In the late twentieth century, oral<unk> s started to be used on a massive scale, with millions of vaccinations taking place, as a tool to control<unk>  outbreaks in addition to the traditional interventions of improving safe water supplies, sanitation, handwashing and other means of improving hygiene. The Dukoral monovalent vaccine from Sweden, which combines formalin, heat-killed whole cells of Vibrio<unk> e O1 and a recombinant<unk>  toxin B subunit, was licensed in 1991, mainly for travellers. Out of a million doses sold during the following decade, 63 negative side effects were reported. The Shanchol/mORCVAX bivalent vaccine, which combines the O1 and O139 serogroups, was originally licensed in Vietnam in 1997 and given in 20 million doses to children in Vietnam during the following decade. , Vietnam continued to incorporate oral<unk> tion in its public health programme, administering the vaccination through targeted mass vaccination of school-aged children in<unk>  endemic regions. The<unk>  is widely used by backpackers and persons visiting locations where there is a high risk of<unk>  infection. However, since it does not provide 100percent immunity from the disease, food hygiene precautions are also recommended when visiting an area where there is a high risk of becoming infected with<unk> . Although the protection observed has been described as "moderate", herd immunity can multiply the effectiveness of vaccination. Dukoral has been licensed for children two years of age and older, Shanchol for children one year of age and older. The administration of the vaccine to adults confers additional indirect protection (herd immunity) to children. The World Health Organization (WHO) recommends both preventive and reactive use of the vaccine, making the following key statements: WHO recommends that current available<unk> s be used as complements to traditional control and preventive measures in areas where the disease is endemic and should be considered in areas at risk for outbreaks. Vaccination should not disrupt the provision of other high priority health interventions to control or prevent<unk>  outbreaks.... Reactive vaccination might be considered in view of limiting the extent of large prolonged outbreaks, provided the local infrastructure allows it, and an in-depth analysis of past<unk>  data and identification of a defined target area have been performed. The WHO as of late 2013 established a revolving stockpile of two million OCV doses. The supply is increasing to six million as a South Korean companies has gone into production (2016), the old production not being able to handle WHO demand in Haiti and Sudan for 2015, nor prior years. GAVI Alliance donated $115 million to help pay for expansions. Oral Dukoral: vial of inactivated vaccine with packet of sodium bicarbonate buffer. The oral vaccines are generally of two forms: inactivated and attenuated. Inactivated oral vaccines provide protection in 52percent of cases the first year following vaccination and in 62percent of cases the second year. Two variants of the inactivated oral vaccine currently are in use: WC-rBS and BivWC. WC-rBS (marketed as "Dukoral") is a monovalent inactivated vaccine containing killed whole cells of V.<unk> e O1 plus additional recombinant<unk>  toxin B subunit. BivWC (marketed as "Shanchol" and "mORCVAX") is a bivalent inactivated vaccine containing killed whole cells of V.<unk> e O1 and V.<unk> e O139. mORCVAX is only available in Vietnam. Bacterial strains of both Inaba and Ogawa serotypes and of El Tor and Classical biotypes are included in the vaccine. Dukoral is taken orally with bicarbonate buffer, which protects the antigens from the gastric acid. The vaccine acts by inducing antibodies against both the bacterial components and CTB. The antibacterial intestinal antibodies prevent the bacteria from attaching to the intestinal wall, thereby impeding colonisation of V.<unk> e O1. The anti-toxin intestinal antibodies prevent the<unk>  toxin from binding to the intestinal mucosal surface, thereby preventing the toxin-mediated diarrhoeal symptoms. A live, attenuated oral vaccine (CVD 103-HgR or Vaxchora), derived from a serogroup O1 classical Inaba strain, was approved by the US FDA in 2016. Injectable Although rarely in use, the injected<unk> s are effective for people living where<unk>  is common. They offer some degree of protection for up to two years after a single shot, and for three to four years with annual booster. They reduce the risk of death from<unk>  by 50percent in the first year after vaccination.
Cholera vaccine
Hookworm vaccine
Malaria vaccine
Schistosomiasis vaccine
Brucellosis vaccine
Rabies vaccine
Ebola vaccine
Dengue vaccine