Cholera vaccine (live attenuated, oral)

How it works

The attenuated organism transiently colonises the gut and induces a mucosal and systemic antibody response against V. cholerae O1 without producing active cholera toxin.

Prescribing in practice

• As a live vaccine it should generally be avoided in significantly immunocompromised patients and in pregnancy unless the benefit clearly outweighs the risk.
• It is reconstituted with the supplied buffer and taken on an empty stomach, avoiding food and drink around the dose.
• Vaccine organisms can be shed in the stool for a period, so attention to hand hygiene reduces any theoretical transmission to close contacts, and it does not protect against the O139 serogroup.

Monitoring

No routine laboratory monitoring is required; observe for immediate hypersensitivity after dosing.

Counselling the patient

• Take the single dose on an empty stomach and avoid food and drink for the recommended period around it.
• Wash hands carefully after using the toilet for several days, and continue normal food and water precautions abroad.

Evidence & guidelines

Single-dose live attenuated oral cholera vaccine is supported by controlled human challenge and immunogenicity data summarised in its SPC and travel-health guidance.