Tools for Practice Outils pour la pratique


#108 Tools for Stools: Oral Cholera Vaccine for Travelers’ Diarrhea Prophylaxis


CLINICAL QUESTION
QUESTION CLINIQUE
Should oral cholera vaccine (DukoralTM) be routinely recommended to prevent travelers’ diarrhea (TD)?


BOTTOM LINE
RÉSULTAT FINAL
Randomized Controlled Trials (RCT) evaluating Dukoral™ for TD did not show a benefit and routine use is not recommended.



CFPCLearn Logo

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session



EVIDENCE
DONNÉES PROBANTES
Systematic review of 24 RCTs of vaccines to prevent TD.1 Many tested vaccines in cholera endemic areas (not travelers) and examined immunologic (not clinical) outcomes.
  • RCT of 502 US college students, given oral cholera vaccine or placebo upon arrival in Mexico, with a second dose ten days later found no difference in:2
    • Diarrhea (any cause): vaccine 51%, placebo 49%.
    • Enterotoxigenic E. coli (ETEC) diarrhea: vaccine 14%, placebo 15%.
    • Diarrhea was reduced ≥7 days after second dose, but this was not confirmed by external re-analysis.1
    • Adverse events: not reported.
  • RCT of 187 travelers comparing ETEC vaccine, oral cholera vaccine, and placebo (given at least seven days before leaving) found:3
    • No significant difference between groups in all-cause diarrhea.
      • Placebo 21%, ETEC vaccine 24%, oral cholera vaccine 27%.
Context:
  • Diarrhea, usually from ETEC, affects up to 50% of travelers to developing countries.4-6
  • Risk of cholera is ~1/10,000 to 1/million per month abroad.7
  • Cholera toxin subunit in vaccine triggers cross-immunity to ETEC8 leading to its indication for prevention of TD.9
  • Most cases of TD resolve spontaneously in 3–4 days,5 but taking antibiotics at onset improves 72 hour cure (84% vs. 50%, Number Needed to Treat 3).10
  • North American guidelines do not recommend oral cholera vaccine for majority of travelers.4,5
  • Vaccine costs ~$90; not covered by any provincial health care plans.


Latest Tools for Practice
Derniers outils pour la pratique

#359 Topical corticosteroids for atopic dermatitis - More than skin deep

What are the benefits/harms of topical corticosteroids for atopic dermatitis in adults/children?
Read Lire 0.25 credits available Crédits disponibles

#358: Any berry good solutions to preventing UTIs: Cranberries?

Do cranberry products prevent recurrent urinary tract infections (UTIs)?
Read Lire 0.25 credits available Crédits disponibles

#357: Overcoming Resistance: Antipsychotics for difficult to treat depression

In patients with treatment-resistant depression, is adding an atypical antipsychotic to current therapy safe and effective?
Read Lire 0.25 credits available Crédits disponibles

This content is certified for MainPro+ Credits, log in to access

Ce contenu est certifié pour les crédits MainPro+, Ouvrir une session


Author(s)
Auteur(s)
  • Michael R Kolber BSc MD CCFP MSc
  • Tony Nickonchuk BScPharm

1. Ahmed T, Bhuiyan TR, Zaman K, et al. Cochrane Database Syst Rev. 2013; 7:CD009029.

2. Scerpella EG, Sanchez JL, Mathewson JJ, et al. J Travel Med. 1995; 2:22-7.

3. Wiedermann G, Kollaritsch H, Kundi M, et al. J Travel Med. 2000; 7:27-9.

4. Canada Communicable Disease Report. 2005; 31. http://www.phacaspc.gc.ca/publicat/ccdr-rmtc/05vol31/asc-dcc-7/index-eng.php. Last accessed November 8, 2013.

5. Hill DR, Ericsson CD, Pearson RD, et al. Clin Infect Dis. 2006; 43:1499-539.

6. Adachi JA, Xiang Z, Mathewson JJ, et al. Clin Infect Dis. 2001; 32:1706-9.

7. Steffen R, Acar J, Walker E, Zuckerman J. Travel Med Infect Dis. 2003; 1:80-8.

8. Hill DR, Ford L, Lalloo DG. Lancet Infect Dis. 2006; 6: 361-73.

9. Dukoral Product Monograph 2012; pg 5. http://www.janssen.ca/subcategory_docdownload?id=1586. Last accessed December 8, 2013.

10. de Bruyn G, Hahn S, Borwick A. Cochrane Database Syst Rev. 2009; 1:CD002242.

Authors do not have any conflicts of interest to declare.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.