Cholera, the Current Status of Cholera Vaccines and Recommendations for Travellers
Abstract
:1. Cause and Symptoms of Cholera
2. Epidemiology of Cholera
2.1. Global Overview
2.2. Cholera in Developed Countries
2.3. Cholera in Travellers
2.4. Under-Reporting of Cholera Cases
2.5. Natural Immunity
3. Prevention of Cholera in Travellers
3.1. Preventive Hygiene Measures Including Washing Hands, Food Control, etc.
- Practice regular hygiene, especially hand hygiene with soap and water or, if not available, with an alcohol-based hand sanitiser solution;
- Practice hand hygiene especially before touching the nose, eyes, or mouth, and after using the toilet or touching objects at high risk of being contaminated;
- All precautions should be taken to avoid the ingestion of potentially contaminated food, drink, and drinking water by consuming food and water only from safe, known sources;
- Follow the five rules for food safety: wash hands often and always before handling and consuming food; make sure the food is cooked thoroughly; peel all vegetables and fruit if they are to be eaten raw; drink bottled water where available, or if the source of water is uncertain, bring it to a vigorous boil; separate cooked food from raw food, avoid uncooked food, and keep food at safe temperatures.
3.2. Chemoprophylaxis
3.3. Vaccination
4. Vaccines Available for Cholera
4.1. WC-rBS, Killed Whole-Cell Monovalent (O1) Vaccines with a Recombinant B Subunit of Cholera Toxin (Dukoral®)
4.2. BivWC, Killed Modified Whole-Cell Bivalent (O1 and O139) Vaccines without B Subunit
4.3. Recombinant Live OCV CVD 103-HgR (Vaxchora®)
Vaccine and Manufacturer | Killed Whole-Cell Monovalent (O1) Vaccine with a Recombinant Cholera Toxin B Subunit WC-rBS (Dukoral®) Valneva (Sweden) [68] | Killed Whole-Cell Bivalent (O1 and O139) Vaccine without the Cholera Toxin B Subunit BivWC (Shanchol®) Shantha Biotechnics (India) [81] | Killed Whole-Cell Bivalent (O1 and O139 without Cholera Toxin B Subunit) BivWC (Euvichol™/Euvichol-Plus™) EuBiologics (S Korea) [85] | Live Attenuated Vaccine CVD 103-HgR (Vaxchora®) Emergent BioSolutions (USA) [65] |
---|---|---|---|---|
Composition | V. cholerae O1 Inaba, classical biotype (heat inactivated) 31.25 × 109 bacteria V. cholerae O1 Inaba, El Tor biotype (formalin inactivated) 31.25 × 109 bacteria V. cholerae O1 Ogawa, classical biotype (heat inactivated) 31.25 × 109 bacteria V. cholerae O1 Ogawa, classical biotype (formalin inactivated) 31.25 × 109 bacteria Recombinant cholera toxin B subunit 1 mg (produced in V. cholerae O1 Inaba, classical biotype strain 213) | V. cholerae O1 Inaba El Tor strain Phil 6973 (formaldehyde inactivated) 600 LEU V. cholerae O1 Ogawa classical strain Cairo 50 (heat inactivated) 300 EU LEU V. cholerae O1 Ogawa classical strain Cairo 50 (formaldehyde inactivated) 300 LEU V. cholerae O1 Inaba classical strain Cairo 48 (heat inactivated) 300 LEU V. cholerae O139 strain 4260B (formaldehyde killed) 600 LEU | V. cholerae O1 Inaba Cairo 48 classical biotype (heat inactivated) 300 LEU V. cholerae O1 Inaba Phil 6973 El Tor biotype (formalin inactivated) 600 LEU V. cholerae O1 Ogawa Cairo 50 classical biotype (formalin inactivated) 300 LEU V. cholerae O1 Ogawa Cairo 50 classical biotype (heat inactivated) 300 LEU V. cholerae O139 4260B (formalin inactivated) 600 LEU | V. cholerae strain CVD 103-HgR (live, attenuated) 4 × 108–2 × 109 CFU |
Pharmaceutical form | Suspension and effervescent granules for suspension | Suspension | Suspension | Suspension |
