Cholera Vaccine

Indications and role:

The UK recommends a vaccine called Dukoral, it contains recombinant cholera toxin B (rCTB) and four strains of V.cholera 01. It does not contain 0139. It is only recommended to a few who are at a specific risk due to the low likelihood in most travellers. Also it is only licensed in children from the age of 2 years old and adults.

• Relief or disaster aid workers.
• Persons with remote itineraries where a cholera epidemic is occurring.
• Travellers to potential cholera risk areas, for whom vaccination is considered potentially beneficial

There is another licensed vaccine by WHO: Bivalent killed whole-cell vaccine (Shanchol) — Contains killed whole cells of several biotypes and serotypes of V. cholerae O1 and V. cholerae O139 without supplemental cholera toxin B subunit. It is licensed in India and has the added benefit of containing 0139 and can be used in children from the age of 1 year. Dosing is 1.5ml on day 0 and 1.5ml on day 14.

Vaxchora is the FDA equivalent but is only licensed from 18 years of age and has the same issue of not covering 0139.

Administration and dosing:

• Administration:
  • Food, drink and other medicine should be avoided 1 hour before and after the oral suspension.
  • Dissolve the effervescent granules in 150ml of water. In children under the age of six years half of this solution can be discarded before adding the vaccine solution. Then drink the solution within 2 hours.
• Adults and children over six years of age:
  • First dose day 0.
  • Second dose between one and six weeks after the first dose.
  • A booster can be given 2 years after completing the primary course. If this time has elapsed a primary course will need to be repeated again.
• Children two to six years of age:
  • First dose day 0.
  • Second dose between one and six weeks after the first dose.
  • Third dose between one and six weeks after the second dose.
  • A booster can be given 6 months after completing the primary course. If this time has elapsed a primary course will need to be repeated again.

Contraindications or complications and special populations:

• Confirmed anaphylactic reaction to a previous cholera vaccine.
• Confirmed anaphylactic reaction to formaldehyde.
• There is no data on pregnant or breastfeeding women, if the risk of contracting cholera is high in this group then the vaccine is recommended.
• Immunosuppressed and HIV patients should be offered the vaccine as per the usual indications stated above but be aware they may not mount a full antibody response. Specialist advice may be required.

References

• The green book
• Shanchol mims
• Shanchol leaflet