Prevention of travellers' diarrhoea by oral B-subunit/whole-cell cholera vaccine

• Published in: The Lancet (British edition) Vol. 338; no. 8778; pp. 1285 - 1289
• Main Authors: Peltola, H, Siitonen, A, Kataja, M.J, Kyrönseppa, H, Simula, I, Mattila, L, Oksanen, P, Cadoz, M
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 23.11.1991; Lancet; Elsevier Limited
• Subjects: Administration, Oral; Adult; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Cholera Toxin - administration & dosage; Cholera Toxin - adverse effects; Cholera Vaccines - administration & dosage; Cholera Vaccines - adverse effects; Diarrhea; Diarrhea - microbiology; Diarrhea - prevention & control; Feces - microbiology; Human bacterial diseases; Humans; Immunization Schedule; Infectious diseases; Medical research; Medical sciences; Peptide Fragments - administration & dosage; Peptide Fragments - adverse effects; Pilot Projects; Prospective Studies; Time Factors; Tourism & travel; Travel; Tropical medicine; Vaccination - adverse effects; Vaccines; Infection; Human; Prevention; Tourism; Respiratory disease; Vaccination; Oral administration; Bacteriosis; Diarrhea; Cholera
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/0140-6736(91)92590-X

B-subunit/whole-cell cholera vaccine (BS-WC) has been shown to give Bangladeshi mothers and children only 3 months' protection against severe diarrhoea due to enterotoxigenic Escherichia coli(ETEC). Since a long-lasting effect is not necessary for protection against travellers' diarrhoea, a prospective double-blind study was conducted among tourists who went to Morocco from Finland. 307 tourists received two oral doses of BS-WC, whereas 308 controls received a placebo before departure. A research team went out with tourists and a laboratory for enteric pathogens was set up on location. A faecal specimen was taken from 100 randomly selected subjects before departure, from all travellers with diarrhoea, and routinely after return. Enteropathogenic bacteria were not isolated from any of the pre-departure specimens but were present during or after the holiday in 47% of tourists with travellers' diarrhoea, and in 14% of those without diarrhoea. BS-WC induced a 52% protection (p=0·013) against diarrhoea caused by ETEC. The protection was better for mixed infections (65%, p=0·016). The protective efficacy against a combination of ETEC and any other pathogen was 71% (p=0·02), and that against ETEC plus Salmonella enterica even better at 82% (p=0·01). Partial protection against travellers' diarrhoea is thus obtainable by active immunisation with BS-WC.