Cholera Vaccine

Cholera is an intestinal infection caused by the bacterium Vibrio cholerae. Like typhoid fever, cholera is contracted by eating or drinking food and water that has been contaminated by feces.

The infection is spread through poor sanitation systems, and caused millions of deaths worldwide prior to the industrial revolution. There continue to be millions of cases of cholera each year, however there are a number of precautions and an oral vaccine travellers can take to mitigate the risk of infection.

Cholera is often accompanied by travellers’ diarrhea, a common problem caused by E-coli contaminated food. During a two week vacation, it is predicted that 50% of people may experience an episode of travellers’ diarrhea. The symptoms, treatment, and protection against travellers’ diarrhea are the same as those of cholera.

The symptoms of cholera include watery diarrhea, vomiting, and rapid dehydration. It can take a few hours to up to five days before the infection causes symptoms. Cholera can be fatal if not treated, and it is recommended that travellers seek immediate medical attention and drink fluids containing oral rehydration salts if cholera is suspected. Antibiotics can be taken to shorten the duration of the infection.

Dukoral is the cholera vaccination currently recommended for Canadian travellers. The vaccine is administered orally in two doses: one taken up to six weeks prior to departure and the second taken at least one week before the trip. It will provide protection one week after immunization and is effective in up to 85% of cholera cases and 25% of travellers’ diarrhea cases.

The vaccination will protect against travellers’ diarrhea for up to three months and from cholera infection for up to two years. A single booster dose every three months is recommended for travellers staying in an at-risk destination for a longer time period.

The Public Health Agency of Canada (PHAC) recommends oral vaccination for those at high risk of contracting the infection, including NGO employees, healthcare professionals, and expats living in high risk areas.

Cholera is a completely preventable disease. In addition to Dukoral, PHAC has a comprehensive list on safe eating and drinking practices. They include:

• Eat raw vegetables only when you have prepared them yourself, having peeled them and given them a thorough wash with safe drinking water
• Avoid salads or raw foods made with fresh produce
• Ask for drinks without ice, as the water used in the cubes may be contaminated
• Eat foods only when they are served hot and cooked well
• Brush your teeth with drinking-safe water
• Boil your water, use a chemical disinfectant, or treat your water with an ultraviolet light

Cholera is still a public health threat in sub-Saharan Africa, Southeast Asia, and Haiti. A lack of water sanitation and sewage processing facilities has led to ongoing cases in these regions. Natural disasters, such as the 2010 earthquake in Haiti, have not helped in the eradication of the infection, and cholera quickly spread through the population following that event.

Time of travel plays a role, too, and there may be an increased risk of cholera transmission during seasonal heavy rainfalls.

The PHAC and World Health Organization have issued a number of travel health notices for regions with recurrent cholera outbreaks. Extra precaution should be taken when travelling to the following locations:

• Haiti : The country has been experiencing a cholera epidemic since 2010. Unfortunately, the number of cases continues to rise, and in 2015 Haiti reported more than 20,000 new cases of the infection.
• Dominican Republic : Haiti’s next door neighbour has been experiencing similar outbreaks of the infection. In 2015, the Dominican Republic reported more than 350 cases, an increase from the previous year.
• Cuba : Isolated cases of cholera have been reported in the province of Holguín. In early 2015 a Canadian traveller contracted the infection during a trip to the region.
• Tanzania : The East African country experienced a cholera outbreak in 2015 which affected 13 regions in the country, including the popular tourist destinations of Dar es Salaam and Zanzibar. The country reported more than 4,800 cases during the year.

While cholera is a serious risk around the world, there are many precautions that can be taken to avoid contraction. Most Canadian travellers following a standard tourist itinerary will be at minimal risk. To discuss precautions and oral vaccination, contact your Passport Health Travel Medicine Specialist today.