Oral cholera vaccine Shanchol is a low-cost option in India

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Shanchol, an Oral Cholera Vaccine (OCV) that is devoid of subunit B, was recently licensed in India in 2009 and WHO-prequalified in 2011. Shanchol, India’s first OCV, is produced by Shantha Biotechnics, and as of May 2012, it was priced at less than Rs 109.

Key Point: Cholera bacterial infection is spread through sewage contamination of water, food, or direct oral contact. In endemic regions, vaccination is recommended in addition to other main prevention and control methods. Shanchol, the recently licensed whole-cell oral cholera vaccine devoid of subunit B is an ideal vaccine for use in India – easy to administer, effective, and low-cost.

Cholera, an acute diarrheal illness, is a major global health problem with variable severity and spreads rapidly in endemic regions. Cholera is an infection of the intestines caused by two groups of Vibrio cholerae bacteria, serogroups O1 and O139, both of which are present in India. About 75% of infected individuals do not present symptoms, 15-20% present mild or moderate symptoms, and 5-10% rapidly develop severe, life-threatening symptoms. If left untreated, severe infection leads to death in 30-50% of cases. Shanchol offers more than 50% effective protection against the two groups of cholera bacteria found in India and should be administered in endemic regions in addition to practicing other prevention methods. The Swedish OCV Dukoral with subunit B does not protect against both types of cholera bacteria in India.


“The disease is characterized in its most severe form by a sudden onset of acute watery diarrhea that can lead to death by severe dehydration and kidney failure within hours.”
-Ramesh Verma, Pardeep Khanna, and Suraj Chawla. Department of Community Medicine; Pt. B.D. Sharma PGIMS; Rohtak, India.


Risk and Diagnosis

Cholera infection is spread by direct fecal-oral contamination or ingestion of contaminated water or contaminated food. Everyone is susceptible to cholera; however the risk of death is greater in those with compromised immune systems, such as[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] children and HIV-infected individuals. Those at higher risk of infection are in population-dense areas with improper sewage disposal or improper water treatment.

Help your patients understand cholera
You can print copies of this PDF handout for your patients, to reinforce what you have told them, and prevent the spread of cholera.
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Clinical diagnosis of cholera should be considered when patient presents watery diarrhea, rapid dehydration, and lives in or has recently traveled to endemic areas. Definitive diagnosis is determined by identification of cholera bacteria in stool samples.

Prevention is Key

Effective prevention strategies are essential in diminishing the prevalence of cholera in India. Patients should always practice good hygiene as the main prevention method. Advise patients to wash hands frequently with soap and water and to clean food before consumption.

Indian-male-doctorDoctors should vaccinate against cholera in endemic areas or for high-risk patients. Shanchol, the recently licensed, whole-cell OCV without the subunit B is ideal for use in India – it protects against both groups of cholera bacteria; does not need a buffer for administration; is low-cost; has minimal side-effects. This vaccine variant, first produced in Vietnam, has been modified to meet international good manufacturing practice (GMP) and World Health Organization (WHO) standards for production. Studies in Kolkata and Vietnam show the vaccine to be extremely safe and effective in adults and children over age 1, with an overall efficiency of 52% in the first year after administration and 62% in the second year. The OCV is given in two doses, at two weeks apart. Revaccination is recommended every second year since significant protection lasts two years.

Treatment

In mild to moderate cases, replace fluids and salt with oral rehydration salts (ORS). In severe cases, early rehydration with ORS or intravenous fluid solutions reduce mortality, and effective antibiotics reduce symptoms and duration. Do not routinely treat cholera with antibiotics or anti-diarrheal drugs, as they have no effect on the spread of cholera and increase the risk of anti-microbial resistance.

Sources: BioSpectrum Bureau. Cholera vaccine from Shantha Biotechnics wins BioSpectrum Award. BioSpectrum. 12 Apr 2012; updated 9 May 2012. Available at: http://www.biospectrumasia.com/biospectrum/news/948/shanthas-generation-cholera-vaccine#.USubpB2R9qw

Cholera vaccine: new preventive tool for endemic countries; 1 May 2012. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22634452

Safety and immunogenicity study of a killed bivalent (O1 and O139) whole-cell oral cholera vaccine Shanchol, in Bangladeshi adults and children as young as 1 year of age; 26 Oct 2010. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21907255

Updated WHO position paper on cholera vaccines; 26 March 2010. Available at: http://www.who.int/immunization/cholera_PP_slides_20_Mar_2010.pdf

Immunization Standards. Inactivated oral cholera. World Health Organization, updated 14 Dec 2011. Available at: http://www.who.int/immunization_standards/vaccine_quality/pq_250_cholera_1dose_shantha/en/index.html

IVI announces the prequalification of innovative cholera vaccine by the World Health Organization. News Release: International Vaccine Institute, Seoul, Korea. 11 Nov 2011. Available at: http://220.93.120.115/web/www/07_01

López-Gigosos RM, Plaza E, Díez-Díaz RM, Calvo MJ. Vaccination strategies to combat an infectious globe: Oral cholera vaccines. J Global Infect Dis 2011;3:56-62 Available at: http://www.jgid.org/text.asp?2011/3/1/56/77297

Verma R, Khanna P, Chawla S. Cholera vaccine: New preventive tool for endemic countries. Human Vaccines & Immunotherapeutics 2012; 8:682 – 684 Available at: http://www.landesbioscience.com/journals/vaccines/article/19083/?nocache=1772092657

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One Comment

  1. VALLURI RAMARAO
    Posted Oct 2013 at 4:31 am | Permalink

    It’s good news for endemic areas in India. The greatest invention of 21st
    Century is ORS. This OCV will be of much help for our country.

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