To the Editor:
The omission of Dukoral™* (oral, inactivated traveller’s diarrhoea and cholera vaccine) from Dr. Patrice Bourée’s article “Safe Foreign Travel” (Geriatrics & Aging 2006;7:472-8) was surprising, especially since the author comments that “traveller’s diarrhea occurs in up to 50% of travellers in tropical areas.”
Could the author comment?
Dr. Patrice Bourée responds:
The reader’s question is not surprising for me. I have not forgotten the matter of vaccination with Dukoral™. I am familiar with this vaccine, manufactured by SBL Vaccin AB (Stockholm) with Vibrio cholerae 01, killed by heat or formol and B-subunit choleric toxin. But, according to the French Health Ministry, the official recommendations are “such a vaccination is not justified for travellers who wash their hands and practice adequate personal hygiene. It is only justified for health teams who are working in a cholera-infected area or in a refugee’s camp.”1 This does not apply to the typical older traveller. Travellers should be attentive to the risk of acquiring cholera, but the risk is very low for most travellers who do not encounter conditions of severe poverty. The fear of this disease is used to promote food safety.2 Besides, “the effectiveness of such a vaccine is not proved in people of 65 years old and more.”1 So, my failure to mention it is not an omission but my estimation that this vaccine is not recommended for older adults.
However, the indications for this drug pose an interesting problem that is not yet satisfactorily resolved. Opinions differ markedly in Europe, Canada, and in the United States on the matter of this and other agents, and it is difficult to say which perspective is best. There is a similar conflict regarding agents used to treat traveller’s diarrhea: in the U.S., bismuth subsalicylate is used as first-line therapy, while this agent is strictly forbidden in France and is not available.
Dr. Patrice Bourée
*Note: Dukoral was approved for use in Canada in 2003. It is indicated for active immunization against disease caused by Vibrio cholerae serogroup O1 in adults and children from two years of age who will be visiting endemic/epidemic areas.
Comité Technique des Vaccinations. Guide des vaccinations. INPES, Paris, 2006, 125-9.
DuPont HL, Steffen R. Textbook of Travel Medicine. BC Decker: Hamilton, Ontario, 1997: 86-91.