Vaccine description | |
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Target | Vibrio cholerae |
Vaccine type | Inactivated |
Clinical data | |
Trade names | Dukoral, Vaxchora, others |
AHFS/Drugs.com | Micromedex Detailed Consumer Information |
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A cholera vaccine is a vaccine that is effective at preventing cholera. [10] The currently recommended cholera vaccines are administered orally to elicit a protective local mucosal immune response in the gut, which was poorly achieved with the injectable vaccines that were used until the 1970s. The first effective oral cholera vaccine was Dukoral, developed in Sweden in the 1980s. For the first six months after vaccination it provides about 85 percent protection, which decreases to approximately 60 percent during the first two years. [10] [11] [12] When enough of the population is immunized, it may protect those who have not been immunized thereby increasing the total protective impact to more than 90 percent (known as herd immunity). [10]
The World Health Organization (WHO) currently recommends the use of three oral cholera vaccines – Dukoral, Shanchol and Euvichol-Plus – in combination with other measures among those at high risk for cholera. [10] Two vaccine doses with a 1-6 week interval are typically recommended. [10] The duration of protection is at least two years in adults and six months in children aged 1–5 years. [10] A live, attenuated single dose oral vaccine is available for those traveling to an area where cholera is common but is not WHO approved for public health use. [13] [14] [15]
The available types of oral vaccine are generally safe. [10] Mild abdominal pain or diarrhea may occur. [10] They are safe in pregnancy and in those with poor immune function. [10] They are licensed for use in more than 60 countries. [10] In countries where the disease is common, the vaccine appears to be cost effective. [10]
The first cholera vaccines were developed in the late 19th century. [16] They were the first widely used vaccine that was made in a laboratory but were largely abandoned in the 1970s due to their then documented reactogenicity and poor efficacy . [16]
Oral cholera vaccines were first introduced in the 1990s. [10] It is on the World Health Organization's List of Essential Medicines. [17] [18]
In the late twentieth century, oral cholera vaccines started to be used on a massive scale, with millions of vaccinations taking place, as a tool to control cholera outbreaks in addition to the traditional interventions of improving safe water supplies, sanitation, handwashing, and other means of improving hygiene. [19] The Dukoral vaccine, which combines formalin- and heat-killed whole cells of Vibrio cholerae O1 and a recombinant cholera toxin B subunit, was licensed in 1991 and has been used widely, mainly for travellers. [10] The Shanchol bivalent vaccine, which combines the O1 and O139 serogroups, was originally developed in Vietnam under the name mORCVAX in 1997 and given in 20 million doses in Vietnam´s public health programme during the following decade through targeted mass vaccination of school-aged children in cholera endemic regions. [10]
The World Health Organization (WHO) recommends both preventive and reactive use of the vaccine, making the following key statements: [20]
WHO recommends that current available cholera vaccines be used as complements to traditional control and preventive measures in areas where the disease is endemic and should be considered in areas at risk for outbreaks. Vaccination should not disrupt the provision of other high priority health interventions to control or prevent cholera outbreaks.... Reactive vaccination might be considered in view of limiting the extent of large prolonged outbreaks, provided the local infrastructure allows it, and an in-depth analysis of past cholera data and identification of a defined target area have been performed.
Although the vaccine specific protection observed, 60–70 percent, has been described as "moderate", herd immunity can multiply the effectiveness of vaccination. Dukoral has been licensed for children two years of age and older, Shanchol and Euvichol-Plus for children one year of age and older. The administration of the vaccine to adults confers additional indirect protection (herd immunity) also to children.
The WHO as of 2013 established a revolving stockpile, initially of only two million oral cholera vaccine doses. [21] With donations from mainly the GAVI Alliance the stockpile has progressively expanded to now more than 40 million doses per year. [22] [23] It consists mainly of the Euvichol-Plus oral cholera vaccine being produced in South Korea. In total more than 150 million doses from the stockpile have been given in mass campaigns against both epidemic and endemic cholera in more than 25 cholera afflicted countries. A set goal of WHO´s Global Task Force for Cholera Control (GTFCC) is, by using oral cholera vaccine and other available tools, by 2030 to have reduced cholera deaths by more than 90% and stopped transmission globally.
