Clinical Update
Cholera Vaccine for Travelers

Please note: As of December 2020, the maker of the cholera vaccine will temporarily stop making and selling this vaccine. The cholera vaccine may be in limited supply or unavailable.

In November 2020, this document was updated to add one country and remove one country considered to have areas of active cholera transmission.

 

In June 2016, the US Food and Drug Administration approved a single-dose oral cholera vaccine (CVD 103-HgR, Vaxchora [Emergent BioSolutions]). The Advisory Committee on Immunization Practices voted to recommend cholera vaccine for adult (18–64 years) travelers to an area of toxigenic Vibrio cholerae O1 transmission. An area of active transmission is defined as an administrative subdivision where cases have been reported within the past year.

Cholera in travelers is extremely rare, and the vaccine is not routinely recommended for most travelers because most travelers do not visit areas of active transmission. Although still rare, cholera appears to be more common in travelers who are visiting friends and relatives and those performing humanitarian aid work in outbreak settings. These groups may have longer stays and limited access to safe food and water.

The key to cholera prevention is practicing food and water precautions and hand hygiene in areas with cholera outbreaks. Clinicians may consider a number of factors when assessing a traveler's risk, including:

  • Intensity of transmission at the traveler’s destination
  • Rarity of severe cholera in most travelers
  • Risk factors for exposure to cholera (for example, performing aid work in outbreak settings)
  • Risk factors for poor outcomes (for example, limited access to medical care, or medical conditions worsened by dehydration)
  • Traveler’s ability to adhere to food and water precautions
  • Availability of medical care (intravenous rehydration) at the destination

In clinical trials, CVD 103-HgR was 90% effective in preventing severe diarrhea after challenge with V. cholerae O1. Efficacy declined to 80% after 3 months. The need for a booster vaccination and the optimal timing of a booster are not yet known.

To determine areas of active transmission, CDC reviews surveillance data at least monthly. Based upon these data, CDC classifies each country as having “widespread,” “localized,” or “presumed” active cholera transmission, and updates these areas in the vaccine recommendation section on each country’s destination page.

Widespread transmission: Countries where where ≥50% of jurisdictions have reported cholera in the previous 12 months.

  • Vaccination may be considered for travelers to any part of the country

Localized transmission: Countries where <50% of jurisdictions have reported cholera in the previous 12 months

  • Vaccination may be considered only for travelers to affected jurisdictions.

Presumed transmission: Countries where there is no reliable surveillance information and presence is based upon expert opinion.

  • Vaccination may be considered for travelers to any part of the country.

CDC considers the following countries to have areas of active transmission.

*This list includes countries that 1) have current cholera outbreaks, 2) have reported >100 cases of cholera in the previous calendar year, or 3) have not reported cholera but where experts believe cholera exists. Cholera activity varies by location within each country:

For More Information

Cholera – Vibrio cholerae infection

Cholera (Yellow Book)

Vaxchora prescribing information

 

Page last reviewed: December 01, 2020
Content source: National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Division of Global Migration and Quarantine (DGMQ)