Letter to the editor
Addressing cholera vaccine scarcity in Turkey and Syria amidst earthquake situation: Call for an urgent action
Hacer frente a la escasez de vacunas contra el cólera en Turquía y Siria en medio de la situación sísmica: llamamiento a una acción urgente
Harendra Kumara,1, Dattatreya Mukherjeeb,
,1, Sumitaksha Banerjeec, Prashant Upadhyayd, Vagisha Sharmae, Moubani Duttaf
a Department of Public Health, Dow University of Health Sciences, Karachi, Pakistan
b Department of Public Health, Raiganj Government Medical College and Hospital, Raiganj, West Bengal, India
c Department of Public Health, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
d Department of General Surgery, BRD Medical College, Gorakhpur, Uttar Pradesh, India
e Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
f Post-Graduation and Research Department of Microbiology, St. Xavier's College (Autonomous), Kolkata 700016, West Bengal, India
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(A) Uptake of empty iLNPs by innate immune cells and other cell types induces local and systemic inflammation, characterised by the release of pro-inflammatory cytokines such as IL-1β and IL-6. (B) Preparation of synthetic mRNA. The incorporation of modified uridines and purification process of IVT mRNA lowers the recognition of IVT mRNA by TLR3, TLR7, TLR8, and other RNA sensors. These modifications are important to minimise the negative effects of type I IFN-stimulated RNA sensors on protein expression of antigen-encoding mRNA and prevent cytotoxicity. Signalling pathway associated with melanoma differentiation-associated gene 5-interferon type α (MDA5-IFN-α) in the induction of CTL to BNT162b2 in a mouse animal model indicates residual type I IFN activity in the current generation of mRNA vaccines. (C) After administration of the second dose of vaccine, strong boost in T cell responses associated with increased IFN-γ production. Enhanced activation of T cells and myeloid cells after booster vaccine reflects cross-talk between lymphocytes and myeloid cells. Verbeke et al. 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Moubani Dutta" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Harendra" "apellidos" => "Kumar" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "af0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 1 => array:4 [ "nombre" => "Dattatreya" "apellidos" => "Mukherjee" "email" => array:1 [ 0 => "dattatreyamukherjee4u@outlook.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "af0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cr0005" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">1</span>" "identificador" => "fn0005" ] ] ] 2 => array:3 [ "nombre" => "Sumitaksha" "apellidos" => "Banerjee" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "af0015" ] ] ] 3 => array:3 [ "nombre" => "Prashant" "apellidos" => "Upadhyay" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "af0020" ] ] ] 4 => array:3 [ "nombre" => "Vagisha" "apellidos" => "Sharma" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "af0025" ] ] ] 5 => array:3 [ "nombre" => "Moubani" "apellidos" => "Dutta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "af0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Department of Public Health, Dow University of Health Sciences, Karachi, Pakistan" "etiqueta" => "a" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Department of Public Health, Raiganj Government Medical College and Hospital, Raiganj, West Bengal, India" "etiqueta" => "b" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "Department of Public Health, Burdwan Medical College and Hospital, Burdwan, West Bengal, India" "etiqueta" => "c" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Department of General Surgery, BRD Medical College, Gorakhpur, Uttar Pradesh, India" "etiqueta" => "d" "identificador" => "af0020" ] 4 => array:3 [ "entidad" => "Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India" "etiqueta" => "e" "identificador" => "af0025" ] 5 => array:3 [ "entidad" => "Post-Graduation and Research Department of Microbiology, St. Xavier's College (Autonomous), Kolkata 700016, West Bengal, India" "etiqueta" => "f" "identificador" => "af0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cr0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Department of Public Health, Raiganj Government Medical College and Hospital, Raiganj 733134, West Bengal, India." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hacer frente a la escasez de vacunas contra el cólera en Turquía y Siria en medio de la situación sísmica: llamamiento a una acción urgente" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="p0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Dear Editor,</span></p><p id="p0010" class="elsevierStylePara elsevierViewall">A strong 7.8-magnitude earthquake struck Turkey and Syria on February 6, 2023. It was followed by several aftershocks and a second, 7.6-magnitude earthquake that caused significant damage and fatalities.<a class="elsevierStyleCrossRef" href="#bb0005"><span class="elsevierStyleSup">1</span></a> In these situation, chances of occurrence of communicable diseases increase. So, it's a major time to utilize the vaccines properly.</p><p id="p0015" class="elsevierStylePara elsevierViewall">The insufficiency of cholera vaccines in the earthquake regions, specially Syria is an urgent issue that necessitates immediate action, especially in light of recent earthquakes that have inflicted severe damage on the region. Cholera is a waterborne infectious disease caused by the bacterium <span class="elsevierStyleItalic">Vibrio cholerae</span>, which can rapidly spread in areas with poor sanitation and limited access to safe drinking water.<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a> Syria has struggled to control the transmission of cholera due to various factors, including inadequate infrastructure, political instability, and ongoing conflict. The recent earthquakes have compounded these challenges, leading to widespread devastation and leaving many communities in dire need of assistance.