Nov 26, 2014 1:15 PM

Guinea, hit by Ebola, reports only 1 cholera case

The Associated Press

CONAKRY, Guinea (AP) The health workers rode on canoes and rickety boats to deliver cholera vaccines to remote islands in Guinea. Months later, the country has recorded only one confirmed cholera case this year, down from thousands.

The rare success, overshadowed by the Ebola outbreak that has ravaged Guinea and two other West African countries, is being cautiously attributed to the vaccinations and to hand-washing in the campaign against Ebola.

Helen Matzger of the Bill & Melinda Gates Foundation said Guinea's experience is encouraging other countries to accept the cholera vaccine and has led the GAVI Alliance which works to deliver vaccines to the world's poor to invest in a global stockpile and the U.N. World Health Organization to increase that stockpile to about 2 million doses.

Matzger, the foundation's senior program officer for vaccine delivery, said she was amazed at the ease and efficiency with which the vaccine was delivered to very remote islands.

She said she was on a wobbly boat that made the first delivery, along with Dr. Sakoba Keita, a Cuban-trained Guinean physician who was responsible for Guinea's epidemics surveillance before being appointed the West African nation's Ebola czar.

"In many instances in global health, you see one brave individual who is willing to do something that's different because they think it will have an impact, and Dr. Sakoba was that person," Matzger said in a telephone interview from her Seattle office.

In March, the World Health Organization, with support from UNICEF and Doctors Without Borders, vaccinated some 200,000 fishermen on islands north of Conakry, the capital, where they gather from Guinea and neighboring Sierra Leone and Liberia during the fishing season, said Julien Labas, in charge of UNICEF's campaign for clean water, sanitation and hygiene. The area had been identified as a major transmission source for cholera since the fishermen set up temporary shelters and have no toilets or clean water.

In 2012, amid a cholera outbreak that sickened 7,350 people and killed 133 of them in Guinea, the World Health Organization carried out a study using the Indian-made vaccine Shanchol on 40 patients. The vaccine is delivered by drops into the mouth and requires two doses two weeks apart. One dose costs $1.85, according to Matzger.

A report published in The New England Journal of Medicine earlier this year said that study found the vaccination provided "significant protection against cholera." Matzger said some studies show that if vaccination is provided for 70 percent of a target population, that effectively protects about 98 percent of the people. The vaccine is effective for about three years.

Advocates say the vaccine should be used in tandem with campaigns for clean water and sanitation.

In Guinea, UNICEF works with a local organization to produce chlorine, has a project to manually drill boreholes at half or a third the cost of commercial drilling, and has developed a smartphone app to map the state of all water points.

WHO estimates there are 3 million to 5 million cholera cases a year worldwide, and 100,000 to 120,000 deaths.

Experts in Guinea are cautious in explaining why Guinea has had only one confirmed case.

"It could be related to the vaccination campaign, and I also think the Ebola outbreak might have an indirect impact," Labas said. He also noted that cholera epidemics come and go.

Guineans have taken to stringently washing their hands in chlorinated water to help halt the transmission of Ebola, which has killed more than 1,100 people in the country where the latest outbreak started nearly a year ago. Ebola is contracted by direct contact with an infected person's bodily fluids. Hotels, shops and restaurants oblige patrons to wash their hands in chlorinated water before they can enter.

Idris Sakalo, vice president of the fishermen's association, said that both in Conakry and further north at Forecariah, "For years we were talking about cholera problems, but today, we don't speak about it anymore." He attributed the transformation to awareness of hygiene and suggested that "through Ebola, we could defeat other diseases."

UNICEF says 40 percent of disease transmission could be halted by rigorous hand-washing.

Matzger said no one expects any country to start mass vaccinations for cholera. After the use in Guinea, the idea is to have a stockpile available to respond to an outbreak but also to strike pre-emptively at high risk populations. The vaccine was administered this year to some refugees in camps in South Sudan.

The vaccine also was used in 2012 in Haiti to help fight an ongoing epidemic that broke out after the Caribbean country's catastrophic earthquake.


Associated Press photographer Jerome Delay contributed to this report from Conakry.


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