Indications And Clinical Uses: For immunization against cholera.
Precautions: As with any injection of biological materials, epinephrine HCl solution (1:1 000) should be immediately available as a precautionary measure should an acute anaphylactoid reaction occur.
Adverse Reactions: Vaccination often results in discomfort at the site of injection for 1 or more days. The local reaction may be accompanied by fever, malaise and headache.
Dosage And Administration: Cholera vaccine is commonly given in 2 s.c. doses, as follows: Adults: first dose: 0.5 mL (approx. 4 000 million vibrios); second dose: 1 mL (approx. 8 000 million vibrios).
It is recommended that the second injection be given 3 to 4 weeks after the first injection. Where practicable, it is desirable to give a third (first booster) s.c. dose of 1 mL approximately 3 to 4 weeks after the second dose. When circumstances do not permit of an interval of from 3 to 4 weeks between doses, the interval may be shortened to 7 days.
Booster Doses: The duration of immunity induced by the vaccine is relatively brief. Antibody titres reach a peak within 4 weeks of vaccination and are maintained for about 3 months. Protection against disease seems to last no more than 6 months after the primary series or a booster dose.
Booster injections should be given every 6 months as long as the likelihood of exposure exists. In areas where cholera only occurs in a 2 to 3 month “season”, protection is optimal when the booster dose is given at the beginning of the season. The primary series need never be repeated for booster doses to be effective.
Administration: The preparation should be administered by s.c. injection. The injection may conveniently be made into s.c. tissue near the insertion of the deltoid muscle. The site of injection should be prepared with a suitable antiseptic.
Shake the vial vigorously until the vibrios are uniformly suspended in the vaccine.
Where sterile disposable syringes and needles are not used, syringes and needles should be sterilized in an autoclave at 121°C for 30 minutes. Failing that, they should be boiled for at least 20 minutes.
Withdrawing the preparation from a rubber-stoppered vial: Do not remove the rubber stopper from the vial: Shake the vial vigorously until the vibrios are uniformly suspended in the vaccine. Apply a sterile pledget of cotton moistened with a suitable antiseptic to the surface of the rubber stopper and allow it to act for at least 5 minutes. Draw into the sterile syringe a volume of air equal to the amount of the preparation to be withdrawn from the vial. Pierce the center of the rubber stopper with the sterile needle of the syringe, invert the vial, slowly inject into the air contained in the syringe, and, keeping the point of the needle immersed, withdraw into the syringe the required amount of the preparation. Then hold the syringe-plunger steady and withdraw the needle from the vial.
Carefully insert the needle into the s.c. tissue. In order to avoid i.v. injection, pull back the plunger of the syringe to make certain that no blood is withdrawn before injecting the desired dose.
Availability And Storage: A saline suspension of killed cholera vibrios. Each mL contains: approximately 8 000 million killed V. cholerae. Vials of 2.5 and 10 mL. Store at 2 to 8°C. Do not freeze.
CHOLERA VACCINE Connaught Cholera Prophylaxis