Live oral vaccines against cholera: an update

One hundred years elapsed between the first (live, parenteral) cholera vaccine that entered clinical trials in 1885 and the field trials of two oral inactivated cholera vaccines undertaken in Bangladesh in the mid-1980s. The oral inactivated vaccines advanced the art by establishing, convincingly, that oral vaccines could protect (although multiple doses were required) and that (at least in adults) protection could last 3 years. Attenuated Vibrio cholerae O1 strain CVD 103-HgR (deleted of the cholera toxin A subunit gene and harbouring a gene encoding resistance to Hg++) constitutes another significant advance. This live oral vaccine is well tolerated and highly immunogenic in adults and children and highly protective (in adult volunteer challenge studies) following ingestion of of a single dose.