Abstract
In addition to improved water supply and sanitation, the 2-dose killed oral cholera vaccine (OCV) is an important tool for the prevention and control of cholera. We aimed to document the immunogenicity and protection (efficacy and effectiveness) conferred by a single OCV dose against cholera. The metaanalysis showed that an estimated 73% and 77% of individuals seroconverted to the Ogawa and Inaba serotypes, respectively, after an OCV first dose. The estimates of single-dose vaccine protection from available studies are 87% at 2 months decreasing to 33% at 2 years. Current immunologic and clinical data suggest that protection conferred by a single dose of killed OCV may be sufficient to reduce short-term risk in outbreaks or other high-risk settings, which may be especially useful when vaccine supply is limited. However, until more data suggest otherwise, a second dose should be given as soon as circumstances allow to ensure robust protection.
Highlights
Cholera is an acute watery diarrheal disease that can spread rapidly and lead to widespread outbreaks
In parallel with WASH, timely treatment, and community engagement, the World Health Organization (WHO) recommends that oral cholera vaccination be considered in areas where the disease is endemic, as part of the response to outbreaks, or in a humanitarian crisis where there is a high risk of cholera [3]
Four articles reported on the immunogenicity of the monovalent oral cholera vaccines (OCV) that contains the recombinant B subunit (Dukoral), while 13 reported on the bivalent OCV, Shanchol, and Euvichol
Summary
Cholera is an acute watery diarrheal disease that can spread rapidly and lead to widespread outbreaks. In parallel with WASH, timely treatment, and community engagement, the World Health Organization (WHO) recommends that oral cholera vaccination be considered in areas where the disease is endemic, as part of the response to outbreaks, or in a humanitarian crisis where there is a high risk of cholera [3]. The second vaccine is Shanchol (Shantha Biotechnics Ltd, Hyderabad, India), a bivalent (V. cholerae O1 and O139) wholecell OCV. A randomized, placebo-controlled trial in India showed that a 2-dose regimen confers 67% protective efficacy against cholera within 2 years of vaccination [6], 66% at 3 years [7], and 65% at 5 years [8]. Our primary question is how well a single-dose regimen of killed OCV protects against cholera. As there are relatively few studies that document OCV efficacy and effectiveness in conferring protection against disease and since a vaccine-induced increase in vibriocidal antibody titer has been linked with protection [15], we included both a systematic review of the efficacy and effectiveness data and a systematic review and metaanalysis of a larger body of immunologic response data
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