Cholera

Transmission

Cholera is transmitted through the faecal-oral route through the consumption of contaminated water and sometimes food, including shellfish. Rarely is it transmitted person-to-person.

Risk to most travellers is small, even where there is an outbreak. Travellers at risk:

  • Humanitarian aid workers
  • Consuming untreated drinking water, or poorly cooked seafood
  • Travellers living in areas of poor sanitation or poverty
  • Long-term travellers in endemic areas

Immunisation against cholera is not required for general travel, however, food and water hygiene measures should be practiced.

Immunisation against cholera is usually only recommended for high risk travellers, for example, humanitarian aid workers and those travelling to areas experiencing an outbreak who will have limited access to safe drinking water or medical care.

Vaccination schedule

Brand Vaccine information Primary course Booster
Dukoral
  • Inactivated, oral
  • Licensed from two years of age

From six years of age: Two doses

2–6 years of age: Three doses

  • Doses to be administered at least one week apart
  • Restart primary course if more than six weeks have elapsed between doses
  • Effective one week after completing course

Single dose

  • From six years of age — within two years
  • 2–6 years of age — within six months

If more than two years have elapsed (or more than six months for children 2–6 years of age) — repeat primary course.

 

The information below is based on Public Health England recommendations; individual Summaries of Product Characteristics should be referred to for manufacturer recommendations regarding individual brands.

Acute illness

If a patient is suffering from an acute febrile or gastrointestinal illness, immunisation should be postponed until they have recovered. Patients with minor infections without fever or systemic upset do not need to postpone their immunisation schedule.

Administration

  • With other vaccines:  cholera vaccine may be given at the same time as injected vaccines
  • Food/other medicines:  patients must avoid food, drink and other oral medicinal products for one hour before and one hour after administration of the vaccine

Immunocompromised patients

Cholera vaccine can be given to patients who are immunocompromised if they are travelling to an area of risk, however it may not be as effective. Specialist advice may be required.

Pregnancy and breast-feeding

There is no data on the use of cholera vaccine during pregnancy or breast-feeding although no harmful effects due to inactivated vaccines in such patients have been reported. Immunisation against cholera should be considered if the risk of cholera is high.