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