The cholera vaccine is generally not required or recommended for travel anywhere in the world, with a few exceptions. For some traveling to a specific area within a particular country, local authorities may require that you receive the vaccine.

The disease

What is cholera?

Cholera is a bacterium (Vibrio cholerae) that attacks the intestines, causing diarrhea in about  five of every 100 people who are infected. Sometimes quite severe, the diarrhea and subsequent loss of fluids can cause people to go into shock and die.

What are the symptoms of cholera?

While many people with cholera do not experience symptoms or only have mild diarrhea, those with more severe disease become quickly dehydrated as a result of frequent diarrhea and vomiting. Because of the rapid loss of fluids, patients can experience complications such as mineral imbalances, kidney failure, and arterial blockages. Expectant mothers can experience premature delivery or miscarriage. In the absence of rehydration therapy, about four of every 10 people with severe disease die from the illness.

How common is cholera?

Each year about 3 million cases of cholera are reported worldwide, and about 95,000 people die from the disease. About half of the deaths around the world occur in Africa. The small number of cases that occur in the U.S. are typically the result of travel to  areas that have disease or from eating undercooked shellfish, such as crabs.

How do you catch cholera?

Cholera bacteria may be present in contaminated food, water or shellfish. Shellfish contain cholera for the same reason that they contain hepatitis A virus. Both cholera and hepatitis A viruses are found in water. Because shellfish filter hundreds of quarts of water each day in their search for food, they actually catch and concentrate cholera and hepatitis A viruses.

Travelers are generally at no risk of cholera if they stay "on the beaten path," use standard tourist accommodations, eat only cooked shellfish and cooked food, practice good hygiene and drink bottled water.

Where can you catch cholera?

Cholera is common in several countries or regions of the world. To learn more about where cholera is occurring, consult this map from the European Centre for Disease Prevention and Control. The World Health Organization offers additional information about cholera including information for travelers, outbreak information and statistics.

How can I protect myself and my family?

If you are traveling to a country where cholera is occurring, follow safe food and water precautions:

• Drink only treated water
• Do not consume raw or undercooked foods, especially seafood
• Practice diligent hand washing before eating and after using the bathroom

The vaccine

Is there a cholera vaccine?

Yes. A number of cholera vaccines have been made; however, vaccination is not commonly recommended. While the vaccines are safe, the risk of disease, even to travelers, is so minute and the immune response so short-lived that they are used infrequently. In 2016, Vaxchora^® was approved in the U.S. for adults 18 to 64 years of age traveling to cholera-affected areas.

How is the cholera vaccine made?

The vaccine, approved by the FDA in 2016, is made by taking the bacteria and weakening it so that it can’t reproduce itself very well. The live weakened vaccine is given as a single dose taken by mouth. It doesn’t cause disease. Two other oral vaccines have been made with inactivated bacteria, but these are not available in the U.S.

In trials, the newest vaccine protected recipients for up to three months. As with other vaccines, this one will continue to be studied as it is used in situations beyond those of controlled research studies.

Does the cholera vaccine have side effects?

People who receive the oral cholera vaccine may experience nausea, vomiting or diarrhea.

Other questions you might have

Why do I need a hepatitis A vaccine, but not a cholera vaccine, given that both can be transmitted in contaminated water and shellfish?

Unlike cholera, hepatitis A virus infections do occur in places with standard tourist accommodations. Also, it is easier and less expensive for countries to eliminate cholera bacteria from water than to eliminate hepatitis A virus from water.

Relative risks and benefits

Do the benefits of the cholera vaccine outweigh its risks?

Although the cholera vaccine does not have serious side effects, people traveling in developing countries are not at high risk of catching cholera if they stay in standard tourist accommodations. So, for most people, the cholera vaccine isn't necessary.

However, people traveling "off the beaten path" in countries where cholera is common and who also engage in high-risk activities such as eating raw or undercooked food (such as shellfish) or drinking unbottled water, should get the cholera vaccine — in these cases the vaccines’ benefits outweigh its risks.

Disease risks

• Diarrhea (five of 100 infected people)
• Severe diarrhea can lead to dehydration, shock and death

Vaccine risks

• Nausea or vomiting
• Diarrhea

Reference

Plotkin SA, Orenstein W, Offit PA, and Edwards KM. Cholera Vaccines in Vaccines, 7th Edition. 2018, 185-197.

Centers for Disease Control and Prevention. Cholera – Vibrio cholerae infection. May. 3, 2018