Community-based assessment of safety and immunogenicity of the whole cell plus recombinant B subunit ( WC rBS) oral cholera vaccine in Peru

Every year since its introduction in 1991, there have been epidemics of cholera in Lima, Peru. Vaccination is one approach to the control of cholera. A pilot study was conducted to assess the safety and immunogenicity of a whole cell plus recombinant B subunit ( WC rBS) cholera vaccine in Lima, Peru. Five hundred and forty-one volunteers aged 2-65 years received two doses two weeks apart of WC rBS vaccine or Escherichia coli K12 placebo administered in bicarbonate buffered water. Symptoms were monitored on all subjects and blood was collected from 102 persons before the first dose and two weeks after the second dose. Mild post-vaccination gastrointestinal symptoms were reported with equal frequency for both the vaccine and placebo recipients. Among 51 vaccinees, 49% had a twofold or greater increase in serum vibriocidal titers (GMT = 78; range <1:10 to 1:5120); and 92% and 82% developed a twofold or greater serum anti-cholera toxin IgG and IgA response, respectively. Persons with elevated prevaccination vibriocidal titers had a decreased response to the WC rBS. Age and blood group did not affect the immune response. The WC rBS vaccine was safe and immunogenic in a group of native Peruvians.