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Infection and Immunity, December 1999, p. 6346-6349, Vol. 67, No. 12
0019-9567/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Validation and Characterization of a Human Volunteer Challenge Model for Cholera by Using Frozen Bacteria of the New Vibrio cholerae Epidemic Serotype, O139

Mitchell B. Cohen,1,2,* Ralph A. Giannella,3 Genevieve A. Losonsky,4 Dennis R. Lang,5 Susan Parker,6,7 Jennifer A. Hawkins,1,2 Carolyn Gunther,1,2 and Gilbert A. Schiff6,7

Gamble Program for Clinical Studies, Division of Infectious Diseases,6 Children's Hospital Medical Center,1 and Division of Pediatric Gastroenterology and Nutrition,2 University of Cincinnati,7 Cincinnati, Ohio 45229; Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio 452673; Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland 212014; and Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, Rockville, Maryland 208925

Received 26 July 1999/Returned for modification 3 September 1999/Accepted 24 September 1999

Until recently, all epidemic strains of Vibrio cholerae were of the O1 serotype. Current epidemics have also been caused by a new serotype, Vibrio cholerae O139. Although the pathogenesis and clinical features of O139 cholera are similar to those of O1 cholera, immunity to serotype O1 does not confer immunity to serotype O139. Therefore, prior to beginning vaccine efficacy studies, we sought to validate the use of a large standardized frozen inoculum of virulent V. cholerae O139 4260B for use in a human volunteer challenge model. Healthy volunteers (n = 25) were recruited for an Internal Review Board-approved inpatient dose-escalation challenge. Our goal was to identify a dose at which the cholera attack rate and the geometric mean purge were sufficient for determining vaccine efficacy against moderate and severe disease. At a dose of 105 CFU, 8 of 10 volunteers experienced purging and had a positive stool culture for V. cholerae. However, at this dose, the geometric mean stool volume of 2,175 g was insufficient by study criteria. At a dose of 106 CFU, 14 of 15 volunteers experienced purging, with a geometric mean stool volume of 5,621 g. Disease severity was significantly greater in volunteers with blood group O than those with non-O blood types (10,353 g versus 3,555 g, P < 0.001). Following challenge, all volunteers demonstrated a significant rise in antitoxin antibodies but the serum vibriocidal titer was attenuated compared to that seen after challenge with an O1 strain. This model provides a reproducible illness of sufficient severity for testing the efficacies of new O139 or combined O1-O139 vaccines.


* Corresponding author. Mailing address: Division of Pediatric Gastroenterology and Nutrition, 3333 Burnet Ave., Cincinnati, OH 45229. Phone: (513) 636-4415. Fax: (513) 636-7805. E-mail: mitchell.cohen{at}chmcc.org.


Infection and Immunity, December 1999, p. 6346-6349, Vol. 67, No. 12
0019-9567/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.






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Copyright © 1999 by the American Society for Microbiology. All rights reserved.