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Newsletter of the Global Task Force on Cholera Control

Dear Friends and Colleagues, 

Welcome to the 3rd issue of Cholera Network Newsaffectionately known as "CNN", the Newsletter of the Global Task Force on Cholera Control (GTFCC).

It has been almost one year since the last issue (June 2015) and so much has happened within the GTFCC that it will be challenging to condense it in one newsletter. For this reason in this issue we will focus mainly (but not only) on the updates regarding the different domains of the GTFCC Working Groups and on our progress towards providing evidence based recommendations for the implementation of cholera control. 

The first Working Group on Oral Cholera Vaccine (OCV) was the first one to meet after the 2nd issue was published, in September 2015 at Johns Hopkins University in Baltimore to further define strategies to use the vaccine in different settings. The working group validated the two technical notes on OCV for travellers and pregnant women, is continuing its work on streamlining procedures for the allocation of vaccines in non-emergency situations, and is editing the OCV Chapter of the Cholera Toolkit. 

Still on the vaccination domain, the GTFCC facilitated an ad-hoc meeting in December 2015 in Geneva specifically to define the agenda for monitoring and evaluation of OCV programmes in preparation for the post-2017 GAVI investment case.  

In parallel, we have continued our work on cholera surveillance procedures, with three meetings organised under the broad surveillance theme. In November 2015, the WG on Surveillance/Epidemiology met for the first time, at AMP in Ferney Voltaire, to agree on procedures for cholera surveillance; while the one on Surveillance/Laboratory met for the second time, at THSTI in Faridabad, to continue the work towards providing recommendations on the use of rapid diagnostic tests and molecular typing techniques. In April 2016, time was ripe for both surveillance WGs to meet and review and validate their common agenda of work. A joint meeting of the Epidemiology and Laboratory WGs was hosted by Save The Children in London (what better place to tackle cholera surveillance than the city where John Snow started it all?) to advance on a homogeneous approach with regards to cholera surveillance, from detection to monitoring, in order to guide control measures.       

Also, in March 2016, we had the first meeting of the Case Management WG at icddr,b (without any doubts the most appropriate venue in the world to agree on recommendations about treating cholera) to review procedures concerning cholera case management at all levels, infection control practices, and the use of antibiotics, oral rehydration and intravenous solutions, and zinc, among other topics.

In addition, you will also find in this issue the usual updates on the global cholera outbreak situation since the previous CNN was issued (15 countries have responded to major cholera outbreaks, in most cases with the help of GTFCC or GOARN partners) and on the use of OCV (vaccination campaigns were organised in Tanzania, Cameroon, South Sudan, Iraq, Niger, Malawi, and Zambia by the respective Ministries of Health with the support of many GTFCC partners; and icddr,b conducted a clinical study in Bangladesh as part of the Gavi Learning Agenda)

Finally, we provide an overview of the most recent scientific publications and news articles on cholera control; and we end the newsletter on a light tone presenting all the social media endeavours that the GTFCC Secretariat is launching with the aim to facilitate connections within the network and beyond. 
 
Enjoy your read!
 

Yours,
 

The GTFCC Secretariat


PS: feel free to contact the GTFCC Secretariat if you wish to present any activity that may be of interest to the rest of the network in the next edition of CNN. 

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June 2016 
 
 

In this issue
 

22-23 September 2015, Baltimore, MD, USA
The second meeting of the GTFCC Oral Cholera Vaccine Working Group was chaired by Prof David Sack (DOVE/JHU) and hosted at Johns Hopkins Bloomberg School of Public Health.

Issues concerning OCV implementation were discussed at the meeting, including supply and demand, effective integration of cholera vaccination with water and sanitation (WaSH) and other cholera control measures, defining research priorities and needs, and agreeing on procedures for approving use of vaccine from the global reserve in non-emergency settings. The WG also finalized two technical notes on the use of OCV in travelers and in pregnant women, which are available at the links below.  
4-5 November 2015, Ferney Voltaire, France  
The first meeting of the GTFCC Working Group on Epidemiology for Cholera Surveillance was chaired by Dr Martin Mengel (Africhol) and hosted at the Agence de Médecine Préventive (AMP). 

Members of this WG represent the principal actors involved in cholera epidemiology globally and are working on methods for cholera surveillance in the field. Issues discussed at the meeting revolved around challenges with cholera surveillance at country level (with examples from South Sudan, Haiti, Nepal, Guinea, and DRC), both in endemic settings and during outbreaks, the role of the laboratory in cholera surveillance, including integrating the use of cholera rapid diagnostic tests (RDTs), information tools for cholera surveillance, and on procedures for surveillance, including definitions for cholera cases, endemic areas, outbreaks, and alerts. The WG also discussed the opportunity to update the "WHO Yellow Book on Cholera Outbreaks" and identified several research priorities ( i.e. review evidence for age cut-offs for case definition using available data, investigate further the role of predictive modelling for cholera surveillance).
2nd Meeting of the Surveillance/Laboratory WG
26-27 November 2015, Faridabad, India   
The second meeting of the GTFCC Working Group on Laboratory Methods for Cholera Surveillance
(Laboratory WG) was chaired by Dr Marie-Laure Quilici (Institut Pasteur) and hosted by Translational Health Science and Technology Institute (THSTI).  


