Urban Cholera Transmission Hotspots and Their Implications for Reactive Vaccination: Evidence from Bissau City,Guinea Bissau

Background: use of cholera vaccines in response to epidemics (reactive vaccination) may provide an effective supplement to traditional control measures. in haiti,reactive vaccination was considered but,until recently,rejected in part due to limited global supply of vaccine. using bissau city,guinea-bissau as a case study,we explore neighborhood-level transmission dynamics to understand if,with limited vaccine and likely delays,reactive vaccination can significantly change the course of a cholera epidemic. methods and findings: we fit a spatially explicit meta-population model of cholera transmission within bissau city to data from 7,551 suspected cholera cases from a 2008 epidemic. we estimated the effect reactive vaccination campaigns would have had on the epidemic under different levels of vaccine coverage and campaign start dates. we compared highly focused and diffuse strategies for distributing vaccine throughout the city. we found wide variation in the efficiency of cholera transmission both within and between areas of the city. hotspots