doi:10.4269/ajtmh.13-0200 Copyright © 2013 by The American Society of Tropical Medicine and Hygiene Development of a Cholera Vaccination Policy on the Island of Hispaniola, 2010–2013

Abstract. Deployment of oral cholera vaccine (OCV) on the Island of Hispaniola has been considered since the emergence of the disease in October of 2010. At that time, emergency response focused on the time-tested measures of treatment to prevent deaths and sanitation to diminish transmission. Use of the limited amount of vaccine available in the global market was recommended for demonstration activities, which were carried out in 2012. As transmission continues, vaccination was recommended in Haiti as one component of a comprehensive initiative supported by an international coalition to eliminate cholera on the Island of Hispaniola. Leveraging its delivery to strengthen other cholera prevention measures and immunization services, a phased OCV introduction is pursued in accordance with global vaccine supply. Not mutually exclusive or sequential deployment options include routine immunization for children over the age of 1 year and campaigns in vulnerable metropolitan areas or rural areas with limited access to health services. BACKGROUND Cholera emerged on the Island of Hispaniola in October of 2010. During the first peak of the outbreak, which lasted from October of 2010 to March of 2011, 526,351 and 22,344 suspect and confirmed cases were reported in Haiti and the Domini-can Republic, respectively.1 Cholera transmission has con-tinued thereafter, although at much decreased rates. Cholera surveillance data for the first 2 years of the Haitian outbreak have been reviewed.