Joint WHO/UNICEF statement for cholera vaccine use in tsunami-affected areas
Systems to be put in place
- Disease surveillance/Early Warning and Response Network (EWARN) to be strengthened if already existent
- Monitoring and evaluation system
- Adverse events following immunization (AEFI) surveillance
- Safe waste-disposal system
Annex 1: Characteristics of currently available cholera vaccines
| Killed WC-rBS OCV^4 | Live attenuated CVD 103 Hg-R OCV^5 | Parenteral WC vaccine | |
| Commercial name | Dukoral® | Orochol E® | NA^6 |
| Number of doses required for full immunization | Two, 10—14 days apart - (3 doses recommended by manufacturer for children; however recent studies indicate that 2 doses are sufficient to induce protection) | One | Two, 1—4 weeks apart |
| Administration | oral | oral | parenteral |
| Earliest onset of protection after full immunization | 10 days^7 | 8 days^8 | NA |
| Protective efficacy | 50—86% | 60—90% | NA |
| Use in pregnancy | possible | not recommended | NA |
| Simultaneous administration with other vaccines | Possible except for orally administered vaccines | Possible also with oral polio and yellow fever vaccines; not possible with live typhoid vaccine (Vivotif®). | NA |
| Exclusion criteria | Children under 2 years of age | Children under 2 years of age; immune deficiency; concomitant treatment with immunosuppressive or anti-mitotic drugs | NA |
| Side-effects | Rare gastrointestinal symptoms | Rare gastrointestinal symptoms | At injection site; general malaise; low-grade fever, headache |
| Precautions | Postpone vaccination in case of acute illness | Do not use during acute febrile illness, acute gastro- intestinal infection, during and up to 7 days after antibiotic or sulfonamid treatment | NA |
| Presentation | Vial with oral suspension (vaccine) plus sachet with effervescent granules (buffer) | 1 double chamber sachet, each chamber containing either vaccine or buffer | Vial (need syringe and needle) |
| Storage volume/50 000 doses | ? but minimum 7m^3 | 7 m^3 | NA |
| Storage | Cold chain (2—8 °C) | Cold chain (2—8 °C) | NA |
| Need for cold chain at immunization point | relative at ambient temperature (20—25 °C) if the vaccine is used within 24 hours | Relative at ambient temperature (20—25 °C) if the vaccine is used within 24 hours | NA |
| Amount of drinkable water needed/dose | 150 ml for adults ; 0.75 dl for children aged 2—6 years | 100 ml | none |
| Manufacturer | SBL Powderject, Stockholm, Sweden | Berna Biotech, Bern, Switzerland | NA |
| WHO prequalification for purchase by UN | yes | no | Was never recommended for use by WHO |
| Availability | yes | currently not available, manufacturer stopped production |
4WC: whole-cell
5OCV: oral cholera vaccine
6NA: information not available
7Jertborn M., Svennerholm AM., Holmgren J.- Evaluation of different immunization schedules for oral cholera B subunit-whole cell vaccine in Swedish volunteers. Vaccine, 1993; 11:1007-1012
8Tacket Co et al., Onset and duration of protective immunity in challenged volunteers after vaccination with live oral cholera vaccine CVD 103-HgR. Journal of Infectious Diseases 1992; 166 (4):837-41