Abstract
Cholera is endemic in approximately 50 countries, primarily in Africa and South and Southeast Asia, and in these areas, it remains a disease associated with poverty. In developed nations, cholera is rare, and cases are typically imported from endemic areas by returning travellers. Cholera is readily preventable with the tools available to modern medicine. In developing nations, cholera transmission can be prevented through improved water, sanitation, and hygiene services and the use of oral cholera vaccines (OCVs). For travellers, risk can be mitigated by practicing regular hand hygiene and consuming food and water from safe sources. OCVs should be considered for high-risk travellers likely to be exposed to cholera patients or contaminated water and food. There are currently three World Health Organization pre-qualified OCVs, which are based on killed whole-cell strains of Vibrio cholerae. These established vaccines offer significant protection in adults and children for up to 2 years. A novel live attenuated vaccine that provides rapid-onset protection in adults and children is licensed in the USA and Europe only. Live attenuated OCVs may mimic the natural infection of V. cholerae more closely, generating rapid immune responses without the need for repeat dosing. These potential benefits have prompted the ongoing development of several additional live attenuated vaccines. The objective of this article is to provide a general review of the current landscape of OCVs, including a discussion of their appropriate use in international travellers.
Highlights
Cholera is endemic in approximately 50 countries, primarily in Africa and South and Southeast Asia, and in these areas, it remains a disease associated with poverty
Cholera is endemic in approximately 50 countries [8,11], primarily in South Asia, Southeast Asia, and Africa [8,12], but this number is variable as the countries affected, according to the Centers for Disease Control and Prevention (CDC) website, change frequently [7]
Cholera is a rare disease among travellers from non-endemic to endemic areas, with a risk of approximately 0.2 cases per 100,000 North American and European travellers [15]
Summary
Secretory diarrhoeal disease caused by toxigenic strains of the Gram-negative bacterium Vibrio cholerae. Infection occursCT orally, thecoregulated ingestion of contaminated water and/or andthe organisms by two critical factors: and via toxin pilus (TCP) These factorsfood are [4], under control of a that survive the gastric environment colonise the small intestine. The resulting leads tothe an generation of antibodies against cholera toxin, which block receptor binding, or against cholera vibrios, which overall movement of water into the intestinal lumen, resulting in the secretory diarrhoea characteristic immobilise the pathogen and prevent colonisation. (5) Cholera vaccines promote the generation of antibodies against cholera toxin, which block toxic B subunit; cAMP, cyclic adenosine monophosphate; CFTR, cystic fibrosis transmembrane conductance receptor binding, or against cholera vibrios, which immobilise the pathogen and prevent colonisation. 90–95% of infected people will remain asymptomatic or experience only mild symptoms [9], V. cholerae can remain present in their faeces for 1–10 days following infection, causing the bacteria to be shed back into the environment, increasing the risk of further infections [4]
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