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a> The shortage of cholera vaccines in these regions is a significant concern, as vaccines are the most effective means of preventing the spread of the disease.<a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a> Without adequate vaccination coverage, individuals in affected communities are at a heightened risk of contracting cholera, which can cause severe dehydration, diarrhea, and in severe cases, death.<a class="elsevierStyleCrossRef" href="#bb0010"><span class="elsevierStyleSup">2</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">It is indeed unfortunate that despite the existence of effective cholera vaccines, the availability of these vaccines in the affected regions remains inadequate. According to a research from the Gavi vaccine alliance, a global scarcity of cholera vaccinations is projected to endure until 2025 as epidemics spread rapidly throughout the world.<a class="elsevierStyleCrossRef" href="#bb0030"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0035"><span class="elsevierStyleSup">7</span></a> The people of these areas, majorly Syria have already been enduring significant hardship, and the limited availability of vaccines only serves to compound the situation. The consequences of not taking swift action to address this issue could be catastrophic, and it is crucial that we act expeditiously to prevent a humanitarian catastrophe.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0020"><span class="elsevierStyleSup">4</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">One of the key causes of the paucity of vaccinations is the absence of financing for immunization campaigns and increase in cases. The international community has to step up and contribute the required cash to guarantee that the afflicted communities get enough vaccinations. In addition, there is a need for greater coordination among the numerous players engaged in the distribution of vaccinations to ensure that they reach the regions most in need.<a class="elsevierStyleCrossRef" href="#bb0015"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0025"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bb0040"><span class="elsevierStyleSup">8</span></a></p><p id="p0030" class="elsevierStylePara elsevierViewall">However, the local administrations in Syria must also take action to solve this situation. Turkey and other countries should help Syria with cholera vaccines. They need to prioritize the vaccination campaigns and commit the required resources to guarantee that the vaccinations are disseminated efficiently. The health authorities should also engage with foreign assistance groups and other partners to guarantee that vaccinations are provided to those who need them the most. Another big problem that has to be addressed is the lack of information among the population about the need for immunizations. Local health officials need to connect with the community and educate them about the advantages of immunization. They should also address the misunderstandings that some individuals have about vaccinations and re-assure them about the safety and effectiveness of immunizations.<a class="elsevierStyleCrossRefs" href="#bb0010"><span class="elsevierStyleSup">2–4</span></a> Following are some of the suggestions that might help handle the present disastrous scenario.</p><p id="p0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Increase funding:</span> The international community should provide more funding to organizations working on the ground in Turkey and Syria to increase the availability and distribution of cholera vaccines. Clean water should be provided with the vaccines.</p><p id="p0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Strengthen health infrastructure:</span> Improving health infrastructure and training healthcare professionals in cholera prevention and treatment could help prevent outbreaks from occurring in the first place. Cold Chain system must be strengthened. Proper vaccine distribution is important. Also, it is important to send more vaccines in the endemic areas Syria where cases are more. Proper standard operating protocol (SOP) should be created in vaccine distribution in the affected areas.</p><p id="p0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Conduct mass vaccination campaigns:</span> Mass vaccination campaigns should be conducted in affected areas to protect as many people as possible from the risk of cholera.</p><p id="p0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Ensure access for vulnerable populations:</span> Efforts should be made to ensure that vulnerable populations, such as refugees and internally displaced persons, have equal access to vaccines and other healthcare resources.</p><p id="p0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Promote public education:</span> Educating the public about the risks of cholera, how to prevent it, and how to seek treatment if infected can help reduce the spread of the disease.</p><p id="p0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Increase research:</span> More research is needed to develop new and more effective cholera vaccines, and to better understand the epidemiology and pathophysiology of the disease. It is important to produce more cholera vaccines. Production should be increased in the middle Asia so that the vaccine could reach in the middle Asian countries in low costs.</p><p id="p0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Address political and social factors:</span> The underlying political and social factors that contribute to the spread of cholera, such as poor sanitation and lack of access to clean water, should be addressed to prevent future outbreaks.