Immunization, Vaccines and Biologicals


Cholera is a disease of poverty, and is closely linked to poor sanitation and lack of clean drinking water. In the majority of cases, it is characterized by acute, profuse watery diarrhoea of one or a few days’ duration. In its extreme form, it is one of the most rapidly fatal infectious diseases known. The global disease burden is estimated to be 3–5 million cases and 100 000–130 000 deaths per year, with both children and adults affected. During the last years, protracted outbreaks have occurred in Angola, Ethiopia, Somalia, Sudan and northern Viet Nam. An epidemic in Zimbabwe lasted nearly a year and spread throughout the country (with over 98 000 cases including over 4 000 deaths as at end July 2009) and to neighbouring Zambia and South Africa.

An update to the WHO position paper on cholera vaccines (first published in 2001) was published in the WHO Weekly Epidemiological Record on 26 March 2010. Given the availability of two oral cholera vaccines and data on their efficacy, field-effectiveness and feasibility, these vaccines should be used, in conjunction with other prevention and control strategies, in areas where the disease is endemic. Use of the vaccines should also be considered in areas at risk for outbreaks. Both vaccines have been shown to provide protection of > 50% lasting for two years in endemic situations. One, Dukoral, has been shown to provide high short-term protection in all age groups at 4-6 months following vaccination, and also provides short-term protection against Enterotoxigenic Escherichia coli. The other, licensed as mORCVAX in Viet Nam and as Shanchol in India, has shown longer-term protection in children under five-years, does not require water for administration, requires less storage space and is less expensive to produce.

Vaccination should be implemented as part of a comprehensive programme to prevent and control cholera. The programme should also include appropriate treatment for people with cholera (primarily prompt rehydration), and water quality and sanitation improvements.

WHO position paper

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Last updated: 21 November 2011