Cholera is a severe form of diarrheal disease that is manifested by the bacterium Vibrio cholerae and remains a major public health concern to the present time, especially for third-world countries. It is an acute disease that is contracted through ingestion of contaminated water and food, and its effect involves rapid loss of fluids. If no treatment is sought, the death occurs within a few hours. Older approaches have aimed to manipulate WASH conditions, but these have rarely been sufficient to prevent cholera’s return, especially in complex emergencies. Thus, OCV has increasingly become an important control measure in the global approach towards cholera. A lot has been achieved in the cholera vaccination, including the single-dose regimens in the last year. These innovations will assist in the ease of immunization, increasing its reach and increasing the general effectiveness of cholera control.
The Evolution of Cholera Vaccines
The development of cholera vaccines has been going on for more than one century; the first efforts were devoted to the parenteral ones. However, these early vaccines were not popular because of their lower efficacy and difficulty in administration. However, the torch was lit only in the last quarter of the twentieth century, with the formulation of oral cholera vaccines. Those vaccines that could be given with a minimum of training and effort—such vaccines gave a new dimension to public health campaigns.
The first OCVs that became available for widespread use were those that needed multiple administrations, preferably two shots a fortnight apart. This approach worked well in terms of immunizing but came with practical difficulties, which included the fact that the doses were administered at least a week apart, which posed challenges, especially in areas with limited access to healthcare facilities. However, follow-up to receive the second dose of the vaccine was also challenging, and therefore, the vaccine coverage rate was lower than anticipated.
Challenges of Multi-Dose Vaccination Regimens
Shanchol and Dukoral are the brands of cholera vaccines that have been used in checking cholera incidences in many parts of the world. However, the prospect of having to give multiple doses has been more of a challenge since it hinders broader coverage of immunization. The interval between the doses can become a severe problem in case of an emergency, for example, during an outbreak. Quite often, the need for immunization is emergency-like, and while waiting for the booster shot, people are at high risk and unprotected.
However, in other places where healthcare is a costly affair or where there is a scarcity of the same, it is very hard to make sure that a person receives the second dose. Experiences like transportation challenges, health literacy, and other commitments make it impossible to follow through with the vaccine completion. This has led to decreased provision of vaccines, reduced success of the Herd Immunity theory, and thus poor cholera control.