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CDC finalizes cholera vaccine recommendation for US travelers
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The CDC recently released a final recommendation for the only cholera vaccine licensed in the U.S., which states that the vaccine should be administered only to adults traveling to areas that have active cholera transmission or reported activity within the last year and are prone to recurring outbreaks.
Vaxchora (single-dose live cholera vaccine, PaxVax) — a single-dose, live-attenuated oral vaccine — was approved last year by the FDA to prevent cholera caused by serogroup O1, which is the predominant cause of the disease, in adults aged 18 to 64 years, according to Karen K. Wong, MD, MPH, of CDC’s Division of Foodborne, Waterborne and Environmental Diseases and National Center for Emerging and Zoonotic Infectious Diseases, and colleagues. On June 22, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend the vaccine in adult travelers visiting areas with endemic or epidemic cholera.
Wong and colleagues reported in a recent MMWR that the vaccine is approximately 90% effective at preventing severe diarrhea 10 days after vaccination, and 80% effective 3 months after vaccination. During a systematic review, members of the ACIP, CDC, NIH, Department of Defense and Infectious Diseases Society of America determined that the vaccine was safe overall; however, it was associated with a slightly elevated risk for mild diarrhea in recipients (3.8%) compared with unvaccinated individuals (1.6%).
Although the duration of protection beyond 3 months is unknown, the CDC does not recommend administering booster doses of the vaccine at this time. Further, the vaccine should not be given to patients who received oral or parenteral antibiotics 14 days prior because of the drugs’ potential activity against the vaccine strain.
To date, there are no data on concomitant administration of the vaccine with other vaccines, or on the use of the vaccine in immunocompromised populations and pregnant or breastfeeding women.
“The vaccine is not absorbed systemically; thus, maternal exposure to the vaccine is not expected to result in exposure to the fetus or breastfed infant to the vaccine,” Wong and colleagues wrote. “However, the vaccine strain might be shed in stool for 7 days or more after vaccination, and theoretically, the vaccine strain could be transmitted to an infant during vaginal delivery.”
Because pregnant women are at an increased risk for poor outcomes caused by cholera infection, the CDC recommends that pregnant women and their clinicians consider the risks associated with active cholera transmission before travel.
In the report, Wong and colleagues further warned that because the live-attenuated vaccine can shed in stool, it could be transmitted to others.
According to the CDC, cholera is endemic in approximately 60 countries and causes an estimated 2.9 million cases and 95,000 deaths each year. The disease is rare in the U.S., occurring mostly among travelers returning from endemic regions.
“All travelers to cholera-affected areas should follow safe food and water precautions and proper sanitation and personal hygiene measures as primary strategies to prevent cholera,” the researchers wrote. “Travelers who develop severe diarrhea should seek prompt medical attention, particularly fluid replacement therapy.” – by Stephanie Viguers
Reference:
Wong KK, et al. MMWR Morb Mortal Wkly Rep. 2017;doi:10.15585/mmwr.mm6618a6.
Disclosure: Wong reports no relevant financial disclosures.