Editing Cholera (section)

=== Vaccination ===
{{Main|Cholera vaccine}}
[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]
Spanish physician [[Jaume Ferran i Clua]] developed the first successful cholera inoculation in 1885, the first to immunize humans against a bacterial disease.<ref>{{Cite web|url=http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others — Timelines — History of Vaccines|archive-date=February 11, 2015}}</ref> His vaccine and inoculation was rather controversial and was rejected by his peers and several investigation commissions but it ended up demonstrating its effectiveness and being recognized for it: out of the 30 thousand people he vaccinated only 54 died.<ref name=":0">{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=Journal of the History of Medicine and Allied Sciences |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570 }}</ref><ref name=":1">{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}</ref><ref name=":2">{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=Journal of Medical Biography |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270 }}</ref><ref>{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}</ref> Russian-French bacteriologist [[Waldemar Haffkine]] also developed a human cholera vaccine in July 1892.<ref name=":0" /><ref name=":1" /><ref name=":2" /><ref>[http://www.haffkineinstitute.org/waldemar.htm haffkineinstitute.org] {{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=2015-09-24}}</ref> He conducted a massive inoculation program in [[British India]].<ref name=":2" /><ref>{{Cite news|date=2020-12-11|title=Waldemar Haffkine: The vaccine pioneer the world forgot|language=en-GB|work=BBC News|url=https://www.bbc.com/news/world-asia-india-55050012|access-date=2021-01-20}}</ref>

Persons who survive an episode of cholera have long-lasting immunity for at least 3 years (the period tested).<ref name="immunity"/> A number of safe and effective oral vaccines for cholera are available.<ref name="pmid21412922">{{cite journal | vauthors = Sinclair D, Abba K, Zaman K, Qadri F, Graves PM | title = Oral vaccines for preventing cholera | journal = The Cochrane Database of Systematic Reviews | issue = 3 | pages = CD008603 | date = March 2011 | volume = 2011 | pmid = 21412922 | pmc = 6532691 | doi = 10.1002/14651858.CD008603.pub2 | editor = Sinclair D }}</ref> The World Health Organization (WHO) has three prequalified oral cholera vaccines (OCVs): Dukoral, Sanchol, and Euvichol. [[Dukoral]], an orally administered, inactivated [[whole-cell vaccine]], has an overall efficacy of about 52% during the first year after being given and 62% in the second year, with minimal side effects.<ref name="pmid21412922" /> It is available in over 60 countries. However, it is not currently{{when|date=August 2017}} recommended by the [[Centers for Disease Control and Prevention]] (CDC) for most people traveling from the United States to endemic countries.<ref name="CDC_Vacc">{{cite web| title=Is a vaccine available to prevent cholera?| work=CDC disease info: Cholera| url=https://www.cdc.gov/cholera/general/#vaccine| date=2010-10-22| access-date=2010-10-24| url-status=live| archive-url=https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine| archive-date=2010-10-26}}</ref> The vaccine that the [[Food and Drug Administration|US Food and Drug Administration]] (FDA) recommends, [[Vaxchora]], is an [[Cholera vaccine#Oral|oral attenuated live vaccine]], that is effective for adults aged 18–64 as a single dose.<ref>{{Cite web|url=http://www.immunize.org/fda/|archiveurl=https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/|url-status=dead|title=FDA Product Approval: View All|archivedate=April 15, 2017}}</ref>

One injectable vaccine was found to be effective for two to three years. The protective efficacy was 28% lower in children less than five years old.<ref>{{cite journal | vauthors = Graves PM, Deeks JJ, Demicheli V, Jefferson T | title = Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) | journal = The Cochrane Database of Systematic Reviews | issue = 8 | pages = CD000974 | date = August 2010 | volume = 2019 | pmid = 20687062 | pmc = 6532721 | doi = 10.1002/14651858.CD000974.pub2 | editor = Graves PM }}</ref> However, {{as of|2010|lc=y}}, it has limited availability.<ref name=WHO2010 /> Work is under way to investigate the role of mass vaccination.<ref>{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=WHO |work=Health topics |year=2008 |access-date=2010-02-01 |url-status=dead |archive-url=https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html |archive-date=2010-02-16 }}</ref> The WHO recommends immunization of high-risk groups, such as children and people with [[HIV]], in countries where this disease is [[Endemism|endemic]].<ref name=WHO2010 /> If people are immunized broadly, [[herd immunity]] results, with a decrease in the amount of contamination in the environment.<ref name=NEJM2006 />

WHO recommends that oral cholera vaccination be considered in areas where the disease is endemic (with seasonal peaks), as part of the response to outbreaks, or in a humanitarian crisis during which the risk of cholera is high.<ref>{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}</ref> OCV has been recognized as an adjunct tool for prevention and control of cholera. The WHO has prequalified three bivalent cholera vaccines—Dukoral (SBL Vaccines), containing a non-toxic B-subunit of cholera toxin and providing protection against ''V.&nbsp;cholerae'' O1; and two vaccines developed using the same transfer of technology—ShanChol (Shantha Biotec) and Euvichol (EuBiologics Co.), which have bivalent O1 and O139 oral killed cholera vaccines.<ref>{{cite journal|vauthors=Ryan ET|date=January 2011|title=The cholera pandemic, still with us after half a century: time to rethink|journal=PLOS Neglected Tropical Diseases|volume=5|issue=1|pages=e1003|doi=10.1371/journal.pntd.0001003|pmc=3026764|pmid=21283611 |doi-access=free }}</ref> Oral cholera vaccination could be deployed in a diverse range of situations from cholera-endemic areas and locations of humanitarian crises, but no clear consensus exists.<ref>{{cite journal|vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA|date=January 2016|title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans|journal=The Lancet. Infectious Diseases|volume=16|issue=1|pages=125–129|doi=10.1016/S1473-3099(15)00298-4|pmid=26494426|doi-access=}}</ref>