Two vaccines are currently available for the prevention of cholera. Dukoral is an inactivated vaccine which provides a high level of protection against the common El Tor strain. It is recommended for travellers, 2 years of age and over who might:
- be visiting areas with a high risk of exposure
- have a predisposition which might put them at higher risk of symptomatic disease
Dukoral is an oral vaccine that needs to be mixed with a buffer solution prior to administration. The buffer protects the vaccine from stomach acid. Children under 6 years receive half the buffer solution. Food and drinks should be avoided for an hour, both before and after administration of the vaccine as this may stimulate acid production.
Antibodies are developed within the gastrointestinal tract and these bind with the cholera toxin to render it less capable of causing diarrhoea.
Two doses 1-6 weeks apart will provide protection for 2 years. Children are advised to receive a 3rd dose at 6 months.
Side effects have been noted in a small number of people (.1-1%) These include mild abdominal pain and diarrhoea.
Although not recognized by the Australian TGA (Therapeutics Goods Administration), in many countries Dukoral is prescribed for the prevention of another bacteria (ETEC) which is often to blame for traveller’s diarrhoea. Its use would probably make traveller’s diarrhoea about 10-20% less likely. The ETEC protection is probably short lasting, but it might be offered to travellers with a higher risk of symptomatic disease or severe illness.
A single booster dose of Dukoral may be given if the initial course has been undertaken less than 2 years previously. The course must be repeated in full if it has been longer than 2 years.
Vaxchora is an oral live attenuated vaccine, and has similar indications for use as Dukoral.
Vaxchora can be used in travellers aged 2 and over. Adults and children over 6 years are recommended to receive 1 dose of the vaccine at least 10 days before travel.
Children aged between 2 and 6 years receive the same dose of the vaccine but with half the buffer, which protects the vaccine from stomach acid. Food and drinks should be avoided for an hour, both before and after administration of the vaccine as this may stimulate acid production.
