Paving the way for the control of Cholera and Typhoid fever in Kolkata - A research project report of the NICED-IVI collaboration

This collaborative research work between National Institute of Cholera and Enteric Diseases (NICED), Kolkata and International Vaccine Institute (IVI), Seoul under the Diseases of the Most Impoverished (DOMI) Program, supported by the Bill and Melinda Gates Foundation aims to give useful information for the prevention and control of typhoid fever and cholera. The aim is to accelerate the introduction of new generation vaccines against cholera, shigellosis, and typhoid fever, through research and capacity-building. 

The overall goal of the project is to generate accurate epidemiologic, socio-behavioural, and economics data on typhoid fever and cholera in impoverished slum populations of eastern Kolkata and to implement this data for field trials of vaccines against these two diseases. It was envisioned that data from this project may be used in the planning and implementation of programs to control typhoid fever and cholera in Kolkata, and that the data may be extrapolated to areas with similar demographic characteristics. 

For the past four years, NICED and IVI scientists have worked together in poor areas of Kolkata on several challenging and important projects to accelerate the introduction of new generation typhoid and cholera vaccines into programs for the poor. The results of the collaboration have been phenomenal -

• A field site for population-based studies among over 100,000 slum-dwellers has been created. The field site includes ongoing demographic surveillance as well as surveillance for febrile and diarrheal diseases among all members of the target population.
• The surveillance for febrile and diarrheal illnesses is being accomplished through a highly successful cooperative system entailing special study health outposts, referrals from private practitioners, and local hospitals.
• NICED’s outstanding laboratories are evaluating clinical specimens with state of the art microbiological techniques.
• A model computerized data entry and management system is maintaining databases for the surveillance in a real-time fashion. 
• The entire study area has been mapped with computerized geographical information system techniques that are providing important geographic insights into patterns of disease and medical service delivery. 
• This robust research infrastructure is supporting two ongoing cluster-randomized trials, one of Vi polysaccharide vaccine against typhoid, being conducted in 38,000 participants, and the other of killed oral cholera vaccine, which succeeded in enrolling nearly 70,000 participants.

Supplementing this epidemiological and clinical trials work has been a program of sociobehavioral and economic studies to provide critical information to Indian vaccine policymakers on population demand for cholera and typhoid vaccines, costs of cholera and typhoid illnesses, and the cost-effectiveness of vaccinating against these two infections.

The will extend beyond the current trials of cholera and typhoid vaccines and the study site is being considered for future studies of several other vaccines. 

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