The Knowledge Hub

What is the Knowledge Hub?

Explore the VoICE Knowledge Hub—a searchable database featuring the latest peer-reviewed research on immunization benefits, especially in low- and middle-income countries. Browse the Knowledge Hub using a variety of different filters to find vaccine evidence based on country, region, topic, or disease. Click on a tag to find more evidence on a specific area, such as the return on investment of vaccines or impacts of infectious disease outbreaks.


Diseases & Vaccines


WHO Regions


Immunization Terms

Vaccinating against cholera is cost-effective, especially for high-risk populations and areas with high fatality rates

A comprehensive review of the economics of cholera and cholera prevention concluded that vaccination using oral cholera vaccines can be cost-effective, especially when herd effects are taken into account and when vaccination is administered to populations and age groups with high incidence rates (e.g., children) and to areas with high cholera case fatality rates.

Hsiao A, Hall AH, Mogasale V et al.. 2018. The health economics of cholera: a systematic review. Vaccine. 36(30).

Vaccinating children in high-risk slum areas in Bangladesh can effectively control cholera and save lives

A study using local epidemiological and economic data found that vaccinating children 1-14 years old in high-risk slum areas in Dhaka, Bangladesh using a locally-produced oral cholera vaccine provided through periodic campaigns would be a highly cost-effective means of controlling endemic cholera — reducing cholera incidence in the entire population by 45% over 10 years and costing US$440-635 per DALY averted. Vaccinating all persons aged one and above would reduce incidence much further (by 91%) but would be less cost-effective.

Khan AI, Levin A, Chao DL, DeRoeck D et al.. 2018. The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh: A disease modeling and economic analysis. PLoS NTD. 12(10).

Malnourishment is one factor contributing to the severity of cholera

The  presence of malnourishment correlates with the severity of cholera illness.  Additional factors include the number of V. cholerae bacteria ingested, lack of immunity from prior exposure or vaccination, pregnancy, lack of breast-feeding, immunocompromised state, reduced ability to produce gastric acid, and having blood group O.

World Health Organization. 2017. Weekly epidemiological record, Cholera vaccines: WHO position paper – August 2017. WHO Weekly epidemiological record. 92(34).

Cholera vaccination programs for children in slums also reduces incidence in adults through herd effects

According to a modeled data study on cholera transmission in Bangladesh, a cholera vaccination program for 1-14 year olds in the slums of Dhaka, Bangladesh involving periodic (every 3 years) campaigns would reduce cholera incidence in adults living in these areas by 40% due to the herd effects of oral cholera vaccines.

Khan IK, Levin A, Chai DL, et al.. 2018. The impact and cost-effectiveness of controlling cholera through the use of oral cholera vaccines in urban Bangladesh: a disease modeling and economic analysis. PLoS NTD. 12(10).

In rural Malawi, families face financial burdens due to the costs of treating cholera

In rural Malawi, even though medical care for cholera is free-of-charge in the public sector, more than half of families had to borrow money or sell livestock or other assets to compensate for the lost wages of patients or caregivers and other costs (such as for food and transportation) incurred as a result of an episode of cholera.

Ilboudo PG, Huang XX, Ngwira B et al.. 2017. Cost-of-illness of cholera to households and health facilities in rural Malawi. PLOS One. 12(9).

Cholera outbreaks can cause millions of dollars in economic impacts

A study of a cholera outbreak in Peru in 1991-92 estimates that the national economy conservatively suffered more than US$50 million in economic losses due to reduced tourism revenue, reduced revenue on export of goods and lower domestic consumption as a result of the outbreak of cholera.

Suarez, R. and Bradford, B.. 1993. The economic impact of the cholera epidemic in Peru: An application of the cost of illness methodology. Office of Health, Bureau for Research and Development, Water and Sanitation for Health (WASH) Project. Field Report. 415.

Preventing cholera outbreaks in Africa can prevent millions of dollars in economic burdens

A study of the economic burden of cholera in Africa found that 110,837 cases of cholera reported in 2007 resulted in an economic loss of $43.3 million, $60 million and $72.7 million US dollars, assuming life expediencies of 40, 53 and 73 years respectively.

Kirigia, J.M., Gambo, L.G., Yolouide, A., et al. 2009. Economic burden of cholera in the WHO African Region. BMC International Health and Human Rights. 9(8).

Cholera vaccination can provide indirect protection to unvaccinated individuals through herd immunity

The evidence on cholera disease dynamics suggests that significant herd protection can result from a relatively small number of immunizations, particularly in endemic areas where there is some natural immunity among the population.

Jeuland, M., Lucas, M., Clemens, J.,et al. 2009. A Cost–Benefit Analysis of Cholera Vaccination Programs in Beira, Mozambique. World Bank Economic Review. 23(2).

Cholera vaccine programs were found to be cost-effective across three countries

A multi-site study of cholera vaccination programs found that the vaccine was cost-effective in school- and community-based vaccination programs for children in India, Mozambique, and Indonesia.

Jeuland, M., Cook, J., Poulos, C., et al. 2009. Cost-effectiveness of new-generation oral cholera vaccines: A multisite analysis. Value Health. 23(2).

Immunization programs provide cost-sharing opportunities with other health interventions, like clean water initiatives

This paper presents the first cost-benefit comparison of improved water supply investments and cholera vaccination programs. The modeling results showed that improved water supply interventions combined with targeted cholera vaccination programs are much more likely to yield attractive cost-benefit ratio outcomes than a community-based vaccination program alone.

Jeuland, M. and Whittington, D.. 2009. Cost-benefit comparisons of investments in improved water supply and cholera vaccination programs. Vaccine. 27(23).