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Cholera Vaccine in Refugee Settings—Reply

Abdollah Naficy, MD, MPH; Malla R. Rao, MEngg, MPH; John D. Clemens, MD; Denise Antona, MD, MPH; Alan Surkin, PhD
JAMA. 1998;280(7):600-602. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-7-jbk0819-i.
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In Reply.—Dr Sack states that our cost-effectiveness analysis on treatment and vaccination strategies to control cholera in sub-Saharan refugee settings "may have led to invalid conclusions" because our assumed case-fatality rates reflected well-served camps, rather than situations in which treatment for cholera might be inadequate. While we agree that case-fatality rates for cholera might well be higher than our assumed values, which reflected rates in poorly organized refugee settings, we disagree that our assumed values led to invalid conclusions. First, we explicitly stated that our analysis was intended only to apply to well-established camps. For these camps, the case-fatality rates postulated in our analyses are well documented to be in our assumed range. Second, it is not clear that an effective cholera vaccination campaign could even be launched in the less organized settings to which Sack refers. Whether such settings are amenable to vaccination campaigns is a subject that deserves further study.


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