infectious diseases
Cholera
Prevention of Cholera
For control of cholera, human excrement must be correctly disposed of, and water supplies purified. In endemic regions, drinking water should be boiled or chlorinated, and vegetables and shellfish cooked thoroughly. Antibiotic prophylaxis for household contacts of patients with cholera is not recommended because data supporting this measure are lacking. In addition, antibiotic resistance emerged in previous epidemics when antibiotic prophylaxis was given to household contacts of cholera patients. Severaloral cholera vaccinesare available. A live-attenuated, single-dose, monovalent vaccine, lyophilizedV. choleraeCVD 103-HgR, is available in the US for adults ages 18 to 64 years who are traveling to cholera-infected areas. It protects against disease caused byV. choleraeO1. The effectiveness of this vaccine beyond 3 to 6 months is unknown. Three killed whole-cell oral vaccines are available for use in children and adults internationally but not in the US: A monovalent vaccine (travelers' diarrhea andcholera vaccine[Dukoral®]) contains onlyV. choleraO1 and El Tor bacteria plus a small amount of nontoxic b subunit cholera toxin; before taking, it must be mixed into buffer fluid (buffer packet is dissolved in 150 mL [5 oz] of cool water). Two bivalent vaccines (ShanChol®and Euvichol®) contain both O1 and O139 serogroups ofV. choleraand have no added components, eliminating the requirement for fluid ingestion at the time of vaccination. These three vaccines provide 60 to 85% protection for up to 5 years. They require 2 doses, and booster doses are recommended after 2 years for people with ongoing risk of cholera. Injectable vaccinesprovide less protection for shorter periods of time with more adverse effects and are not recommended when an oral vaccine is available. 