Immunizing Against Cholera

Cholera is an acute diarrheal disease that in severe cases rapidly leads to dehydration and death if appropriate treatment is not provided immediately. It is caused by infection of the intestine with the bacterium Vibrio cholerae (toxigenic strains of O1 and O139 types). An estimated 3-5 million cases and over 100,000 deaths occur each year around the world.

Rehydration treatment, provision of safe water, and adequate sanitation and hygiene remain the mainstay of cholera control and prevention efforts. Oral cholera vaccines (OCV) are an additional tool for cholera prevention and control until long-term improvements in water and sanitation infrastructure occur. Two oral cholera vaccines are currently available internationally and are prequalified by the World Health Organization for purchase by United Nations agencies: Dukoral® (manufactured by Crucell/SBL Vaccine, Sweden), and Shanchol™ (manufactured by Shantha Biotechnics/Sanofi, India). Other cholera vaccines are under development.

CDC’s work to vaccinate against cholera

Photo Essay: Cholera Vaccination in Haiti

Response to Cholera in Haiti

• Assisted in planning and monitoring of the 2013 oral cholera vaccination campaign conducted by the Haitian government
• Developed and implemented surveys to evaluate the 2013 oral cholera vaccination campaign which included :
  • Pre- and post-vaccination campaign assessments to evaluate the impact of the campaign on community knowledge, attitudes and practices regarding cholera, safe water, sanitation, hygiene, and immunization practices
  • A vaccination coverage survey to identify vaccine acceptability, barriers to vaccination, and any adverse events reported after receiving the oral cholera vaccine
  • A vaccine effectiveness study to assess the success of the vaccine in preventing severe cholera in vaccinated areas

Results from those investigations will help guide the implementation of future OCV campaigns in Haiti.

Oral Cholera Vaccination Intervention at Mae La Refugee Camp, Thailand

• Assisted with the planning, implementation and evaluation of an OCV campaign in a long-standing refugee camp on the Thai border with Myanmar with a history of cholera outbreaks
• CDC has worked on and will soon finish the following evaluation activities:
  • Assessment of vaccine effectiveness and impact
  • Assessment of knowledge, attitudes and practices regarding cholera, water, sanitation and hygiene, and immunizations before and after the OCV campaign
  • Evaluation of the feasibility, success and cost of the OCV campaign in a long-standing refugee camp
• Read about collaboration in Thailand: Oral Cholera Vaccination in Mae La Refugee Camp, Thailand "Inspiring Partnerships: Protecting Against Cholera in Thailand."

Policy Development

• Member of the Coalition for Cholera Prevention and Control
• Member of technical advisory committee of DOVE Cholera project: Delivering Oral Vaccine Effectively
• Member of the Africhol Project (African Cholera Surveillance Network)

Additional resources

• Read about oral cholera vaccines
• Learn about the oral cholera vaccine stockpile
• WHO guidance on mass immunization campaigns with oral cholera vaccine
• Recent Publications:
  • Considerations for Oral Cholera Vaccine use During a Cholera Outbreak in an Emergency Setting and Lessons Learned, Post-Earthquake Haiti, 2010-2011
  • Real-time modelling used for outbreak management during a cholera epidemic, Haiti, 2010-2011