Cholera is an infection of the small intestine caused by the consumption of food or drinking water contaminated by the bacterium Vibrio Cholerae; the main symptoms being profuse watery discharge and vomiting. Cholera continues to be a global threat, particularly in under-developed countries where there is lesser or absolutely no access to safe drinking water and adequate sanitation. Worldwide it affects 3-5 million people and causes 100,000-130,000 deaths annually.
Primary prevention to this dreadful disease is with oral rehydration solution or with intravenous fluids and in worst cases, with vaccination. Dukoral is one such orally administered vaccine with a documented 85% effect against diarrhea caused by cholera, as well as traveler’s diarrhea. Dukoral was first licensed in 1992 and is now licensed in over 60 countries. Today, it is the only licensed preventive oral cholera vaccine internationally. Over 10 million doses of Dukoral have been administered till date.
Ducoral belongs to the class of medications called the vaccines. Dukoral contains the killed whole V. cholerae O1 bacteria and the non-toxic B-subunit of the cholera toxin (CTB). Included in the vaccine are bacterial strains of both Inaba and Ogawa serotypes as well as the El Tor and Classical biotype. The vaccine is a whitish suspension in a single-dose glass vial. The sodium hydrogen carbonate is supplied as white effervescent granules with a raspberry flavor.
The vaccine works by introducing very small amounts of the above bacteria and other non-toxic components of cholera toxin into the body which allows the human body to develop new antibodies against the bacteria and toxin.
Before administration, one must take appropriate measures to prevent reactions. Some common preventive measures include reviewing the patient’s history to detect a possible hypersensitivity to the vaccine and to study immunization history.
To prevent diarrhea caused by cholera: Adults and children alike should be administered 2 doses of the vaccine separated by a week’s time ideally and not exceeding 6 weeks. The third dose is mostly administered at least 1 week before departure. The protection so administered lasts for 2 years.
To prevent travelers’ diarrhea caused by ETEC (Enterotoxigenic E. Coli ): Adults and children above 2 years of age should be administered 2 doses of the vaccine, separated by 2 to 6 weeks of time. Just like in the case of vaccination prescribed for diarrhea caused by cholera, the second dose must be administered at least 1 week before departure. In contrast, the protection lasts for 3 months only in this case.
Any intake of food or liquids must be avoided for 1 hour before and 1 hour after the actual administration of the vaccine, as any such intake may hamper the effectiveness of the vaccine. Also, no other medication must be consumed for 1 hour before and 1 hour after taking the vaccine.
In all cases, if more than 5 years have passed after the last administration of the vaccine, the above prescribed dosage procedures must be repeated.
Several factors affect the working of the vaccine – severity of the condition, body weight, other medical disorders and medications.
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