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Background  Cholera is an acute voluminous dehydrating diarrheal disease caused by toxigenic strains of  Vibrio cholerae  O1 and occasionally O139. A growing body of evidence indicates that immune responses targeting the O-specific polysaccharide (OSP) of  V .  cholerae  are involved in mediating protection against cholera. We therefore assessed whether antibody responses against OSP occur after vaccination with live attenuated oral cholera vaccine CVD 103-HgR, and whether such responses correlate with protection against cholera.    Methodology  We assessed adult North American volunteers (n = 46) who were vaccinated with 5 × 10 8  colony-forming units (CFU) of oral cholera vaccine CVD 103-HgR and then orally challenged with approximately 1 × 10 5  CFU of wild-type  V .  cholerae  O1 El Tor Inaba strain N16961, either 10 or 90 days post-vaccination.    Principal findings  Vaccination was associated with induction of significant serum IgM and IgA anti-OSP and vibriocidal antibody responses within 10 days of vaccination. There was significant correlation between anti-OSP and vibriocidal antibody responses. IgM and IgA anti-OSP responses on day 10 following vaccination were associated with lower post-challenge stool volume (r = −0.44,  P  = 0.002; r = −0.36,  P  = 0.01; respectively), and none of 27 vaccinees who developed a ≥1.5 fold increase in any antibody isotype targeting OSP on day 10 following vaccination compared to baseline developed moderate or severe cholera following experimental challenge, while 5 of 19 who did not develop such anti-OSP responses did ( P  = 0.01).    Conclusion  Oral vaccination with live attenuated cholera vaccine CVD 103-HgR induces antibodies that target  V .  cholerae  OSP, and these anti-OSP responses correlate with protection against diarrhea following experimental challenge with  V .  cholerae  O1.    Trial registration  ClinicalTrials.gov  NCT01895855

plos neglected tropical diseases

Anti-O-specific polysaccharide (OSP) immune responses following vaccination with oral cholera vaccine CVD 103-HgR correlate with protection against cholera after infection with wild-type Vibrio cholerae O1 El Tor Inaba in North American volunteers