Today we’ll get back to the outline. 

02. IMMUNOLOGY/VACCINOLOGY

Types of Vaccines/Immunizations/Immunobiologics

04. Cholera

• Indications/contraindications
  • Indicated in adults: “18 – 64 years old who are traveling to an area of active cholera transmission.
  • An area of active cholera transmission is defined as a province, state, or other administrative subdivision within a country where cholera infections may be reported regularly (endemic) or where a cholera outbreak is occurring (epidemic), and includes areas with cholera activity within the past year.
  • The vaccine is not regularly recommended for most travelers from the United States, as most travelers do not visit areas with active cholera transmission.
  • No country or territory currently requires vaccination against cholera as a condition for entry.” ¹

• Contraindicated?  “The safety and effectiveness of Vaxchora^® in pregnant or breastfeeding women is not yet known” ¹
• Routes of administration
  • “A single-dose live oral cholera vaccine called Vaxchora^® (lyophilized CVD 103-HgR) in the United States
  • Three other oral inactivated, or non-live cholera vaccines are available: Dukoral (manufactured by SBL Vaccines); ShanChol (manufactured by Shantha Biotec in India), and Euvichol-Plus/Euvichol (manufactured by Eubiologics). These cholera vaccines are World Health Organization (WHO) prequalified, but are not available in the U.S.” ¹

• Dosing regimens
  • “A single-dose live oral cholera vaccine called Vaxchora^® (lyophilized CVD 103-HgR) in the United States
  • Three other oral inactivated, or non-live cholera vaccines are available: Dukoral (manufactured by SBL Vaccines); ShanChol (manufactured by Shantha Biotec in India), and Euvichol-Plus/Euvichol (manufactured by Eubiologics). These cholera vaccines are World Health Organization (WHO) prequalified, but are not available in the U.S.” ¹
• Duration of protection
  • “Vaxchora^® has been reported to reduce the chance of severe diarrhea in people by 90% at 10 days after vaccination and by 80% at 3 months after vaccination.
  • It is also not known how long protection lasts beyond 3 – 6 months after getting the vaccine.” ¹
  • “Cholera vaccines offer incomplete protection. Therefore, vaccination should never take the place of standard prevention and control measures.” ²

• Immunogenicity
  • Do NOT give live oral vaccine to patients on antibiotics; wait 14 days after antibiotics end (give vaccine at least 10 days before chloroquine but atovaquone/proguanil is OK) for it to be effective (CDC Yellow Book)
• Efficacy
  • “Vaxchora^® has been reported to reduce the chance of severe diarrhea in people by 90% at 10 days after vaccination and by 80% at 3 months after vaccination.
  • It is also not known how long protection lasts beyond 3 – 6 months after getting the vaccine” ¹
  • “Cholera vaccines offer incomplete protection. Therefore, vaccination should never take the place of standard prevention and control measures” ²
• Potential adverse reactions and medical management of adverse reactions
  • “Side effects from Vaxchora^® are uncommon and may include tiredness, headache, abdominal pain, nausea and vomiting, lack of appetite, and diarrhea” ¹
  • “Some people have mild problems following cholera vaccination.  These include:
    • Abdominal pain
    • Tiredness or fatigue
    • Headache
    • Lack of appetite
    • Nausea or diarrhea

• “No serious problems reported after cholera vaccine were considered related to the vaccine
  • Any medication can cause a severe allergic reaction. Such reactions from a vaccine are very rare, estimated at about 1 in a million doses, and would happen within a few minutes to a few hours after the vaccination
  • As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death” ²

Summary ⁴

Summary of cholera vaccines
Vaccine name (Manufacturer)	How given	Number of doses recommended	Age range	How long vaccination is effective	Available in the US?
Vaxchora (Emergent BioSolutions)	By mouth	1 dose	2–64 years	At least 3–6 months	Not currently*
Dukoral (SBL Vaccines)	By mouth	2 doses, given 1–6 weeks apart (Children aged 2–5 years need 3 doses, given 1 to 6 weeks apart)	2 years and older	2 years	No
ShanChol  ** (Sanofi Healthcare India Private Limited)	By mouth	2 doses, given at least 2 weeks apart	1 year and older	At least 3 years for 2 doses; short-term protection for 1 dose	No
Euvichol-Plus  ** (EuBiologics)	By mouth	2 doses, given at least 2 weeks apart	1 year and older	At least 3 years for 2 doses; short-term protection for 1 dose	No

* In December 2020, the maker of this cholera vaccine temporarily stopped making and selling it. This vaccine is currently unavailable.
** Shanchol and Euvichol-Plus use the same vaccine formula but are produced by different makers. These vaccines are currently available for mass vaccination campaigns.

1. Cholera. Military Health System. https://www.health.mil/Military-Health-Topics/Health-Readiness/Immunization-Healthcare/Vaccine-Preventable-Diseases/Cholera
2. Centers for Disease Control and Prevention. (2019, October 30). Cholera vaccine information statement. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/cholera.html
3. Centers for Disease Control and Prevention. Interactions between travel vaccines & drugs – chapter 2 – 2020 yellow book. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/interactions-between-travel-vaccines-and-drugs
4. Centers for Disease Control and Prevention. (2022, September 30). Vaccines. Centers for Disease Control and Prevention. https://www.cdc.gov/cholera/vaccines.html