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OSP:rTTHc cholera conjugate vaccine with aluminum phosphate adjuvant is an investigational biological vaccine developed by the International Vaccine Institute (IVI) for the prevention of cholera. The vaccine consists of the O-specific polysaccharide (OSP) from the *Vibrio cholerae* O1 Inaba strain PIC018, which is conjugated to a recombinant heavy chain fragment of tetanus toxin (rTTHc) carrier protein. This conjugation, achieved via squaric acid chemistry, converts the T-cell independent polysaccharide antigen into a T-cell dependent antigen, thereby enhancing immunogenicity, particularly in young children who typically respond poorly to polysaccharide vaccines. The vaccine is formulated with an aluminum phosphate (alum) adjuvant to further stimulate the immune response against the OSP component of the *V. cholerae* lipopolysaccharide, which is the primary antigen mediating serogroup-specific protection. It has been evaluated in Phase I clinical trials (NCT05559983) to assess its safety and immunogenicity in healthy adults.
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