When Should Cholera Vaccine be Used in Cholera-endemic Areas?
The paper by Vu Dinh Thiem et al. in this issue of the Journal provides valuable documentation of the costs for providing killed oral cholera vaccine during a mass-vaccination programme in Vietnam (1). Vietnam is the only country where cholera vaccine is now being given to endemic populations, although many other countries in Asia and Africa have regular seasonal outbreaks of cholera. This raises the question of defining the circumstances for using cholera vaccine in endemic areas. The World Health Organization (WHO) has recommended use of killed oral cholera vaccine in refugee populations of Africa (2), but it has not yet formulated a policy for use of either the live or killed oral vaccines in areas endemic for cholera (Chaignat C-L. Personal communication, 2003). There are several reasons why it has been difficult for WHO to formulate such a policy. The true burden of disease from cholera is not well-understood since many nations with cholera do not report it because of fears of res