</p><p id="p0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Strengthening case surveillance:</span> The lack of recorded incidents from the Turkish zone, despite legal reporting obligations, raises concerns about the monitoring system's accuracy. Monitoring is critical for early detection and response to cholera outbreaks, allowing for focused treatments and tracking disease spread. Local health authorities must raise awareness among healthcare professionals and communities about the need for timely reporting, as well as educate healthcare workers on recognizing symptoms and following proper reporting procedures. Using digital tools and real-time reporting systems may help speed up data collection and processing, while investing in advanced laboratory facilities and portable diagnostics can help speed up case confirmation. Effective case monitoring will assist public health authorities in Turkey and Syria in taking fast action, allocating resources correctly, and limiting disease transmission in vulnerable populations.</p><p id="p0075" class="elsevierStylePara elsevierViewall">Moreover, massive immigration played an important role in alleviating the cholera vaccine scarcity in these regions during the earthquake scenario, necessitating prompt action by both national governments and the international community. The latest earthquakes have wreaked havoc in the region, resulting in an influx of displaced people and aggravating an already dire healthcare situation. With a large number of people transferring to safer areas, the threat of cholera outbreaks becomes even more apparent due to crowded living conditions and insufficient access to clean water and sanitation facilities. As a result, governments and humanitarian organizations must prioritize the distribution and administration of cholera vaccines in high-migration areas. To guarantee equal access to immunizations for both the local population and new migrants, substantial collaboration between host communities and humanitarian groups is required.</p><p id="p0080" class="elsevierStylePara elsevierViewall">In conclusion, the shortage of cholera vaccinations in these regions, majorly in Syria is a grave concern, and urgent action is required to address the issue. To address this issue, it is crucial that governments and NGOs collaborate to mobilize the resources necessary to increase the availability of cholera vaccines in affected regions. This will require not only funding but also improvements to supply chains and logistics to ensure that vaccines are delivered effectively to those in need. Moreover, efforts should be made to promote the importance of hygienic practices and safe drinking water, as these measures can help reduce the transmission of cholera and other waterborne diseases. In addition, efforts should be made to engage with communities to dispel any misunderstandings and raise awareness about the importance of vaccination in preventing the spread of cholera. The consequences of inaction in addressing this issue could be catastrophic, particularly given the existing challenges facing these regions. The ongoing conflict, political instability, and limited access to safe drinking water and sanitation infrastructure have already made these communities vulnerable to disease outbreaks. The scarcity of cholera vaccinations only adds to the difficulties faced by these populations, increasing the risk of transmission and further exacerbating the situation. Only collective action can mitigate the impact of cholera in these vulnerable populations and save numerous lives.</p><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0005">Funding</span><p id="p0085" class="elsevierStylePara elsevierViewall">No funding is attached with this project.</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sectitle0025">Author's Contribution</span><p id="p0105" class="elsevierStylePara elsevierViewall">Conceptualization: DM, Writing: HK, DM, SB Editing: PU, VS, MD.</p><p id="p0110" class="elsevierStylePara elsevierViewall">Critical Comments and Final Editing: HM, DM, MD. All authors have agreed the final version of the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "s0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "s0025" "titulo" => "Author's Contribution" ] 2 => array:2 [ "identificador" => "xack752084" "titulo" => "Acknowledgements" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-10-18" "fechaAceptado" => "2024-03-01" "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "<p class="elsevierStyleNotepara" id="ntpara0005">Authors contribution is same.</p>" "identificador" => "fn0005" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bb0005" "etiqueta" => "1." 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Rigby, Cholera vaccine shortage will last until 2025 amid surging cases- Gavi, Reuters, <a target="_blank" href="https://www.nasdaq.com/articles/cholera-vaccine-shortage-will-last-until-2025-amid-surging-cases-gavi">https://www.nasdaq.com/articles/cholera-vaccine-shortage-will-last-until-2025-amid-surging-cases-gavi</a>" ] ] ] 7 => array:3 [ "identificador" => "bb0040" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An emerging health crisis in Turkey and Syria after the earthquake disaster on 6 February 2023: risk factors, prevention and management of infectious diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Mavrouli" 1 => "S. Mavroulis" 2 => "E. Lekkas" 3 => "A. Tsakris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/healthcare11071022" "Revista" => array:6 [ "tituloSerie" => "Healthcare (Basel)" "fecha" => "2023 Apr 3" "volumen" => "11" "numero" => "7" "paginaInicial" => "1022" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37046949" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack752084" "titulo" => "Acknowledgements" "texto" => "<p id="p0120" class="elsevierStylePara elsevierViewall">We want to thank Dr. Aymar Akilimali for his help during preparation of the manuscript.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/24451460/0000002500000002/v1_202406161040/S244514602400030X/v1_202406161040/en/main.assets" "Apartado" => array:4 [ "identificador" => "66708" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24451460/0000002500000002/v1_202406161040/S244514602400030X/v1_202406161040/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S244514602400030X?idApp=UINPBA00004N" ]