The oral vaccines are generally of two forms: inactivated and attenuated.[ citation needed ]
The first developed effective oral cholera vaccine, Dukoral, is a monovalent inactivated vaccine containing killed whole cells of V. cholerae O1 plus additional recombinant cholera toxin B subunit. Bacterial strains of both Inaba and Ogawa serotypes and of El Tor and Classical biotypes are included in the vaccine. Dukoral is taken orally with bicarbonate buffer, which protects the antigens from the gastric acid. The vaccine acts by inducing antibodies against both the bacterial components and CTB. The antibacterial intestinal antibodies prevent the bacteria from attaching to the intestinal wall, thereby impeding colonisation of V. cholerae O1. The anti-toxin intestinal antibodies prevent the cholera toxin from binding to the intestinal mucosal surface, thereby preventing the toxin-mediated diarrhoeal symptoms. [24]
The two later inactivated oral cholera vaccines recommended by WHO, Shanchol and Euvichol-Plus, have an identical composition, containing killed whole cells of V. cholerae O1 (the same components as in Dukoral) plus formalin-killed V. cholerae O139 bacteria.[ citation needed ]
A live, attenuated oral vaccine (CVD 103-HgR or Vaxchora), derived from a serogroup O1 classical Inaba strain, was approved for use in travellers by the US FDA in 2016. [13] [25] [14]
Although rarely in use, the injected cholera vaccines can be effective for people living where cholera is common. While being ineffective in young children, in such areas they can offer some degree of protection in adults and older children for up to six months. [11]
Both of the available types of oral vaccine are generally safe. [10] Mild abdominal pain or diarrhea may occur. [10] They are safe in pregnancy and in those with poor immune function. [10] They are licensed for use in more than 60 countries. [10] In countries where the disease is common, the vaccine appears to be cost effective. [10]
The first cholera vaccines were developed in the late 19th century. There were several pioneers in the development of the vaccine:
Oral cholera vaccines were first introduced in the 1990s. [10]
In 2016, the U.S. Food and Drug Administration (FDA) approved Vaxchora, [15] [14] [25] a single-dose oral vaccine to prevent cholera for travelers. As of June 2016 [update] , Vaxchora was the only FDA-approved vaccine for the prevention of cholera. [25]
The cost to immunize against cholera is between US$0.10 and US$4.00 per vaccination. [35]
The Vaxchora vaccine can cost more than US$250. [36]
Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea lasting a few days. Vomiting and muscle cramps may also occur. Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance. This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish. Symptoms start two hours to five days after exposure.
A vaccine is a biological preparation that provides active acquired immunity to a particular infectious or malignant disease. The safety and effectiveness of vaccines has been widely studied and verified. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as a threat, destroy it, and recognize further and destroy any of the microorganisms associated with that agent that it may encounter in the future.
Polio vaccines are vaccines used to prevent poliomyelitis (polio). Two types are used: an inactivated poliovirus given by injection (IPV) and a weakened poliovirus given by mouth (OPV). The World Health Organization (WHO) recommends all children be fully vaccinated against polio. The two vaccines have eliminated polio from most of the world, and reduced the number of cases reported each year from an estimated 350,000 in 1988 to 33 in 2018.
The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis, and tetanus (lockjaw). The vaccine components include diphtheria and tetanus toxoids, and either killed whole cells of the bacterium that causes pertussis or pertussis antigens. The term toxoid refers to vaccines which use an inactivated toxin produced by the pathogen which they are targeted against to generate an immune response. In this way, the toxoid vaccine generates an immune response which is targeted against the toxin which is produced by the pathogen and causes disease, rather than a vaccine which is targeted against the pathogen itself. The whole cells or antigens will be depicted as either "DTwP" or "DTaP", where the lower-case "w" indicates whole-cell inactivated pertussis and the lower-case "a" stands for "acellular". In comparison to alternative vaccine types, such as live attenuated vaccines, the DTP vaccine does not contain any live pathogen, but rather uses inactivated toxoid to generate an immune response; therefore, there is not a risk of use in populations that are immune compromised since there is not any known risk of causing the disease itself. As a result, the DTP vaccine is considered a safe vaccine to use in anyone and it generates a much more targeted immune response specific for the pathogen of interest.
Influenza vaccines, colloquially known as flu shots, are vaccines that protect against infection by influenza viruses. New versions of the vaccines are developed twice a year, as the influenza virus rapidly changes. While their effectiveness varies from year to year, most provide modest to high protection against influenza. Vaccination against influenza began in the 1930s, with large-scale availability in the United States beginning in 1945.
Varicella vaccine, also known as chickenpox vaccine, is a vaccine that protects against chickenpox. One dose of vaccine prevents 95% of moderate disease and 100% of severe disease. Two doses of vaccine are more effective than one. If given to those who are not immune within five days of exposure to chickenpox it prevents most cases of disease. Vaccinating a large portion of the population also protects those who are not vaccinated. It is given by injection just under the skin. Another vaccine, known as zoster vaccine, is used to prevent diseases caused by the same virus – the varicella zoster virus.
Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within 24 hours of birth with either two or three more doses given after that. This includes those with poor immune function such as from HIV/AIDS and those born premature. It is also recommended that health-care workers be vaccinated. In healthy people, routine immunization results in more than 95% of people being protected.
