By Ethan Covey

The CDC Advisory Committee on Immunization Practices (ACIP) announced its final recommendation the use of a cholera vaccine in adults who will be traveling to areas where the infection exists (MMWR Morbid Mortal Week Rep 2017:66(18);482–485).

The FDA approved the lyophilized CVD 103-HgR single-dose live oral cholera vaccine (Vaxchora, PaxVax) in 2016, and it is the only cholera vaccine approved for use in the United States. The CDC recommends that all adults aged 18 to 64 years traveling to areas with active cholera transmission receive the vaccine.
The efficacy of the vaccine against severe diarrhea—defined as fecal output of more than 3 L in 24 hours—after oral toxigenic Vibrio cholerae O1 challenge is estimated to be 90% at 10 days after vaccination and 80% at three months after vaccination.

The ACIP work group included, among others, experts in travel medicine, immunology, infectious diseases, public health, immunization safety and vaccine policy. Its work reviewing the epidemiology and efficacy of the vaccine began in August 2015; the recommendations were presented in June 2016.

The vaccine is recommended for individuals traveling to certain countries in Africa, Asia and the Caribbean. “The countries affected by cholera are constantly changing, so it is important to talk to your doctor about your travel plans,” said Karen Wong, MD, a medical officer with the CDC’s Enteric Diseases Epidemiology Branch, and the lead author of the recommendations.

Dr. Wong noted that most U.S. travelers do not visit areas with active cholera transmission, and are rarely at risk. However, “all travelers going to areas with cholera should use and drink safe water, cook food thoroughly, and wash hands properly to prevent cholera infection and other diarrheal illnesses,” she said.
While cholera is rare, it can be deadly if untreated. “Talk to your doctor about your travel plans and discuss what vaccinations you should get, depending on where you are going and what you’ll be doing,” Dr. Wong said. “Travelers who develop severe diarrhea should seek medical attention, particularly therapy to restore lost fluids, as soon as possible.”