following financial interests/personal re-\nlationships which may be considered as potential competing interests:\nAnais Broban reports financial support was provided byWellcome Trust.\nAnais Broban reports a relationship with Epicentre that includes:\nemployment. Emily Briskin reports a relationship with Epicentre that\nincludes: employment. Rachel Mahamba reports a relationship with\nEpicentre that includes: employment. Klaudia Porten reports a rela-\ntionship with Epicentre that includes: employment. Placide Okitayemba\nWelo reports a relationship with Ministry of Health DR Congo that in-\ncludes: employment. Laurent Akilimali reports a relationship with\nMinistry of Health DR Congo that includes: employment. Deka Kabunga\nreports a relationship with Ministry of Health DR Congo that includes:\nemployment. Janvier Kubuya reports a relationship with Ministry of\nHealth DR Congo that includes: employment. Stephane Hans Bateyi\nMustafa reports a relationship with Ministry of Health DR Congo that\nincludes: employment. The authors have no other conflict of interest to\ndeclare. If there are other authors, they declare that they have no known\ncompeting financial interests or personal relationships that could have\nappeared to influence the work reported in this paper.\n\nData availability\n\nData are publicly available under the following doi: 10.5281/\nzenodo.12651251.\n\nAcknowledgements\n\nThe authors would like to thank the Wellcome Trust and Foreign\nCommonwealth Development Office (FCDO) for their core funding\nsupport, as well as all contributors to the implementation of this study,\nincluding MSF missions in DRC, head of health zones and representa-\ntives, data collectors, Epicentre organizational support, survey partici-\npants, and communities.\n\nAppendix A. Supplementary data\n\nSupplementary data to this article can be found online at https://doi.\norg/10.1016/j.jvacx.2024.100555.\n\nReferences\n\n[1] Ganesan D, Gupta SS, Legros D. Cholera surveillance and estimation of burden of\ncholera. 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Briskin et al. Vaccine: X 20 (2024) 100555 \n\n6 \n\nhttps://doi.org/10.1016/S0140-6736(24)00467-7\nhttps://doi.org/10.1016/S0140-6736(24)00467-7\nhttps://press.un.org/en/2024/sc15646.doc.htm\nhttps://doi.org/10.1016/j.ijid.2022.05.039\nhttps://plateformecholera.info/republique-democratique-du-congo-plan-strategique-multisectoriel-delimination-du-cholera-2018-2022\nhttps://plateformecholera.info/republique-democratique-du-congo-plan-strategique-multisectoriel-delimination-du-cholera-2018-2022\nhttps://plateformecholera.info/republique-democratique-du-congo-plan-strategique-multisectoriel-delimination-du-cholera-2018-2022\nhttps://doi.org/10.1016/j.vaccine.2023.01.026\nhttps://doi.org/10.1016/j.vaccine.2023.01.026\nhttps://scienceportal.msf.org/assets/6894\nhttps://scienceportal.msf.org/assets/6894\nhttp://refhub.elsevier.com/S2590-1362(24)00128-1/h0085\nhttp://refhub.elsevier.com/S2590-1362(24)00128-1/h0085\nhttp://refhub.elsevier.com/S2590-1362(24)00128-1/h0085\nhttp://refhub.elsevier.com/S2590-1362(24)00128-1/h0085\nhttp://refhub.elsevier.com/S2590-1362(24)00128-1/h0090\nhttp://refhub.elsevier.com/S2590-1362(24)00128-1/h0090\nhttp://refhub.elsevier.com/S2590-1362(24)00128-1/h0090\nhttp://refhub.elsevier.com/S2590-1362(24)00128-1/h0090\nhttps://doi.org/10.1080/21645515.2019.1616502\nhttps://doi.org/10.1080/21645515.2019.1616502\nhttps://doi.org/10.1093/ofid/ofad701\nhttps://doi.org/10.1093/ofid/ofad701\n\n\tOral cholera vaccine coverage in Goma, Democratic Republic of the Congo, 2022, following 2019–2020 targeted preventative ma ...\n\tBackground\n\tMethods\n\tResults\n\tVaccine coverage\n\tSocio-demographic factors\n\tPopulation movements\n\tEpisodes of severe diarrhea\n\n\tDiscussion\n\tConclusion\n\tAuthors’ contributions\n\tFunding\n\tCRediT authorship contribution statement\n\tDeclaration of competing interest\n\tData availability\n\tAcknowledgements\n\tAppendix A Supplementary data\n\tReferences\n\n\n","UrlSlug":"oral-cholera-vaccine-coverage-goma-democratic-republic-congo-2022-following-2019-2020-targeted-preventative-mass-campaigns","collections":[],"countries":[{"Name":"Democratic Republic of Congo","Id":52}],"asset_languages":[{"AlternateTitle":null,"language":[{"Id":1,"Name":"English"}],"contentTranslation":[],"contentLocation":[]}],"creators":[{"Name":"Porten K","Id":17066,"ac":[{"Order":5}]},{"Name":"Broban A","Id":28637,"ac":[{"Order":9}]},{"Name":"Briskin E","Id":29398,"ac":[{"Order":0}]},{"Name":"Bateyi Mustafa SH","Id":33973,"ac":[{"Order":1}]},{"Name":"Mahamba R","Id":34664,"ac":[{"Order":2}]},{"Name":"Akilimali L","Id":34665,"ac":[{"Order":7}]},{"Name":"Kabunga D","Id":34953,"ac":[{"Order":3}]},{"Name":"Kubuya J","Id":34954,"ac":[{"Order":4}]},{"Name":"Okitayemba Welo P","Id":34955,"ac":[{"Order":8}]},{"Name":"Epicentre-MSF DRC cholera working group","Id":34956,"ac":[{"Order":6}]}],"keywords":[{"Name":"vaccination","Id":6},{"Name":"cholera","Id":41}]}}

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Oral cholera vaccine coverage in Goma, Democratic Republic of the Congo, 2022, following 2019–2020 targeted preventative mass campaigns