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:

serious consequences from travellers’ diarrhea (e.g., chronic

renal failure, congestive heart failure, insulin-dependent diabetes

mellitus, inflammatory bowel disease);

gastric hypochlorhydria and young children aged > 2 years);

immunodeficiency states;

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.