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Cholera Immunisation
A new oral cholera vaccine became available in the UK in 2004. It is not needed by most travellers
but may be advised if you are travelling to a high-risk area. You can prevent getting cholera and
other water-borne infections by avoiding contaminated water and having good personal and food
hygiene.

What is cholera?
Cholera is an illness cased by a bacterium called Vibrio cholerae. The illness can be mild and may even not lead
to any symptoms in some people. However, in many cases it causes severe diarrhoea, sometimes with vomiting.
This can quickly lead to serious dehydration and can even be fatal.
Cholera is usually caught from drinking infected water or eating infected shellfish and other foods. Person-to
person spread can occur though.
The worst affected areas are the Indian subcontinent, the Far East, Africa and South America. The risk to
travellers even in infected areas is still quite small.

Preventing cholera
The most important part of prevention is to be very careful about personal, food and water hygiene. This is most
important in areas where sanitation is poor and where there is a risk of catching cholera. You should not drink any
water that is untreated and be very careful what you eat. This not only applies to cholera but also to all sorts of
other water-borne infections found in areas of poor sanitation.

Cholera immunisation
A new oral vaccine (Dukoral) became available in the UK in 2004. This is now the only vaccine for cholera
available in the UK. It is not advised for most travellers. It may be advised for certain people travelling to places
where cholera may occur. Your doctor or nurse will advise if you should consider having this vaccine.
Examples of people who are likely to be advised to have this vaccine include:
People going to work in an area of a known cholera outbreak. For example, aid workers, health
workers, etc, who will be working in emergency relief camps where cholera has broken out.
People planing to stay for a long time in an area where there is high risk of cholera - especially any
area where there is limited access to medical care.

The vaccine
The oral vaccine comes in sachets which are dissolved in a drink. It can be used by adults and children aged two
years and over. You should not eat or drink anything for an hour before and an hour after taking a dose of the
vaccine. This is to make sure it is absorbed fully from your gut.
The course of immunisation is two doses for people over six years old and three doses for children 2-6 years old.
Each dose is given at least one week apart but no later than six weeks apart. The course of immunisation should
be finished at least one week before potentially coming into contact with cholera. Typically, this is one week
before travel.

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A booster dose is needed to maintain protection. This is after two years for people over six years old, and after six
months for children 2-6 years old. The cholera vaccine can be given at the same time as other injected vaccines.

Note: the vaccine does not provide complete protection. For example, it does not protect against all strains of
cholera. Therefore, it is still important that you should be careful with regard to what you eat and drink in the usual
way.

Who should not receive the vaccine?

There are very few people who cannot have the oral cholera vaccine. It should not be given if:
You have had a severe reaction to a previous dose of the oral cholera vaccine.
You have had a severe (anaphylactic) reaction to formaldehyde or to any of the ingredients of the
vaccine.
There are currently no data on the safety of this vaccine in pregnant or breast-feeding women. Therefore, if you
are pregnant or breast-feeding, the vaccine should only be considered if the risk of cholera is high.
Side-effects from this vaccine are uncommon. Less than 1 person in 100 develops some abdominal pains,
diarrhoea or nausea for a short time after taking the vaccine.

Further information
Health Advice for Travellers
Web: www.dh.gov.uk
Go to the Department of Health website (above) and search for 'Health Advice for Travellers'

Patient UK Travel Health Page

Web: www.patient.co.uk/showdoc/38/
Has a comprehensive list of links to UK websites on travel health.

Further reading & references

Immunisation - The Green Book; Dept of Health
Sinclair D, Abba K, Zaman K, et al; Oral vaccines for preventing cholera. Cochrane Database Syst Rev. 2011 Mar
16;(3):CD008603.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical
conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its
accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
For details see our conditions.
Original Author:
Dr Tim Kenny

Current Version:
Dr Louise Newson

Peer Reviewer:
Dr Hannah Gronow

Document ID:
4217 (v40)

Last Checked:
20/04/2012

Next Review:
20/04/2015

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