Cholera vaccine shortage: advice for health professionals

Cholera cases increase worldwide, with shortages of cholera vaccine reported

An increase in cholera has been reported worldwide since 2022, with four regions: Africa, the Americas, Eastern Mediterranean and Southeast Asia all reporting an increase in outbreaks and geographic spread of cholera [1-3]. The World Health Organization has advised that the global response to this increase in cholera continues to be affected by a critical shortage of cholera vaccines [1].

Cholera is a potentially fatal, acute diarrhoeal disease caused by ingesting food or water contaminated with the bacterium Vibrio cholerae (V. cholerae). It is rarely reported in returning travellers to the United Kingdom (UK) [4, 5]. Cholera vaccines are available in the UK but are only recommended for certain travellers [5].

Vaccination against cholera can be considered, after a full risk assessment, for the following travellers:

• Relief or disaster aid workers.
• People with remote itineraries visiting areas where cholera epidemics are occurring and there is limited access to medical care.
• Travellers to potential cholera risk areas, for whom vaccination is considered potentially beneficial.

Cholera vaccine is also recommended for UK laboratory workers who may be exposed to cholera at work. This normally only includes those working in infectious diseases units or reference laboratories [5].

In the UK, an oral (drink) inactivated cholera vaccine called Dukoral® for the prevention of cholera can be offered to adults and children from the age of aged two years and protects against V. cholerae serogroup O1 [5, 6]. There is currently a shortage of Dukoral® vaccine in the UK. Since January 2023 there has been a critical shortage of oral cholera vaccines globally [1].

Vaxchora®, a live, oral cholera vaccine for the prevention of cholera in adults and children from the age of aged two years was given UK marketing authorisation (licensed) in 2020 [7, 8]. The UK Joint Committee on Vaccination and Immunisation (JCVI) have reviewed the product information and recommend the cholera chapter of the Green Book will be updated to include Vaxchora®. This update will be published in due course [9].

Advice for travellers

Before you travel

Check the risk of cholera for your destination using the TravelHealthPro website: country-specific information can be found on our Country Information pages and Outbreak Surveillance section.

If you think you are at increased risk, make an appointment with your GP, a travel clinic, or a pharmacy to discuss if a cholera vaccine is appropriate for you.

While you are away

Follow good food and water hygiene precautions and take care with your personal hygiene.

When you return

Get medical advice if you have returned from a country with cholera and you have:

• Severe watery diarrhoea and/or vomiting.
• Signs of dehydration like feeling very thirsty and/or dark yellow, strong-smelling urine (pee).

Remember- tell the health professional treating you that you visited a country with cholera.

Advice for health professionals

Health professionals should advise travellers about their destination specific risk of cholera according to TravelHealthPro Country Information pages. Travellers at higher risk include those who will be living or working in unsanitary conditions and drinking untreated water or eating raw or undercooked seafood, particularly shellfish, in endemic areas.

Cholera vaccine should be offered to those at increased risk of exposure; further information is available in our cholera factsheet.

Health professionals should be alert to the possibility of cholera in a returned traveller presenting with a severe watery diarrhoeal illness. Stool samples (or rectal swabs if stool not available) with full clinical and travel histories should be sent to their local microbiology laboratory for testing. Isolates of V. cholerae can be referred for typing by the microbiology laboratory to the UK Health Security Agency Gastrointestinal Bacterial Reference Unit (UKHSA GBRU).