Cholera vaccines are vaccines that are effective at preventing cholera. For the first six months after vaccination they provide about 85 percent protection, which decreases to 50 percent or 62 percent during the first year. After two years the level of protection decreases to less than 50 percent. When enough of the population is immunized, it may protect those who have not been immunized (known as herd immunity).The World Health Organization (WHO) recommends the use of cholera vaccines in combination with other measures among those at high risk. With the oral vaccine, two or three doses are typically recommended. The duration of protection is two years in adults and six months in children aged 2–5 years. A single dose vaccine is available for those traveling to an area where cholera is common. In 2010, in some countries an injectable cholera vaccine was available.The available types of oral vaccine are generally safe. Mild abdominal pain or diarrhea may occur. They are safe in pregnancy and in those with poor immune function. They are licensed for use in more than 60 countries. In countries where the disease is common, the vaccine appears to be cost effective.The first vaccines used against cholera were developed in the late 1800s. They were the first widely used vaccine that was made in a laboratory. Oral vaccines were first introduced in the 1990s. It is on the World Health Organizations List of Essential Medicines.
The mealoncytic macules are not associated with malignant transformation.Complications associated with Peutz-Jeghers syndrome include obstruction and intussusception, which occur in up to 69 percent of patients, typically first between the ages of 6 and 18, though surveillance for them is controversial. Anemia is also common due to gastrointestinal bleeding from the polyps. Genetics
In 1998, a gene was found to be associated with the mutation. On chromosome 19, the gene known as STK11 (LKB1) is a possible tumor suppressor gene. It is inherited in an autosomal dominant pattern, which means that anyone who has PJS has a 50% chance of passing the disease on to their offspring.Peutz–Jeghers syndrome is rare and studies typically include only a small number of patients. Even in those few studies that do contain a large number of patients, the quality of the evidence is limited due to pooling patients from many centers, selection bias (only patients with health problems coming from treatment are included), and historical bias (the patients reported are from a time before advances in the diagnosis of treatment of Peutz–Jeghers syndrome were made). Probably due to this limited evidence base, cancer risk estimates for Peutz–Jeghers syndrome vary from study to study. There is an estimated 18–21% risk of ovarian cancer, 9% risk of endometrial cancer, and 10% risk of cervical cancer, specifically adenoma malignum. Diagnosis
The main criteria for clinical diagnosis are:
Family history
Mucocutaneous lesions causing patches of hyperpigmentation in the mouth and on the hands and feet.