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An Advisory Committee Statement (ACS)

Committee to Advise on Tropical Medicine and Travel (CATMAT) and National Advisory Committee on Immunization (NACI)*†

Recommended Usage: Travellers’ Diarrhea DUKORAL

Indications for the oral BS-WC vaccine are limited because of the
following:

1. most episodes of travellers’ diarrhea are usually mild
   and self-limited;
2. therapeutic options (oral rehydration, dietary
   management, antimotility, and antibiotic treatment) are available
   if prevention fails;
3. < 50% (range 25% to 50%) of travellers’
   diarrhea cases are caused by ETEC bacteria;
4.  the protection by
   the vaccine against ETEC diarrhea is approximately 50%; and
5. vaccinated travellers may gain a false sense of security and
   possibly avoid being as strict in observing food and water
   precautions.

In summary, vaccination with the BS-WC (DURORAL)vaccine as a prevention strategy for travellers’ diarrhea is of limited value and cannot be routinely recommended for the majority of travellers.

BS-WC vaccine may be considered for the following selected
high-risk, short-term travellers who are aged > 2 years:

* with chronic illnesses for whom there is an increased risk of
serious consequences from travellers’ diarrhea (e.g., chronic
renal failure, congestive heart failure, insulin-dependent diabetes
mellitus, inflammatory bowel disease);

* with an increased risk of acquiring travellers’ diarrhea (e.g,.
gastric hypochlorhydria and young children aged > 2 years);

* who are immunosuppressed due to HIV infection or other
immunodeficiency states;

* with a history of repeated severe travellers’ diarrhea; or

* for whom a brief illness cannot be tolerated (i.e., elite athletes
or business or political travellers).
Conduct a detailed, individual travel-related risk assessment to
determine those travellers who may benefit most from BS-WC
vaccination as a prevention strategy for travellers’ diarrhea.

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