Vibrio Cholerae Management

CHEMOPROPHYLAXIS:
  • Death rates from severe cholera can be decreased from ~50% to The most important part of therapy consists of correction water and electrolyte imbalance to correct severe dehydration and salt depletion.
  • Oral Tetracycline tends to reduce stool output in cholera and shortens the period of excretion of vibrio's
  • Antibiotic treatment of choice for treating cholera in an adult is a single dose of Doxycycline300 mg OD
  • TMP-SMX – antibiotic of choice for children.
  • Furazolidone – antibiotic of choice for pregnant women.
VACCINES:
  • The licensed parenteral cholera vaccine provides only limited and brief protection against V cholerae 01, may not provide any protection against V cholerae 0139, and has a high cost-benefit ratio; therefore, the vaccine is not recommended for travellers.
  • New oral cholera vaccines are being developed. 
  • Cholera vaccine effectiveness is 85% for 6 months which declines to 50% for 12 months 
  • Oral cholera vaccine is effective for 3 years
Two types of oral cholera vaccines are available:
  • Dukoral (WC-rBS) 
  1. Dukoral is a monovalent vaccine based on formation and heat-killed whole cells (WC) of V. cholerae 01 (classical and El Tor, Inaba and Ogawa) plus recombinant cholera toxin B Subunit.
  2. The vaccine is provided in 3 ml. single dose vials together with the bicarbonate buffer.
  3. Primary immunization consists of 2 oral doses given 7 days apart (but < 6 weeks apart) for adults and children aged 6 years. 
  4. Children aged 2-5 years should receive 3 doses. Intake of food and water should be avoided for 1 hour before and after vaccination.
  5. 1 booster dose is recommended after 2 years for adults aged 2-5 years and children aged 6 years. For children aged 2-5 years, 1 booster dose is recommended every 6 months.
  6. Dukoral is not licensed for children < 2 years
  • Shanchol and mORCVAX. 
  1. It is Bivalent oral vaccine based on serogroups 0-1 and 0-139. Unlike Dukoral, these vaccines do not contain the bacterial toxin B Subunit.
  2. Vaccine is given in 2 doses 14 days apart for individuals 1 year. a booster dose is recommended after 2 year.
NEWER VACCINES:
  • CDC – On Vaccination for Cholerae
  • Cholera vaccine is no longer required, nor recommended for the vast majority of travellers by the Centres for Disease Control and Prevention (CDC). 
USE OF VACCINE & CHEMOPROPHYLAXIS:
  • Chemoprophylaxis with antibiotics is effective.
  • Repated injection of vaccine containing either Lipopolysaccharides extracted from Vibrio's or dense Vibrio's suspension can offer limited prevention to heavily exposed persons.
  • Vaccines not useful in Epidemic controls
Exam Question of:
  • Antibiotic treatment of choice for treating cholera in an adult is a single dose of Doxycycline 300 mg OD
  • Recommended drug for cholera chemoprophylaxis is tetracyclin
  • The drug of choice for treating cholera in pregnant women is Furazolidone
  • Cholera vaccine effectiveness is 50% for 12 months
  • Dukoral (WC-rBS) ,Shanchol and mORCVAX are cholera vaccine 
  • Oral cholera vaccine is effective for 3 years
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