An overview of cholera vaccines and their public health implications.

PURPOSE OF REVIEW: The current cholera pandemic now involves almost the entire developing world and represents an important global challenge. Though improved water and sanitation remain the mainstays of cholera prevention efforts, major improvements to infrastructure continue to be a goal far out of reach for many of those affected and near-term interventions, including vaccines, need consideration. RECENT
FINDINGS: Prolonged and frequent epidemics, increased antimicrobial resistance, and heightening awareness of the role of climate change in disease burden have returned cholera to the forefront of the international public health forum. The availability of new oral cholera vaccines and supporting data have prompted the WHO to recommend vaccination be used with other prevention and control strategies where disease is endemic, and their use should be considered in outbreak situations.
SUMMARY: Vibrio cholerae, a highly transmissible organism, is found in aquatic reservoirs and is not an eradicable disease. New variant strains appear to cause more severe clinical disease, and may be displacing earlier seventh pandemic organisms as the major cause of cholera. Licensed newer-generation oral vaccines have proven to be well tolerated, protective (including against new variant strains), and affordable and offer a new tool to control cholera.