Vaccination

Cholera

Vaccination against cholera cannot prevent the introduction and spread of the infection. The use of cholera vaccine to stem epidemics is controversial, because of its low-moderate efficacy against V. choleræ El Tor O1, and null efficacy against V. choleræ Bengal O139. These are the reasons why cholera vaccine shouldn´t be required as a condition for entry in any country.

Travellers are not at significant risk from cholera if they take basic personal hygiene procedures and simple precautions to avoid potentially contaminated food and water.  Nevertheless, vaccination against cholera may give some protection to those who are most at risk of serious illness or death, including travellers (adults and children from 2 years of age). Immunization against cholera can be considered for the following categories of traveller: a) relief or disaster aid workers, and b) persons with remote itineraries where cholera epidemicas are occuring and there is limited access to medical care.

Vaccination is recommended for laboratory workers who may be regularly exposed to cholera in the course of their work. The vaccine is not recommended for prevention of the "travellers' diarrhoea" (no matter its protection against the heat-labile toxin of enterotoxigenic Escherichia coli).

Currently, only the oral inactivated (killed) vaccine is available commercially: 2 doses for adults and children over 6 years of age, and 3 doses for children 2-6 years of age, with an interval of at least one week but less than six weeks. If more than six weeks have elapsed between doses, or if more than two years have elapsed since the last vaccination, the primary immunization course should be restarted (these recommendations are unique to this vaccine). Adults and children over 6 years of age should receive a single booster dose after two years, and children 2-6 years of age should reveive a booster six months after the completion of the primary course.

Important remarks:

- Food and drink should be avoided for one hour before and one hour after vaccination, as well as the oral administration of any medicinal products;

- There should be an interval of at least eight hours between the administration of the oral inactivated cholera and oral typhoid vaccines;

- The primary course of vaccination must be administered three weeks before departure;

- The vaccine should not be given during acute febrile diseases or acute intestinal infections, and if there is an history of hypersensitivity to a previous dose;

- There is not enough information on the use of inactivated oral cholera vaccines during pregnancy and breastfeeding.

Fernando Costa Silva, 1999 (last update: 2009)