Cholera vaccine

Cholera is a severe diarrhoeal illness caused by Vibrio cholerae bacteria. It leads to sudden watery diarrhoea and vomiting which can cause dehydration. If left untreated, over 50% of people with the most severe cases die within a few hours of the symptoms developing.   

As of 1 February 2023, at least 18 countries continue to report cases of cholera, and the World Health Organization expect this number to increase due to the ongoing humanitarian crises and a lack of sanitation in some countries. Preventing cholera involves improving sanitation and hygiene, though vaccines can offer some protection. 

In the UK, Dukoral is the only cholera vaccine available. It is an oral vaccine containing inactivated (killed) cholera toxin and cholera bacteria which is mixed with a buffer (that keeps the vaccine at a similar pH to the body) and water. 

Alongside Dukoral, another vaccine, Euvichol, is prequalified by the World Health Organization, meaning that it has met the WHO criteria for quality, safety and efficacy of medicinal products. Euvichol is often used as part of mass vaccination campaigns. So far, over 20 million doses of oral cholera vaccines have been used as part of mass campaigns, mostly in areas where the disease is endemic, or in areas facing humanitarian crises.  

Previously, a cholera vaccine called Shanchol was also available, but production of this stopped in 2023. SAGE, the Scientific Advisory Group for Emergencies asked that new approaches be explored for increasing vaccine supply. Other vaccines are under development, such as Hillchol and Euvichol-S.  

In the UK, the cholera vaccine Dukoral is only given to individuals who are at the highest risk of cholera, as the risk to general travellers is relatively low. These people include;  

• Humanitarian or aid workers travelling to an at-risk area 

• Travellers to areas with potential cholera risk 

• People who work in laboratories who may regularly be exposed to cholera as part of their work.  

For adults and children over six years of age, two doses are given. The second dose is given between one and six weeks after the first dose. A third booster dose should be given two years after completing the primary course for continuous protection.   

For children aged two to six years, three doses are given. The second dose is given between one and six weeks after the first dose, and the third is given another one to six weeks after the second dose. For continuous protection, a fourth booster dose should be given six months after completing the primary course. If it has been more than six weeks between doses, the primary immunisation course should be restarted.  

Like all medicines, Dukoral, the vaccine used in the UK, can cause side effects, although not everybody gets them.  
Uncommon side effects, affecting up to 1 in 100 people: 

• Diarrhoea 

• Stomach pain, cramps, gurgling, bloating, gas, or general stomach discomfort 

• Headache  

Rare side effects, affecting up to 1 in 1,000 people: 

• Fever 

• Generally feeling unwell or dizzy 

• Nausea or vomiting 

• Loss of appetite  

• Swelling/irritation inside the nose  

• A cough  

Very rare side effects (may affect up to 1 in a 10,000 people)  

• Rash  

• Sore throat  

• Reduced sense of taste  

• Fatigue/feeling tired 

• Sweating or shivering 

• Joint pain  

• Difficulty in sleeping  

Other side effects 

• Flu-like symptoms 

• Chestiness  

• Chills 

• General pain or weakness 

• Hives or itching 

• Swelling of the lymph glands 

• Numbness or pins and needles  

• High blood pressure  

Contact a doctor immediately if you experience the following serious side effects:  

• severe diarrhoea with loss of water from the body 

• serious allergic reactions causing swelling of the face or throat and breathlessness  

The above side effects are only relevant to the Dukoral vaccine. If you are outside of the UK, check with your healthcare provider to see which vaccine you received.  

Other than the active ingredients, the other ingredients in the Dukoral suspension (the liquid formulation of the vaccine) are: 

• sodium dihydrogen phosphate  

• disodium hydrogen phosphate  

• sodium chloride 

• water for injections.  

The effervescent powder (powder dissolved in a specified amount of water to create a fizzy solution) contains: 

• sodium hydrogen carbonate  

• citric acid  

• sodium carbonate  

• saccharin sodium  

• sodium citrate 

• raspberry flavouring.  

Cholera – the forgotten pandemic