Cholera Vaccination

Transmission

Cholera is transmitted by drinking contaminated water or eating food contaminated by faeces, such as shellfish. Person to person contact can occur where there is poor hygiene.

What are the symptoms of cholera?

The incubation period varies between 2 to 5 days, but symptoms can occur in hours. The majority of people infected with cholera do not have symptoms or have mild symptoms. However, they pass the bacteria in their faeces for up to 10 days and can spread the infection to others.

The symptoms of severe disease are sudden onset of profuse watery diarrhoea that can lead to death by severe dehydration and kidney failure. Untreated, the death rate is up to 50%, but with prompt and correct treatment, this fall to less than 1%.

Treatment

Cholera is an easily treatable disease. The prompt administration of oral re-hydration salts to replace lost fluids nearly always results in cure in mild to moderate cases. In especially severe cases, intravenous administration of fluids and antibiotics  may be required to save the patient’s life.

Prevention

It is important to maintain food and water hygiene at all times while travelling, particularly so, if you are carrying out voluntary work or are in remote areas. The cholera vaccine is a safe and effective vaccine for those who are at increased risk of contracting this potentially life threatening illness.

The cholera vaccine is an oral vaccine containing inactivated cholera bacteria. Please note that patients need to be nil by mouth (no food or fluids) for one hour prior to receiving the cholera vaccine.

Inclusions

The vaccine can be given to anyone over 2 years of age travelling to endemic areas or to an area where there is a current outbreak.

Common and rare side effects of the cholera vaccine

Common side effects include mild stomach discomfort, nausea, and diarrhoea. Rare side effects can include severe allergic reactions.

Can children have the cholera vaccine?

Yes, children over a certain age (usually 2 years and older) can receive the cholera vaccine, especially if traveling to an area with a high risk of cholera.

How does cholera interact with other vaccines?

Cholera vaccines can generally be administered alongside other travel vaccines, but it’s important to discuss scheduling and interactions with a healthcare provider.

If an interval of more than 6 weeks has elapsed between doses, then the course needs to be restarted.

Who is not able to have the cholera vaccine?

The vaccine is not recommended for individuals with severe allergies to any of the vaccine components or those with a compromised immune system.

The cholera vaccine should not be given in the following cases:

• Anyone under 2 years of age
• If there is a history of previous allergic reaction to the vaccine or any of it’s components
• If there is an acute illness affecting the gastrointestinal tract,, such as acute gastroenteritis
• If there is an acute illness with fever (greater than 38.5 degrees Celsius)

Pregnancy

There is no data on the safety of the cholera vaccine in pregnancy. However, during a mass-vaccination campaign conducted in Zanzibar, 196 pregnant women had received at least one dose of of the cholera vaccine and there was no evidence of a harmful effect of during pregnancy. Therefore, the vaccine can be given if the risk of cholera is sufficiently high.

Breast Feeding

There is no data on safety of the cholera vaccine administered to breast feeding mothers. However, there have no demonstrated evidence of harm when inactivated vaccines are given to breast feeding mothers. Therefore, the vaccine can be given if the risk of cholera is sufficiently high.

Common Side Effects

Mild gastro-intestinal symptoms, such as  abdominal pain, diarrhoea and nausea are the most commonly reported symptoms.

Less frequently,  flu-like symptoms,  rash and joint pains have occurred.

Interaction with Other Vaccines

The vaccine does not interact with other vaccines and can be given at the same time or at any time before or after the following vaccines:

All travel vaccines, including Yellow fever, Hepatitis A, Hepatitis B, Typhoid and DTP.

All routine vaccines such as Influenza, MMR, Chickenpox

The cholera vaccine is recommended for travellers to areas where cholera is common, especially in parts of Asia, Africa, and Latin America. It’s also advised for people who have close contact with an infected individual or are going to areas with poor sanitation and limited access to clean water.

The protection provided by the cholera vaccine typically lasts for about 2 years. After this period, a booster dose may be needed for continued immunity.

A cholera booster is recommended every 2 years for those who remain at risk, either through continued travel or other exposure to cholera-prone areas.

High-risk areas for cholera include parts of South Asia, Southeast Asia, Africa, and some regions in Central and South America.

The cost of each Cholera vaccination is £39 per dose, 2 required. Initially, there is an additional base fee of £20 which covers time spent with one of our specially trained healthcare professionals who will carry out a risk assessment.

We have clinics nationwide that offer the cholera vaccine. Below you will find a list of top clinics that provide the cholera vaccine.

• Ashford Flagship Clinic
• City of London (Moorgate) Flagship Clinic
• Hitchin Flagship Clinic
• Hove Flagship Clinic
• London Bridge Flagship Clinic
• Southampton Flagship Clinic
• Victoria Flagship Clinic
• Wimpole Street (Marylebone) Flagship Clinic
• Winchester Flagship Clinic
• Worthing Flagship Clinic
• Glasgow East End Clinic

The cholera vaccine is usually free on the NHS, but only for travel purposes or may be available for specific clinical indications.

1) What does the vaccine contain?

In addition to killed cholera bacteria, the vaccine contains:

• Sodium dihydrogen phosphate dihydrate
• Disodium hydrogen phosphate dihydrate
• Sodium chloride
• Water for injections
• Sodium hydrogen carbonate
• Citric acid
• Sodium carbonate, anhydrous
• Saccharin sodium
• Sodium citrate
• Raspberry flavour
• Formaldehyde-used in the manufacturing process. Trace amounts may still be detectable in the vaccine

The vaccine does not contain latex, egg, thiomersal or gelatin.

2) Is the cholera vaccine infectious?

The vaccine contained dead bacteria and therefore, it cannot cause the disease in the vaccinated individual. The bacteria is not shed in the faeces of the vaccinated individual and thus, they are not infectious to others.

3) Does the cholera vaccine protect against traveller’s diarrhoea?

The vaccine can protect against one type of traveller’s diarrhoea caused by a strain of the bacteria, E. coli.

4) Can I have the vaccine is I have a condition causing poor immune system?

As an inactivated vaccine, it can be given to anyone with poor immune system due to disease or medications. However, the immune response to the vaccine will not be as effective and thus, general precautions must be observed.

5) What are the booster requirements for travellers at ongoing risk of infection?

After the initial course, a booster is required within 2 years (in those older than 6 years) or within 6 months (in those aged 2-6 years).  It is not known if further booster doses are required. However, it is advised that if more than 2 years or 6 months has passed, then the initial course needs to be restarted.

Written by Travel Health and Vaccination Lead Derek Evans

Edited on 03-11-2023
Next edit on 26-11-2024