Oral cholera vaccination in hard-to-reach communities, Lake Chilwa, Malawi.

OBJECTIVE: To evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak. METHODS: We performed a two-stage cluster survey. The population interviewed was divided in three strata according to the second-dose vaccine distribution strategy: (i) a standard strategy in 1477 individuals (68 clusters of 5 households) on the lake shores; (ii) a simplified cold-chain strategy in 1153 individuals (59 clusters of 5 households) on islands in the lake; and (iii) an out-of-cold-chain strategy in 295 fishermen (46 clusters of 5 to 15 fishermen) in floating homes, called zimboweras. FINDING: Vaccination coverage with at least one dose was 79.5% (1153/1451) on the lake shores, 99.3% (1098/1106) on the islands and 84.7% (200/236) on zimboweras. Coverage with two doses was 53.0% (769/1451), 91.1% (1010/1106) and 78.8% (186/236), in the three strata, respectively. The most common reason for non-vaccination was absence from home during the campaign. Most interviewees liked the novel distribution strategies. CONCLUSION: Vaccination coverage on the shores of Lake Chilwa was moderately high and the innovative distribution strategies tailored to people living on the lake provided adequate coverage, even among hard-to-reach communities. Community engagement and simplified delivery procedures were critical for success. Off-label, out-of-cold-chain administration of oral cholera vaccine should be considered as an effective strategy for achieving high coverage in hard-to-reach communities. Nevertheless, coverage and effectiveness must be monitored over the short and long term.

Oral cholera vaccination in hard-to-reach communities, Lake Chilwa, Malawi

Objective To evaluate vaccination coverage, identify reasons for non-vaccination and assess satisfaction with two innovative strategies for distributing second doses in an oral cholera vaccine campaign in 2016 in Lake Chilwa, Malawi, in response to a cholera outbreak. Methods We performed a two-stage cluster survey. The population interviewed was divided in three strata according to the second-dose vaccine distribution strategy: (i) a standard strategy in 1477 individuals (68 clusters of 5 households) on the lake shores; (ii) a simplifiedcold-chain strategy in 1153 individuals (59 clusters of 5 households) on islands in the lake; and (iii) an out-of-cold-chain strategy in 295 fishermen (46 clusters of 5 to 15 fishermen) in floating homes, called zimboweras. Finding Vaccination coverage with at least one dose was 79.5% (1153/1451) on the lake shores, 99.3% (1098/1106) on the islands and 84.7% (200/236) on zimboweras. Coverage with two doses was 53.0% (769/1451), 91.1% (1010/1106) and 78.8% (186/236), in the three strata, respectively. The most common reason for non-vaccination was absence from home during the campaign. Most interviewees liked the novel distribution strategies. Conclusion Vaccination coverage on the shores of Lake Chilwa was moderately high and the innovative distribution strategies tailored to people living on the lake provided adequate coverage, even among hard-to-reach communities. Community engagement and simplified delivery procedures were critical for success. Off-label, out-of-cold-chain administration of oral cholera vaccine should be considered as an effective strategy for achieving high coverage in hard-to-reach communities. Nevertheless, coverage and effectiveness must be monitored over the short and long term

"I pick you": the impact of fairness and race on infants' selection of social partners.

By 15 months of age infants are sensitive to violations of fairness norms as assessed via their enhanced visual attention to unfair versus fair outcomes in violation-of-expectation paradigms. The current study investigated whether 15-month-old infants select social partners on the basis of prior fair versus unfair behavior, and whether infants integrate social selections on the basis of fairness with the race of the distributors and recipients involved in the exchange. Experiment 1 demonstrated that after witnessing one adult distribute toys to two recipients fairly (2:2 distribution), and another adult distribute toys to two recipients unfairly (1:3 distribution), Caucasian infants selected fair over unfair distributors when both distributors were Caucasian; however, this preference was not present when the fair actor was Asian and the unfair actor was Caucasian. In Experiment 2, when fairness, the race of the distributor, and the race of the recipients were fully crossed, Caucasian infants' social selections varied as a function of the race of the recipient advantaged by the unfair distributor. Specifically, infants were more likely to select the fair distributor when the unfair recipient advantaged the Asian (versus the Caucasian) recipient. These findings provide evidence that infants select social partners on the basis of prior fair behavior and that infants also take into account the race of distributors and recipients when making their social selections.