Vibrio Cholerae Management

Vibrio Cholerae Management


CHEMOPROPHYLAXIS:

  • Treatment of Choice:Rehydration therapy
    • Mild to moderate rehydration:ORS
    • For severe: IV fluid.Ringer lactate is best
  • DOC :single dose of doxycycline/tetracycline
  • Oral Tetracycline tends to reduce stool output in cholera and shortens the period of excretion of vibrio’s
  • TMP-SMX – antibiotic of choice for children.
  • Furazolidone – antibiotic of choice for pregnant women.

VACCINES:

Killed vaccine

  • The licensed parenteral cholera vaccine provides only limited and brief protection against V cholerae 01
  • Not provide any protection against V cholerae 0139
  • High cost-benefit ratio; therefore, the vaccine is not recommended for travellers. 
  • New oral cholera vaccines are being developed. 
  • Cholera vaccine effectiveness is 85% for 6 months which declines to 50% for 12 months 
  • Oral cholera vaccine is effective for 3 years
Two types of oral cholera vaccines are available:

1. Dukoral (WC-rBS) 

  • Dukoral is a monovalent vaccine
  •  Based on formation and heat-killed whole cells (WC) of V. cholerae 01 (classical and El Tor, Inaba and Ogawa) plus recombinant cholera toxin B Subunit.
  • Provided in 3 ml. single dose vials together with the bicarbonate buffer.
  • Primary immunization consists of 2 oral doses given 7 days apart (but < 6 weeks apart) for adults and children aged 6 years. 
  • Children aged 2-5 years should receive 3 doses. Intake of food and water should be avoided for 1 hour before and after vaccination.
  • 1 booster dose is recommended after 2 years for adults aged 2-5 years and children aged 6 years. For children aged 2-5 years, 1 booster dose is recommended every 6 months.
  • Dukoral is not licensed for children < 2 years
2. Shanchol and mORCVAX. 
  •  It is Bivalent oral vaccine based on serogroups 0-1 and 0-139. 
  • This vaccines do not contain the bacterial toxin B Subunit.
  •  Vaccine is given in 2 doses 14 days apart for individuals 1 year. 
  • A booster dose is recommended after 2 year.

NEWER VACCINES:

  • CDC – On Vaccination for Cholerae
  • Cholera vaccine is no longer required, nor recommended for the vast majority of travellers by the Centres for Disease Control and Prevention (CDC).

Exam Important

CHEMOPROPHYLAXIS:

  • Treatment of Choice:Rehydration therapyDOC :single dose of doxycycline/tetracycline
    • Mild to moderate rehydration:ORS
    • For severe: IV fluid.Ringer lactate is best
  • Oral Tetracycline tends to reduce stool output in cholera and shortens the period of excretion of vibrio’s
  • TMP-SMX – antibiotic of choice for children.
  • Furazolidone – antibiotic of choice for pregnant women.

VACCINES:

Killed vaccine

  • Cholera vaccine effectiveness is 85% for 6 months which declines to 50% for 12 months 
  • Oral cholera vaccine is effective for 3 years
Two types of oral cholera vaccines are available:

Dukoral (WC-rBS) 

  • Dukoral is a monovalent vaccine based on formation and heat-killed whole cells (WC) of V. cholerae 01 (classical and El Tor, Inaba and Ogawa) plus recombinant cholera toxin B Subunit.
Shanchol and mORCVAX.

  • NEWER VACCINES:Cholera vaccine is no longer required, nor recommended for the vast majority of travellers by the Centres for Disease Control and Prevention (CDC). 
  • CDC – On Vaccination for Cholerae
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