Effect of HIV Status and Vitamin A on Oral Cholera Vaccine Uptake in Adult Population Living in an Endemic Area of Lukanga Swamps, Zambia.

Authors: Mr. Charlie Luchen, Mwaba, John (CIDRZ) Ng’ombe, Harriet (CIDRZ) Peter Ibukun Oluwa Alabi (CIDRZ), Simuyandi, Michelo (CIDRZ), Obvious N. Chilyabanyama (CIDRZ), Luiza MiyandaHatyoka (CIDRZ), Mubanga Cynthia (CIDRZ), Samuel Bosomprah (CIDRZ), Chilengi, Roma (CIDRZ), Chisenga, Cleopatra Caroline(CIDRZ)

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Citation Style For This Article: Luchen C, Mwaba J, Ng’ombe H, et al . Effect of HIV Status and Vitamin A on Oral Cholera Vaccine Uptake in Adult Population Living in an Endemic Area of Lukanga Swamps, Zambia.. Health Press Zambia Bull. 2020; 4(4); pp 18


While Oral Cholera Vaccines (OCV) are known to be effective in the prevention and control of deadly diseases, vaccine uptake, and its effectiveness could be affected by several factors. We set out to assess the impact of the human immunodeficiency virus (HIV) and micronutrient deficiency as indicated by serum retinol levels (a proxy for vitamin A) in Lukanga Swamps where OCV was deployed among fishmongers during the 2016 outbreak in Zambia.


HIV testing was done only among consenting participants. The enumeration of percentage and absolute cell counts of CD4+ T lymphocytes was performed on the FACS Calibur instrument while viral load testing was performed using the COBAS®Ampliprep/ COBAS®Taqman® 48 HIV-1 Test, version 2. Vitamin A analysis was performed using the Shimadzu Prominence HCT-2010 High-Performance Liquid Chromatography (HPLC). The plasma vibriocidal antibody assay was used to evaluate the immunogenicity of Shanchol™ OCV against both Inaba and Ogawa cholera strains. 223 participants in the Lukanga Swamps, were enrolled and followed up for 30 months after the administration of the 1st and 2nd doses.


Out of 223 participants, 47 consented for HIV screening, and of these 24 tested positive. HIV – individuals had geometric mean titers (GMTs) of 49.79 against Ogawa and 23.31 against Inaba, while HIV + individuals had GMTs of 10.76 against Ogawa and 7.20 against Inaba. HIV-negative participants had higher GMTs compared to the HIV + participants, even though they were not statistically significant. There was a positive association between serum retinol levels and Ogawa GMTs among the HIV- participants at baseline, days 28, and Month 6 while among the HIV + participants this association was positive only at baseline. Against Inaba, there was a significant inverse association between serum retinol levels and GMTs at all time points.


Our study shows that HIV + participants from the Lukanga Swamps had lower vibriocidal antibody titers and responded poorly to the OCV Shanchol™ as compared to the HIV – participants. This is consistent with reported observations from other vaccines in HIV +/- participants. Serum retinol levels do not play a clear role in affecting the immunogenicity of OCV in HIV +/- individuals due to non-consistent patterns observed against the two strains and across different time points.

Recommendations: We recommend that future studies have a more powered sample size and also investigate other micronutrients such as Zinc which has been reported to affect vaccine uptake. Another recommendation is that future studies try to have short blood sampling timelines as opposed to the ones our study had due to logistical feasibility challenges.