What is cholera?

Cholera is a bacterial infection that causes diarrhea after consuming food or water contaminated with the bacteria. Oral rehydration is the main treatment for cholera.

What are the symptoms of cholera?

The symptoms of cholera include profuse watery diarrhea, nausea, vomiting, lethargy, and more. This all leads to dehydration and complications if not treated with fluids promptly. Oral rehydration salts include electrolytes to help rehydrate people quickly.

Children are more likely to come down with cholera than adults, especially those under 5 years old. They can become severely dehydrated from the diarrheal illness which can lead to shock and death.

How does cholera spread?

A cholera infection is caused by a bacteria spread by eating or drinking things contaminated with the feces of an infected person. Mass vaccination campaigns due to global health efforts in these countries are performed somewhat regularly to help control cholera outbreaks.

Treated water in factory-sealed bottles is usually clean water, but watch out for ice cubes which can be made with contaminated water. Follow safe food habits like eating hot meals and avoiding produce that cannot be peeled.

About Vaxchora, the oral cholera vaccine

Vaxchora is an oral cholera vaccine administered in a few ounces of water to people aged 2-64 years old. Vaxchora may also be shed in the stool of those vaccinated for at least a week, so those living with immunocompromised individuals should be careful and wash their hands thoroughly after using the restroom and before preparing food for at least 2 weeks.

The vaccine should be taken at least 10 days before travel to ensure adequate protection against cholera. People should wait 60 minutes after eating and drinking to take the cholera vaccine, then wait another 60 minutes before eating or drinking.

Patients taking immunosuppressive medications like steroids may have a reduced immune response to Vaxchora. They will also be at increased risk of contracting cholera due to their dampened immune system. Vaxchora demonstrated 90% effectiveness at day 10 post vaccination at preventing moderate to severe diarrhea and by 80% a few months after vaccination. It has not been studied how long protection lasts beyond 3-6 months.

Who is at risk for contracting cholera?

Cholera is found in some African, Middle Eastern, and Asian countries. The only country in the Americas with reported cholera cases is Haiti. Travelers to these developing countries should be careful with their food and drink choices due to ongoing cholera outbreaks.

Africa: Burundi, Cameroon, Democratic Republic of the Congo, Ethiopia, Kenya, Malawi, Mozambique, Niger, Nigeria, Somalia, South Sudan, Tanzania, and Zambia.

Asia: Afghanistan, Bangladesh, India, Nepal, Pakistan, Philippines

Middle East: Iraq, Lebanon, Syria, Yemen

Are there any risks with cholera vaccination?

Tiredness, headache, abdominal pain, nausea, vomiting, lack of appetite, and diarrhea are some common side effects reported with the cholera vaccine.

As with most vaccinations, there is always a small chance of severe allergic reactions and death. Vaccine availability has been variable due to supply chain and demand fluctuations, but should be returning in May 2023.

How can cholera be prevented?

Prevent cholera by eating hot foods and avoiding produce that cannot be peeled. Contaminated food is the most likely cause if you drink bottled water or canned beverages. Lettuce cannot be washed easily, so your risk of cholera is higher eating a salad than an orange where the outer skin can be peeled.

Fecal matter can cause many other kinds of diseases besides cholera, so it is important to have clean hygiene habits and be aware of the water precautions in the country.

History of the oral cholera vaccine

Oral cholera vaccination was first developed in the late 19th century by the Germans. It was made of killed bacteria, but it was limited in how well it could prevent cholera. Other cholera vaccines are available in countries with cholera epidemics, but only one is available in the U.S.

The only vaccine currently approved in the United States for cholera is Vaxchora. It is mixed with a few ounces of water and given an hour before eating. It is available to those aged 2-64 years old. Cholera vaccination has not been studied in those aged 65 and older.