Cholera is a substantial health burden in many countries in Africa and Asia, where it is endemic. It is as well responsible for ongoing epidemics in sub-Saharan Africa which are becoming greater in terms of frequency, extension, and duration. Given the availability of two oral cholera vaccines and the new data on their efficacy, field effectiveness, feasibility, and acceptance in cholera-affected populations and in travelers, these vaccines should be used in endemic areas, in travelers for these areas and should be considered in areas at risk for outbreaks. The two vaccines currently available in worldwide are: (1) The killed oral vaccine (Dukoral, licensed by SBL–Sweden to Crucell–Holland) is recommended since 1999 by WHO and consists of a mixture of four preparations of heat or formalin killed whole cell Vibrio cholera O1 (Inaba and Ogaba serotypes, and classical and El Tor biotypes) that are then added with purified recombinant cholera toxin (CT) B subunit. Because CT cross-reacts with Escherichia coli LT the vaccine also provides short-term protection against ETEC (enterotoxigenic E. coli) which is of added benefit for travelers. It is available in more than 60 countries. (2) A bivalent O1 and O139 whole cell oral vaccine without CT B subunit (Shanchol) has been lately developed in Vietnam (licensed by VaBiotech–Viet Nam to Shantha Biotechnics–India. It is available in India and Indonesia. A structured search of papers in PubMed and reports on cholera vaccines by WHO and CDC, as well as critical reading and synthesis of the information was accomplished. Inclusion criteria were defined according to reports quality and relevance.
BackgroundNowadays there is a debate about the indication of the oral whole-cell/recombinant B-subunit cholera vaccine (WC/rBS) in traveller's diarrhoea. However, a cost-benefit analysis based on real data has not been published.MethodsA cost-effectiveness and cost-benefit study of the oral cholera vaccine (WC/rBS), Dukoral® for the prevention of traveller's diarrhoea (TD) was performed in subjects travelling to cholera risk areas. The effectiveness of WC/rBS vaccine in the prevention of TD was analyzed in 362 travellers attending two International Vaccination Centres in Spain between May and September 2005.ResultsThe overall vaccine efficacy against TD was 42,6%. Direct healthcare-related costs as well as indirect costs (lost vacation days) subsequent to the disease were considered. Preventive vaccination against TD resulted in a mean saving of 79.26 € per traveller.ConclusionAccording to the cost-benefit analysis performed, the recommendation for WC/rBS vaccination in subjects travelling to zones at risk of TD is beneficial for the traveller, regardless of trip duration and visited continent.
Continued growth in international travel and forecasts for a great increase in the number of people who travel from industrialized to emerging and developing countries make it necessary to develop and improve the capacity to provide health protection to travelers. Measures available to prevent some diseases include a currently limited number of marketed vaccines which represent extremely useful tools to protect travelers. Travelers very often experience diarrheal and gastrointestinal diseases for which some vaccines are available. Use of these vaccines should be evaluated based on traveler and travel destination and characteristics. Vaccines available include those against cholera, typhoid fever, hepatitis A, hepatitis E (only available in China), and rotavirus. The aim of this review is to provide an updated summary about each of the abovementioned vaccines that may be useful for making decisions regarding their use and assessing their indications in recommendations for travelers.
Background The protease inhibitors boceprevir and telaprevir are indicated for treatment of chronic hepatitis C (CHC) genotype 1 in combination with peginterferon-alfa and ribavirin. These drugs increase efficacy and adverse effects. Purpose To study the effectiveness and safety of boceprevir and telaprevir for treatment of CHC. Materials and Methods Retrospective observational study including all patients who started treatment with telaprevir or boceprevir for treatment of CHC from January to September 2012. Collected data: age, sex, type of patient (treatment-naive, recurrent or non-responder), liver fibrosis, HIV coinfection, viral loads at weeks 0, 4, 8, 12, 24 to evaluate efficacy and adverse effects and supportive treatment to evaluate safety. Abstract DGI-055 Table 1Baseline characteristics Telaprevir Boceprevir Patients 29 (58%) 21 (42%) Type of patient treatment-naive 5 (17.24%) 4 (19.05%) recurrent 4 (13.79%) 10 (47.62%) non-responder 20 (68.97%) 7 (33.33%) Liver fibrosis 0–1 6 (20.69%) 1 (4.76%) 2 6 (20.69%) 2 (9.52%) 3–4 17 (58.62%) 19 (90.48%) Abstract DGI-055 Table 2Efficacy and safety Telaprevir Boceprevir Negative viral loads at week 4 15/23 (65.22%) 7/15 (46.67%) 8 18/21 (85.71%) 8/14 (57.14%) 12 19/19 (100%) 4/5 (80.00%) 24 8/8 (100%) 1/1 (100%) Anaemia Reduced dose of ribavirin 6 (20.69%) 6 (28.57%) Treatment with erythropoiesis-stimulating agent 2 (6.90%) 1 (4.76%) Discontinued 1 (3.45%) 1 (4.76%) Neutropenia Reduction dose of peginterferon-alfa 2 (6.90%) 4 (19.05%) Treatment with granulocyte colony-stimulating factor (G-CSF) 1 (3.45%) 4 (19.05%) Rash Discontinued 1 (3.45%) 0 (0%) Results We included 51 patients, 35 (70%) men and 15 (30%) women, with a mean age of 51 years. 5 patients were co-infected with HIV (off-label use). Conclusions Most patients had grade 3–4 liver fibrosis. Most patients were recurrent or non-responders to previous treatment. Telaprevir was the most used protease inhibitor. Patients using telaprevir got negative viral loads before patients using boceprevir. A high percentage of patients using boceprevir required the dose of peginterferon-alfa to be reduced and treatment with G-CSF due to neutropenia. No conflict of interest.
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