Vaccines: Cholera

Specific vaccination recommendations vary among countries or even within a given country. Local or country-specific guidelines should be consulted.

1. Vaccines: The only vaccine authorized for use in Canada is an oral inactivated vaccine containing the whole-cell heat-inactivated Vibrio cholerae O1 Inaba classic strain, formalin-inactivated O1 Inaba El Tor strain, and heat- and formalin-inactivated O1 Ogawa classic strain. In addition, the vaccine contains a recombinant cholera toxin B (rCTB) subunit to provide protection against traveler’s diarrhea caused by enterotoxigenic Escherichia coli (ETEC).

2. Indications: Vaccination is not routinely recommended for most travelers. It is recommended in persons at high risk of developing the disease, either because they are travelling to a high-risk area (eg, one with an ongoing epidemic of toxigenic V cholerae serogroup O1) or because of their activities (eg, humanitarian aid personnel, health-care worker).

While the vaccine contains rCTB to provide protection against ETEC, a meta-analysis has demonstrated no benefit compared with placebo in the vaccine’s ability to prevent traveler’s diarrhea caused by ETEC. Therefore it is not routinely recommended for this purpose.

3. Contraindications include general contraindications for all inactivated vaccines such as allergy to vaccine components or anaphylactic reaction to previous cholera vaccination, as well as hypersensitivity to formaldehyde. Vaccination should be postponed in individuals with acute febrile or gastrointestinal illness. There are no safety data for pregnant or breastfeeding women.

4. Adult immunization schedule: The primary vaccination series consists of 2 oral doses at an interval of 1 to 6 weeks; the second dose should be given ≥1 week before travel. If >6 weeks elapse between doses, the primary series should be repeated. Booster doses should be received every 2 years if there is ongoing high-risk exposure; if >5 years have elapsed since the last booster dose, the primary series should be repeated. Patients should be advised to refrain from eating or drinking 1 hour before and after vaccination, as this may impair vaccine efficacy.

In the event that a person is receiving a cholera vaccine and oral typhoid vaccine prior to travel to an endemic area, the administration of these vaccines should be ≥8 hours apart.

5. Adverse events: Abdominal pain (16%), diarrhea (12%), nausea (4%), emesis (3%).