Hepatitis A vaccine is a vaccine that prevents hepatitis A. It is effective in around 95% of cases and lasts for at least twenty years and possibly a person's entire life. If given, two doses are recommended beginning after the age of one. It is given by injection into a muscle. The first hepatitis A vaccine was approved in Europe in 1991, and the United States in 1995. It is on the World Health Organization's List of Essential Medicines.
The Haemophilus influenzae type B vaccine, also known as Hib vaccine, is a vaccine used to prevent Haemophilus influenzae type b (Hib) infection. In countries that include it as a routine vaccine, rates of severe Hib infections have decreased more than 90%. It has therefore resulted in a decrease in the rate of meningitis, pneumonia, and epiglottitis.
The rotavirus vaccine is a vaccine used to protect against rotavirus infections, which are the leading cause of severe diarrhea among young children. The vaccines prevent 15–34% of severe diarrhea in the developing world and 37–96% of the risk of death among young children due to severe diarrhea. Immunizing babies decreases rates of disease among older people and those who have not been immunized.
The rabies vaccine is a vaccine used to prevent rabies. There are several rabies vaccines available that are both safe and effective. Vaccinations must be administered prior to rabies virus exposure or within the latent period after exposure to prevent the disease. Transmission of rabies virus to humans typically occurs through a bite or scratch from an infectious animal, but exposure can occur through indirect contact with the saliva from an infectious individual.
Diphtheria vaccine is a toxoid vaccine against diphtheria, an illness caused by Corynebacterium diphtheriae. Its use has resulted in a more than 90% decrease in number of cases globally between 1980 and 2000. The first dose is recommended at six weeks of age with two additional doses four weeks apart, after which it is about 95% effective during childhood. Three further doses are recommended during childhood. It is unclear if further doses later in life are needed.
Meningococcal vaccine refers to any vaccine used to prevent infection by Neisseria meningitidis. Different versions are effective against some or all of the following types of meningococcus: A, B, C, W-135, and Y. The vaccines are between 85 and 100% effective for at least two years. They result in a decrease in meningitis and sepsis among populations where they are widely used. They are given either by injection into a muscle or just under the skin.
Plague vaccine is a vaccine used against Yersinia pestis to prevent the plague. Inactivated bacterial vaccines have been used since 1890 but are less effective against the pneumonic plague, so live, attenuated vaccines and recombinant protein vaccines have been developed to prevent the disease.
Tick-borne encephalitis vaccine is a vaccine used to prevent tick-borne encephalitis (TBE). The disease is most common in Central and Eastern Europe, and Northern Asia. More than 87% of people who receive the vaccine develop immunity. It is not useful following the bite of an infected tick. It is given by injection into a muscle.
Rubella vaccine is a vaccine used to prevent rubella. Effectiveness begins about two weeks after a single dose and around 95% of people become immune. Countries with high rates of immunization no longer see cases of rubella or congenital rubella syndrome. When there is a low level of childhood immunization in a population it is possible for rates of congenital rubella to increase as more women make it to child-bearing age without either vaccination or exposure to the disease. Therefore, it is important for more than 80% of people to be vaccinated. By introducing rubella containing vaccines, rubella has been eradicated in 81 nations, as of mid-2020.
Yellow fever vaccine is a vaccine that protects against yellow fever. Yellow fever is a viral infection that occurs in Africa and South America. Most people begin to develop immunity within ten days of vaccination and 99% are protected within one month, and this appears to be lifelong. The vaccine can be used to control outbreaks of disease. It is given either by injection into a muscle or just under the skin.
Tetanus vaccine, also known as tetanus toxoid (TT), is a toxoid vaccine used to prevent tetanus. During childhood, five doses are recommended, with a sixth given during adolescence.
Firdausi Qadri is a Bangladeshi scientist with specialization in immunology and infectious disease research. She has worked over 25 years on the development of vaccines for cholera and has expertise on other infectious disease like ETEC, Typhoid, Helicobacter pylori, rotavirus, etc. Currently, she is working as a director for Centre for Vaccine Sciences of International Centre for Diarrhoeal Disease and Research, Bangladesh (ICDDR,B). She also serves as chairperson of the Institute for developing Science and Health initiatives. Her scientific achievements lie in enteric infections and vaccines including Vibrio cholerae and enterotoxigenic Escherichia coli—major causes of severe diarrhea. She has also focused on studying the immune response in Helicobacter pylori infected people in Bangladesh and the responses in patients with typhoid fever as well as vaccinees. The Government of Bangladesh awarded her the Independence Award in 2023.
Jan Roland Holmgren is a Swedish physician, microbiologist, immunologist, and vaccinologist, known for his research on cholera and mucosal immunology, specifically, for his leadership in developing "the world's first effective oral cholera vaccine".
This vaccine can cost more than $250, and travelers may have to pay out of pocket if their insurance does not cover travel vaccines