Following V cholerae O1 infection, robust serum vibrio-cidal antibody responses and rises in immunoglobulin G (IgG) cholera antitoxin are observed.60,61 Approximately 90% of complement-dependent vibriocidal antibodies are directed toward the O antigen with the remaining 10% to 15% of antibodies being against protein antigens. In immunologically primed individuals, strong SIgA intestinal antibody responses are recorded following cholera infection. However, significant rises in SIgA anti-LPS and antitoxin are surprisingly sparse in nonprimed individuals. The detection of gut-derived, trafficking IgA antibody-secreting cells that make specific antibody to LPS and CT antigens is a good measure of priming of the intestinal immune system.62
Whereas infection-derived immunity to cholera is believed to be mediated by intestinal mucosal SIgA antibodies, curiously, serum vibriocidal antibodies are the best correlate of protection.33,63 These serum antibodies are presumed to be a proxy for the stimulation of intestinal antibodies.
Whereas high titers of specific vibriocidal antibodies appear after V cholerae O1 infection, vibriocidal responses following O139 infection are weak and rather nonspecific.64 A correlate of protection for O139 cholera has not yet been identified.
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