Cholera Vaccine for Haiti Relief Workers

Typical Cholera bed with the drainage hole in center and plastic lining

The Cholera outbreak currently ravaging Haiti is prompting aid workers to try to get vaccinated prior to travel.  Unfortunately, there is not a vaccine that is licensed for use in America.  Canada does offer the Dukoral vaccine for protection against Cholera.  The Dukoral cholera vaccine is produced by Crucell Sweden and their website can be visited at www.SBLVaccines.se/en/.  Currently, no country in the world requires the cholera vaccine for entry requirements.

The Cholera Vaccine:

The Dukoral cholera vaccine contains a mixture of inactivated Vibrio cholera bacteria and a non-toxic component of the toxin secreted by the cholera bacteria.  The goal of the vaccine is to stimulate the body’s immune response to the infection without actually make the recipient ill.  The granules containing the vaccine are to be dissolved into a glass of water, then drank.

Cholera Basics:

Cholera is a bacterial infection that causes profuse, watery diarrhea.  Vomiting is also common.  The massive water loss caused by the diarrhea can lead to electrolyte abnormalities and eventually death from dehydration, if left untreated.  The bacteria secretes a “cholera toxin” which is responsible for the majority of symptoms. 

Cause:

Vibrio Cholerae groups O-1 or O-139; many other serogroups of Vibrio Cholerae exist with or without the cholera toxin gene and can cause similar presenting illness.  Vibrio O-1 has two biotypes: Classical and El Tor.  Each of these biotypes has two different serotypes: Inaba and Ogawa.  The symptoms of these variations is indistinguishable and identical. 

Transmission:

V. Cholerae is a free-living organism that is found living in both fresh and brackish wasters, often associated with plankton, shellfish and aquatic plants.  Cholera infections is most commonly acquired from drinking water that is naturally infected with V. Cholerea or has been previously infected with  the feces of a previously infected person.  Other common routes of infection include contaminated fish/shellfish, produce or cooked grains that have not been properly heated/cooked.  Person to person transmission, even with healthcare workers is rare. 

New York Board of Health 1832 advice on Cholera prevention

Symptoms:

Cholera is often a mild diarrhea illness and can even go unnoticed.  Severe cholera can cause a massive amount of “rice water” diarrhea.  Vomiting is often seen.  Dehydration can occur rapidly and is marked with increased heart rate (tachycardia), low blood pressure (hypotension), dry mucous membranes and thirst.   

Treatment:

The cornerstone of treatment for cholera is rehydration.  This can be accomplished with either oral fluids or through the intravenous (IV) route.  If properly treated, the mortality rate drops to less than 1%.  Electrolytes are an important part of the treatment.  Oral rehydration solutions (ORS) such as Ceralyte, EmergenC or sports drinks such as Gatorade can be used for oral replacement.  Severe cases can be treated with antibiotics which have been shown to shorten the length of disease and decrease fluid requirements.  Tetracycline, Doxycycline, Erythromycin or Ciprofloxacin are commonly used options.   

Prevention:

Food and water precautions are essential.  Hand washing after personal contact and especially before preparing meals or eating is vital.  Ensure you are drinking from purified sources and using safe water for cooking, as well.  Chemoprophylaxis is not necessary or indicated.

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