BACKGROUND Cholera causes an estimated 100,000 deaths annually worldwide, with the majority of burden reported in sub-Saharan Africa. In May 2018, the World Health Assembly committed to reducing worldwide cholera deaths by 90% by 2030. Oral cholera vaccine (OCV) plays a key role in reducing the near-term risk of cholera, although global supplies are limited. Characterizing the potential impact and cost-effectiveness of mass OCV deployment strategies is critical for setting expectations and developing cholera control plans that maximize the chances of success. METHODS AND FINDINGS We compared the projected impacts of vaccination campaigns across sub-Saharan Africa from 2018 through 2030 when targeting geographically according to historical cholera burden and risk factors. We assessed the number of averted cases, deaths, and disability-adjusted life years and the cost-effectiveness of these campaigns with models that accounted for direct and indirect vaccine effects and population projections over time. Under current vaccine supply projections, an approach optimized to targeting by historical burden is projected to avert 828,971 (95% CI 803,370-859,980) cases (equivalent to 34.0% of projected cases; 95% CI 33.2%-34.8%). An approach that balances logistical feasibility with targeting historical burden is projected to avert 617,424 (95% CI 599,150-643,891) cases. In contrast, approaches optimized for targeting locations with limited access to water and sanitation are projected to avert 273,939 (95% CI 270,319-277,002) and 109,817 (95% CI 103,735-114,110) cases, respectively. We find that the most logistically feasible targeting strategy costs US$1,843 (95% CI 1,328-14,312) per DALY averted during this period and that effective geographic targeting of OCV campaigns can have a greater impact on cost-effectiveness than improvements to vaccine efficacy and moderate increases in coverage. Although our modeling approach does not project annual changes in baseline cholera risk or directly incorporate immunity from natural cholera infection, our estimates of the relative performance of different vaccination strategies should be robust to these factors. CONCLUSIONS Our study suggests that geographic targeting substantially improves the cost-effectiveness and impact of oral cholera vaccination campaigns. Districts with the poorest access to improved water and sanitation are not the same as districts with the greatest historical cholera incidence. While OCV campaigns can improve cholera control in the near term, without rapid progress in developing water and sanitation services or dramatic increases in OCV supply, our results suggest that vaccine use alone is unlikely to allow us to achieve the 2030 goal.

中文翻译：

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撒哈拉以南非洲口服霍乱疫苗接种的地理定位的预计影响：一项模型研究。

背景技术霍乱每年在世界范围内估计导致100,000人死亡，其中大部分负担报告在撒哈拉以南非洲。2018年5月，世界卫生大会承诺到2030年将全世界的霍乱死亡人数减少90％。尽管全球供应有限，但口服霍乱疫苗（OCV）在降低近期霍乱风险方面起着关键作用。表征大规模OCV部署策略的潜在影响和成本效益对于设定期望和制定霍乱控制计划以最大程度地提高成功率至关重要。方法和结果我们根据历史霍乱负担和风险因素，在地理上进行了定位时，比较了从2018年到2030年整个撒哈拉以南非洲地区的疫苗接种运动的预计影响。我们评估了避免案件，死亡人数，残疾调整生命年，以及这些运动的成本效益，这些模型采用模型说明了直接和间接疫苗的影响以及随着时间的推移对人口的预测。根据当前的疫苗供应预测，预计将优化以历史负担为目标的方法可避免828,971例（95％CI 803,370-859,980）（相当于预计病例的34.0％； 95％CI 33.2％-34.8％）。在后勤可行性与针对历史负担的目标之间取得平衡的方法预计可避免617,424例（95％CI 599,150-643,891）案例。相反，针对针对水和卫生设施有限的目标而优化的方法预计分别避免273,939（95％CI 270,319-277,002）和109,817（95％CI 103,735-114,110）案例。我们发现，在逻辑上最可行的定位策略的成本为1,843美元（95％CI 1，在此期间避免的每一个DALY中有328-14,312）的影响，OCV活动的有效地理定位对成本效益的影响比对疫苗效力的改善和覆盖率的适度增加要大。尽管我们的建模方法不能预测基线霍乱风险的年度变化，也不能直接纳入天然霍乱感染的免疫力，但我们对不同疫苗接种策略的相对表现的估计应对这些因素具有鲁棒性。结论我们的研究表明，针对地理区域的目标可大大提高口服霍乱疫苗接种运动的成本效益和影响。获得改善的水和卫生条件最差的地区与历史霍乱发病率最高的地区不同。尽管OCV运动可以在短期内改善霍乱的控制，