Cholera
Cholera is a disease, characterised by profuse, watery diarrhoea, caused by certain toxin-producing forms of the bacteria called Vibrio cholera. Cholera is transmitted by ingesting (eating and drinking) contaminated water or food. It is common in many low-income countries and is largely linked to poverty, bad sanitation and poor access to clean drinking water.
The risk of cholera for most travellers is extremely low. Activities that may increase risk include drinking untreated water or eating poorly cooked food (particularly seafood) in areas where outbreaks are occurring. Travellers living in unsanitary conditions, including humanitarian workers in disaster/refugee areas, are also at risk.
Cholera can be mild or occur without symptoms in healthy individuals. Symptoms include sudden, profuse, watery diarrhoea with associated nausea and vomiting. If untreated, cholera can rapidly lead to serious dehydration and shock; fifty percent of those with serious complications, die. With quick and effective treatment, risk of dying is less than one percent.
Prevention
Travellers can reduce their risk of being ill from cholera by ensuring good personal hygiene and following advice on preventing food and water spread diseases.
Cholera vaccines
In the United Kingdom (UK) cholera vaccination is not recommended for most travellers. It is only advised for travellers whose activities or medical history put them at increased risk, including:
- aid workers
- those going to areas of cholera outbreaks who have limited access to safe water and medical care
- those for whom vaccination is considered potentially beneficial (i.e. for those who do not fit into the above groups, but are still considered at higher risk)
There are two cholera vaccines available in the UK: Dukoral® and Vaxchora®.
Dukoral® is an oral (drink), inactivated cholera vaccine that protects against V. cholerae serogroup O1.
Vaccine schedule (Dukoral)
| Age range | Schedule | Duration of protection |
| Adults and children from 6 years | Two doses with an interval of at least 1 week but less than 6 weeks between them* | 2 years |
| Age 2 to below 6 years | Three doses with an interval of at least 1 week but less than 6 weeks between them* | 6 months |
*If more than 6 weeks have elapsed between doses the primary course should be restarted. If more than 2 years (or 6 months for children aged 2 to below 6 years of age) has elapsed since the last dose of vaccine, the primary course should be repeated.
Further information about Dukoral® can be found in the Summary of Product Characteristics (SPC).
Vaxchora® is also an oral (drink) cholera vaccine that protects against V. cholerae serogroup O1.
Vaxchora® is a live vaccine (it contains live attenuated cholera bacteria) and is contraindicated for anyone who is immunosuppressed.
In the UK, it was given marketing authorisation (licensed) in 2020. The UK Joint Committee on Vaccination and Immunisation (JCVI) have agreed to include recommendations for use of Vaxchora® in an updated chapter of Immunisation against infectious disease (also known as 'the Green Book'), which will be published in due course.
Vaccine schedule (Vaxchora)
| Age range | Schedule | Duration of protection |
| Adults and children from 2 years of age** | A single oral dose should be administered at least 10 days prior to potential exposure to V. cholerae O1 | No data are available on revaccination interval |
**The safety and efficacy of Vaxchora® in children less than 2 years has not been established.
Further information about Vaxchora® can be found in the Summary of Product Characteristics (SPC).
Resources
- More detailed information can be found in our cholera factsheet
- UKHSA: Immunisation against infectious disease. Cholera
- UKHSA (previously Public Health England): Guidance. The diagnosis, management and epidemiology of cholera
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Recent News on Cholera
Cholera vaccine shortage: advice for health professionals
Cholera cases increase worldwide, with shortages of cholera vaccine reported
Updated: 05 March 2024Cholera: worldwide risk reminder
A reminder of the risks of cholera worldwide and the importance of good food, water and personal hygiene for all travellers
Updated: 22 June 2023Recent Cholera Outbreaks
Cholera in Brazil
On 19 April 2024, the first locally acquired cholera (Vibrio cholerae O1 Ogawa) case in Brazil since 2005 was confirmed. A resident of Salvador, presented with symptoms in March 2024 with no history of travel to risk countries or contact with suspected or confirmed cases. Cholera is rare in travellers, a vaccine is available for those who are at increased risk.
Cholera in Comoros
As of 14 April 2024, a total of 1,484 cholera cases, with 38 deaths (representing a 2.5% case mortality rate) have been reported since this cholera outbreak was declared on 2 February 2024. The three islands have reported cases, with most from Anjouan island.
Cholera in Zambia
As of 20 January 2024, the World Health Organization has reported rapid expansion of the cholera outbreak in Zambia. A total of 10,887 cases and 432 deaths have been reported since this outbreak started in October 2023. Cases have been reported in nine of the country's 10 provinces, with Lusaka, Central and Eastern worst affected and Lusaka district described as the outbreak epicentre.
Cholera in Zimbabwe
As of 10 January 2024, a total of 16,815 suspected cholera cases, 2,019 confirmed cases, 67 confirmed deaths and 308 suspected deaths have been reported. In the first week of January, a total of 1,473 new suspected cases were reported. All 10 provinces have reported cases, but three provinces (Harare, Manicaland, and Masvingo) account for approximately 90% of all reported cases.
