Cholera is endemic in at least 47 countries, but it poses its greatest challenge in the form of explosive epidemics among vulnerable, at-risk populations in low-resource and inaccessible settings. Approaches to managing cholera epidemics have recently been revitalized and are increasingly being applied at scale. 

The influence of scientific evidence has been particularly important in building consensus on new action plan on cholera. The World Health Organisation's Global Task Force on Cholera Control seeks a 90% reduction in cholera deaths by 2030. 

Although a powerful public health tool, current killed vaccines confer poor protection to infants and young children, vulnerable groups that can spread cholera. The label requirement for two vaccine doses administered 7 to 14 days apart and the delayed onset of acquired protective immunity during a period of high infection risk can complicate the response in cholera emergencies. This problem would be resolved with the availability of a live single-dose vaccine that confers rapid protection through colonization resistance while acquired immunity develops. The rapid-onset probiotic-like activity of one particular engineered  of V. cholerae strain, HaitiV, suggests a new functionality for live vaccines in cholera prevention

Although potentially devastating, cholera epidemics are not the only source of disease burden and often distract attention from the >90% of the 1.3 million to 4.0 million cholera cases that occur annually in regions where V. cholerae is endemic. Children living in cholera-endemic regions usually also live with poor sanitation, malnutrition, enteric enteropathy, persistent low-grade diarrhea, and frequent exposure to empirical antimicrobials. A healthy gut microbiota is associated with nutritional benefits and with resistance to enteric infection and enteropathy. Potentially, harnessing specific probiotics could play a role in easing this disease burden.

For the full article please see Vol. 10, Issue 445 of Science Translational Medicine