The group continued it's work towards standardizing the use of RDTs and of molecular typing techniques for cholera surveillance, reviewed recent developments in molecular epidemiology of Vibrio cholerae and discussed the opportunity to update its classification, and made progress towards outlining a global cholera laboratory network. Also, WG member institutions presented their research projects, involving field evaluations of RDTs in Cameroon, South Sudan, and Uganda (Maryland University and Epicentre) studies on the evolution of El Tor variant of V. cholerae in India (NICED), evaluation of RDTS and an antibiotic resistant traits (THSTI), Cholera and Biofilm Research Lab (Rajiv Gandhi Centre for Biotechnology), and future plans on field evaluation of cholera RDTs (Epicentre). 
Meeting on OCV M&E
15-16 December 2015, Geneva, Switzerland
This meeting was convened to review evidence gathered since the creation of the OCV stockpile as well as present ongoing and planned projects to help recommend priorities on an OCV monitoring and evaluation (M+E) research agenda. The meeting was chaired by Dr Daniel Tarantola.
 

Partners concluded that it is imperative to maximize future OCV campaigns to gather as much information that can assist in how best to use OCV in each of the following contexts, where cholera can thrive (humanitarian emergencies, outbreaks, and endemic hotspots). Key M+E research priorities agreed upon in the two day meeting included:
  • Use of single dose OCV in reactive settings
  • Determine definitions and methodologies in order to measure vaccine impact (may require adaptation to different settings)
  • Perform systematic and routine analysis of cost effectiveness for each epidemiological setting.
Since the adjournment of the meeting, the consequential announcement of WHO’s prequalification of a second low cost OCV (Euvichol) has significant implications on one of the key points of discussion related to the shortage in relation to global demand. The addition of this vaccine to the market is expected to double the global supply to 6 million doses for 2016, with the potential for further increased production in the future.
1st Meeting of the Case Management WG
15-16 March 2016, Dhaka, Bangaldesh

Members of the GTFCC Working Group on Case Management met for the first time at icddr,b in Dhaka, Bangladesh to review and discuss recommendations related to care of patients during cholera epidemics.

The meeting was chaired by Dr Pradip Kumar Bardhan, icddr'b consultant and former chief physician of icddr,b’s Dhaka Hospital. The working group saw experts on cholera patient care and case management discussing about procedures on cholera case management from the peripheral to the specialized level, infection control procedures to be followed while managing cholera patients, the use of antibiotics, oral réhydratation solutions, intravenous solutions, and zinc for cholera treatment with the aim to define recommendations for health practitioners in the field. The WG also discussed future areas of research which included review evidence on the use of antibiotics for cholera prophylaxisdeveloping new antibiotics for cholera, the possibility of establishing a database for antibiotic resistance, reviewing evidence on cholera in specific populations (e.g. malnourished and pregnant women), how best to assess hypoglycaemia in cholera patients to guide clinical management, evaluate the transition to the new cholera kits, and assessing health system preparedness in terms of cholera treatment. Working group members also took the opportunity to visit icddr,b's Dhaka hospital which is one of, if not the most, advanced centre of excellence with regards to cholera patient care. 
Joint meeting of the Laboratoy and Epidemiology WGs
12-14 April 2016, London, UK

After having already met separately twice for the Laboratory WG and once for the Epidemiology WG, a joint 3 days meeting was convened at Save The Children International in London to advance on the broader Cholera Surveillance theme.

The GTFCC Working Group on Surveillance has been established to provide recommendations on all areas related to cholera surveillance. This working group is divided into two working groups: the Working Group on Laboratory Methods for Cholera Surveillance (Laboratory WG) and the Working Group on Epidemiology for Cholera Surveillance (Epidemiology WG).
The Laboratory WG held two meeting (on 19 December 2014 in Paris, France and on 26-27 November 2015 in Faridabad, India) to discuss issues related to the use of rapid diagnostic tests (RDTs) for cholera surveillance, the use of molecular techniques for cholera surveillance, and steps needed to establish a laboratory network for the surveillance of cholera. The Epidemiology WG held its first meeting on 4-5 November 2015 in Ferney Voltaire, France, with the aim to review, validate, and standardize cholera surveillance procedures. A joint meeting of the two Surveillance Working Groups (Epidemiology  & Laboratory) was organized on 12-14 April to bring both aspects of cholera surveillance (cholera detection and monitoring) together and
to validate cholera surveillance procedures integrating all aspects discussed so far. During the 3 days, the WG validated the interim note on RDTs and agreed to move forward with the possibility of establishing prequalification procedures for RDTs; made progress towards finalizing the interim note on molecular typing techniques; started working on standardising methods for antibiotic resistance testing; validated the document on surveillance procedures (including case definitions); and advanced on conceptualizing a global cholera surveillance network. In addition the experts reviewed electronic tools for cholera surveillance and the role of modelling studies for cholera control.  
Countries Reporting Cholera, June 2015 - May 2016

Fifteen countries reported major cholera to WHO in the period from June 2015 to May 2016.


 
Deployments from the OCV Stockpile, June 2015 - May 2016 


 
Publications & News 

This section is dedicated to selected scientific publications on cholera control or to cholera being in the spotlight in the general media 

 Articles:

News:
 

 

 
 
The GTFCC and social media

The GTFCC has lunched a couple of social media accounts. We hope that these initiatives can facilitate communications within the network and also be a way to reach out to anyone interested in cholera control.  

Twitter:
Follow our Twitter handle @SecGTFCC (https://twitter.com/SecGTFCC). We tweet about activities concerning the GTFCC. We do also retweet news concerning outbreaks of cholera and activities from other GTFCC partners. 

Flickr:
Check out our Flickr account (https://www.flickr.com/photos/142195038@N02/) for photographic updates on cholera, whether they are taken during activities in the filed or during working groups.

Instagram:
Finally, we also have launched @secgtfcc on Instagram (https://www.instagram.com/secgtfcc/) where we upload pictures on specific cholera control activities with a short captions to describe hl=enCheck out our Flickr account (https://www.flickr.com/photos/142195038@N02/) for photographic updates on cholera, whether they are taken during activities in the filed or during working groups.




 


 
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