Route of administration | Oral | Oral | Oral | Oral |
Recommended dose/regimen | 2 doses in adults and children ≥6 years of age, 3 doses for children aged <6 years; ≥1 week before potential exposure | 2 doses at an interval of 2 weeks; earliest onset of protection 7–10 days after completion | 2 doses at an interval of 2 weeks | Single dose; ≥10 days before potential exposure |
Recommended age of vaccination | Adults and children ≥2 years of age | Adults and children ≥1 year of age | Adults and children ≥1 year of age | Adults and children aged ≥6 years |
Availability | Worldwide (unavailable in the USA) | Worldwide (unavailable in the USA) | Worldwide (unavailable in the USA) | USA and Europe |
5. Development of Live Attenuated V. cholerae Vaccines
6. Unmet Needs in Cholera Vaccination
7. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Country | Recommending Bodies | Cholera Vaccination a Consideration for These Populations and under These Conditions |
---|---|---|
Spain | Asociación Española de Vacunología (AEV) [28,29] | ALL |
Viajarseguro.org [30,31] | NGO HCPs VFR | |
Ministerio de Sanidad [32] | NGO HCPs VFR | |
Italy | Viaggiare Sicuri [33] | NGO |
Società Italiana di Medicina dei Viaggi e delle Migrazioni (SIMVIM) [34] | No general advice—check website for specific recommendations according to type of trip | |
Ministero della Salute [35] | ALL in endemic areas or during epidemic | |
Germany | Fit for Travel Germany [36] | NGO HCPs VFR during epidemic or prolonged stay |
Centrum für Reisemedizin (CRM) [37] | NGO HCPs | |
Robert Koch Institute (RKI) [38] | NGO HCPs VFR | |
Switzerland | Safetravel [39] | NGO HCPs VFR |
Bundesamt für gesundheit (BAG) [40] | NGO SEA | |
Tropimed Suisse [41] | NGO HCPs | |
Infovac [42] | NGO HCPs SEA | |
Sweden | 1177 Vardguiden [43] | VFR ALL during epidemic |
Vaccin.se [44] | NGO VFR | |
VaccinationsGuiden.se [45] | ILL ALL in endemic areas or during epidemic | |
Public Health Agency (PHA) [46] | NGO VFR ILL | |
France | Institut Pasteur de Lille [47,48] | NGO |
Institut Pasteur (Paris) [49] | NGO HCPs | |
MesVaccins.net [50] | NGO and HCPs only during an epidemic | |
United Kingdom | NHS Fit for Travel [51] | NGO HCPs VFR during epidemic |
Canada | Institut National de Santé Publique du Québec (INSPQ) [52] | NGO HCPs VFR during epidemic ILL |
USA | Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices [53] | ALL adults (aged 18–64 years) during epidemic |
Australia | Healthdirect.gov.au [54] | NGO HCPs VFR ILL |
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Share and Cite
Gabutti, G.; Rossanese, A.; Tomasi, A.; Giuffrida, S.; Nicosia, V.; Barriga, J.; Florescu, C.; Sandri, F.; Stefanati, A. Cholera, the Current Status of Cholera Vaccines and Recommendations for Travellers. Vaccines 2020, 8, 606. https://doi.org/10.3390/vaccines8040606
Gabutti G, Rossanese A, Tomasi A, Giuffrida S, Nicosia V, Barriga J, Florescu C, Sandri F, Stefanati A. Cholera, the Current Status of Cholera Vaccines and Recommendations for Travellers. Vaccines. 2020; 8(4):606. https://doi.org/10.3390/vaccines8040606
Chicago/Turabian StyleGabutti, Giovanni, Andrea Rossanese, Alberto Tomasi, Sandro Giuffrida, Vincenzo Nicosia, Juan Barriga, Caterina Florescu, Federica Sandri, and Armando Stefanati. 2020. "Cholera, the Current Status of Cholera Vaccines and Recommendations for Travellers" Vaccines 8, no. 4: 606. https://doi.org/10.3390/vaccines8040606