Advair Diskus and Cholera Vaccine Live Oral

• Generic Name: fluticasone / salmeterol
• Dosage Forms: aerosol, metered
• Other Brand Names: Advair Diskus, Advair HFA, AirDuo RespiClick, Wixela Inhub

Advair Diskus inhalation is a steroid and bronchodilator combination medicine that is used to prevent asthma attacks. It is also used to prevent flare-ups or worsening of chronic obstructive pulmonary disease (COPD) associated with chronic bronchitis and/or emphysema.

In people with COPD, Advair Diskus is for long-term treatment. In people with asthma, Advair Diskus is for short-term treatment until symptoms are well controlled with with other medicines.

Advair Diskus is for use in adults and children who are at least 4 years old. Advair HFA and AirDuo Respiclick are for use in adults and children who are at least 12 years old.

Advair Diskus may also be used for purposes not listed in this medication guide.

• Generic Name: cholera vaccine, live
• Dosage Forms: n.a.
• Other Brand Names: Vaxchora

Prevention of disease caused by V. cholerae serogroup O1 in adults 18 through 64 years of age traveling to cholera-affected areas.

Cholera is an acute, intestinal infection caused by toxigenic V. cholerae and may be associated with sudden onset of profuse watery diarrhea and rapid progression to volume depletion, severe dehydration, hypovolemic shock, and death. Many individuals with V. cholerae infection are asymptomatic or have only mild to moderate disease; 10–20% of infected individuals develop severe disease and potentially fatal dehydration. Transmitted principally by ingestion of water and/or food contaminated with feces from individuals with V. cholera infection and generally occurs in countries that lack clean drinking water or proper sanitation. Although more than 200 V. cholerae serogroups identified, only toxigenic strains of V. cholerae serogroups O1 and O139 have been associated with cholera epidemics; serogroup O1 is the leading cause of cholera worldwide.

Cholera is uncommon in US, but endemic in approximately 50–60 countries, principally in less well-developed areas of the world that have poor sanitation and primitive water systems (e.g., areas of Africa, South and Southeast Asia, the Caribbean). In 2015, 172,454 cases (including 1304 fatalities) were reported in 42 different countries. However, many cases unreported and it has been estimated that up to 3–4 million cholera cases (up to 95,000–143,000 fatalities) may occur annually worldwide. Large cholera epidemic began in Haiti in 2010 following a devastating earthquake; CDC states cholera likely to persist at endemic levels in Haiti for the foreseeable future and sporadic cases may continue be associated with travel to and from Caribbean countries, including Haiti, the Dominican Republic, and Cuba.

During 2001–2013, there were 123 confirmed cases of cholera in the US in individuals who had been traveling abroad. Risk of acquiring cholera is highest in those traveling to countries where cholera is endemic or epidemic, and is especially high in travelers who drink untreated water, eat raw or poorly cooked food (especially seafood), or do not follow proper hygiene recommendations while in cholera endemic or outbreak settings. Individuals at increased risk for poor clinical outcome if infected with toxigenic V. cholerae include those without rapid access to medical care and rehydration therapy; those with certain chronic medical conditions (e.g., immunosuppression, cardiovascular disease, renal disease); those with low gastric acidity related to antacid therapy, partial gastrectomy, or other causes; those with blood type O; and pregnant women.

For US travelers, the US Public Health Service Advisory Committee on Immunization Practices (ACIP) recommends cholera vaccine live oral for adults 18 through 64 years of age who will be at increased risk of exposure to toxigenic V. cholerae O1 because they will be traveling to areas with active cholera transmission. These areas are defined as a province, state, or other administrative subdivision within a country with endemic or epidemic cholera caused by toxigenic V. cholerae O1. This includes areas that have had cholera activity within the past year and are prone to recurrence of cholera epidemics; does not include areas with only rare imported or sporadic cholera cases.

ACIP states that routine use of cholera vaccine is not recommended for most travelers from the US since the majority do not visit areas with active cholera transmission and, therefore, are at low risk of exposure to toxigenic V. cholerae.

Efficacy for prevention of cholera not established in individuals living in cholera-affected areas or in individuals who have preexisting immunity because of previous exposure to V. cholerae or previous vaccination with a cholera vaccine.

Has not been shown to provide protection against disease caused by V. cholerae serogroup O139 or other non-O1 serogroups.

All travelers to cholera-affected areas should follow safe food and water precautions and proper sanitation and personal hygiene measures, regardless of vaccination status. If severe diarrhea develops, traveler should seek prompt medical attention, particularly fluid replacement therapy.

The most recent information regarding geographic areas where cholera is actively being transmitted and additional information on vaccination and other precautions for prevention of cholera are available from CDC.