Cholera vaccine Michael H.N. Golden 18.12.97
Cholera vaccine Lola Nathanail 24.12.97
Cholera vaccine -Reply Serge Male 25.04.97
2nd measles vaccination Saskia VD KAM 28.04.97
2nd measles vaccination Michael H.N.Golden 28.04.97

Subject: Cholera vaccine

Date: Fri, 25 Apr 1997 11:44:57 +0100 (BST)

From: "Michael H.N. Golden" <>


Cholera vaccine is not available in the UK. Presumably the British NGOs are sending their volunteers out to refugee camps to work in Therapeutic Feeding Centres without protecting them from cholera. I have contacted some non-british NGOs and it would seem that they are also sending volenteers without cholera vaccine of any sort. In TCFs it is highly likely that the volenteers will be in direct contact with and looking after cholera patients. National vaccination guidelines that are designed for tourists etc are not really applicable to our staff.

The question of the efficacy of the vaccine arises. I understand that the live-attenuated oral vaccine is much more effective than the older vaccines which were at best about 60% protective. The live vaccine is available from Institute Serotherapique et Vaccinal Suisse


I would be grateful if NGOs would let me know what their policy is on vaccination and prophylaxsis for the staff that they send to refugee camps - perhaps the NGOs should have a common and agreed policy on this matter.

Best wishes,


Prof. Michael H.N.Golden

From: Lola Nathanail, SCF,

Date: Mon, 28 Apr 1997 13:07:08 +0000

Subject: Cholera vaccine


I checked with our health adivsor and staff health officer: Our policy to date has been do not vaccinate with the old injectable vaccine (as advised by WHO since vaccine ineffective) and ensure good hygiene conditions in the field.

There are questions as to whether the new attenuated oral vaccine is licensed for the UK - we will investigate. We will also raise this at a meeting on EPI in Geneva in June.


Date: Mon, 28 Apr 1997 15:26:24 +0200

From: Serge Male <>

Subject: Cholera vaccine -Reply


1.On cholera vaccine policies for UNHCR staff, contact Dr Baduraux (to whom i copy this e-mail)

2. For refugees: UNHCR does not recommend vaccination

Tue, 2 Sep 97

From: (Saskia VD KAM)

Subject: 2nd measles vaccination


Dear colleagues,

The patients in Therapeutic Feeding Centres get a standard measles vaccination on admission. (unless there is a written proove of vaccination). In Therapeutic Feeding Centres severe malnutrition is treated.

A measles epidemic within the feeding centres is a serious threat. Besides, malnutrition is not a contraindication for measles vaccination.

The vaccinated patient is protected for the time in the feeding centre, and aa unknown period after that.

The question is how long this protection lasts.

It is thinkable that the immuno response is at least a bit suppressed, resulting in a shorter protected period.

If this is true it might a good idea to vaccinate the patients on discharge from the feeding centre, ensuring a full protection.

Is the assumption that the first measles vaccination is less effective right?

Is the strategy to vaccinate on admissions well as on discharge a good strategy for the vaccination status of the patient?


Saskia van der Kam

Nutritionist Médecins Sans Frontières Holland


From: Michael H.N.Golden

Wed, 3 Sep 1997 12:09:48 +0100 (BST)

Subject: 2nd measles vaccination


Dear Saskia,

In ACF we follow the policy of giving a first measles vaccine on admission (to prevent an outbreak in the TFC and nosocomial infection) and then give a second vaccination on discharge.

The second is based upon a presumed non-conversion of a proportion of the severely malnourished when given the measles vaccine immediatly on admission.

To my knowlege, nobody has measured measles sero-conversion rates in severely malnourished chidren, whilst they still have other infections, gross oedema, absent inflammatory response etc - obviously, such measurements would guide our policy if they are available. However, from my reading of the literature, is seems that the degree of immunocompetence that accompanies severe malnutition is quite variable from one geographical area to another and also with the clinical form of malnutrition (at least when malnutrition is defined in purely anthropometric terms). Thus, data from one area would probably not be sufficient to ammend a general policy now based entirely on extrapolation from studies of the immune response in general.

Would the Danish members of the list please ask Peter Aaby to comment.

Best wishes,


Prof. Michael H.N.Golden