By Stan Deresinski, MD, FACP, FIDSA
Clinical Professor of Medicine, Stanford University
Dr. Deresinski reports no financial relationships relevant to this field of study.
SYNOPSIS: The new oral cholera vaccine is recommended for adults 18-64 years of age who are planning to travel to areas at risk.
SOURCE: Wong KK, Burdette E, Mahon BE, et al. Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine. MMWR Morb Mortal Wkly Rep 2017;66:482-485.
In 2016, the Advisory Committee on Immunization Practices (ACIP) recommended the use of lyophilized CVD 103-HgR vaccine, which also was approved by the FDA in 2016, for prevention of cholera in individuals age 18-64 years traveling to areas with endemic or epidemic cholera caused by toxigenic Vibrio cholerae O1. It also recommended vaccination for travel to areas at risk of recurrence of epidemic cholera that had had cholera activity in the past 12 months.
COMMENTARY
While rare in the United States, cholera affects 2.9 million individuals globally each year, and these infections result in 95,000 deaths.
The vaccine has an estimated efficacy of 90% when tested by oral challenge with toxigenic V. cholerae 10 days after its receipt, an efficacy of 80% at three months, and is well tolerated. Travelers to selected areas who are considered at higher than usual potential risk include healthcare workers, epidemic response workers, those with extended residence in endemic areas, and, importantly, those visiting families and friends. Among those who become infected, the following are risk factors for adverse outcomes: those with reduced gastric acidity because of, e.g., partial gastrectomy or antacid therapy, those without ready access to medical care, and individuals with blood group O. The last risk factor is true of 45% of the U.S. population.
Vaccination should be avoided in individuals who received an antibiotic in the previous 14 days. Chloroquine may interfere with the immunogenicity of the vaccine, and its initiation, if indicated, should be delayed for at least 10 days after vaccination. The vaccine strain is shed in stool in 11.1% of recipients in the week after administration.
Receipt of the vaccine does not preclude the need for personal protection, including hygiene, food and water precautions, and effective sanitation. The duration of protection beyond three months is unknown.
The new oral cholera vaccine is recommended for adults 18-64 years of age who are planning to travel to areas at risk.
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