Cholera is a major global health problem, causing approximately 100,000 deaths annually, about half of which occur in sub-Saharan Africa. Although early-generation parenteral
cholera vaccines were abandoned as public health tools owing to their limited efficacy, newer-generation oral
cholera vaccines have attractive safety and protection profiles. Both killed and live oral
vaccines have been licensed, although only killed oral
vaccines are currently manufactured and available. These killed oral
vaccines not only provide direct protection to vaccinated individuals, but also confer herd immunity. The combination of direct
vaccine protection and
vaccine herd immunity effects makes these
vaccines highly cost-effective and, therefore, attractive for use in developing countries. Administration of these oral
vaccines does not require qualified medical personnel, which makes their use practical--even in developing countries. Although new-generation oral
cholera vaccines should not be considered in isolation from other preventive approaches, especially improved water quality and sanitation, they represent important tools in the public health armamentarium to control both endemic and epidemic
cholera.