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 two-dose vaccine; however, no vaccine for cholera is available in the United States.
- The disease
What is cholera?
Cholera is a bacterium (Vibrio cholera) 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 100,000 to 300,000 cases of cholera are reported to the World Health Organization, and about 5,000 to 7,500 people die from the disease.
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, 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 an interactive map from the World Health Organization (WHO). 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. Two cholera vaccines have been made; however, neither is commonly recommended. While both 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. No vaccine against cholera is available in the United States.
How is the cholera vaccine made?
One cholera vaccine is made by taking the whole cholera bacteria and killing (or inactivating) it with a chemical. The whole killed vaccine is given as a shot. Once injected into the body, the killed cholera bacteria cause an immune response against cholera, but, because the bacteria are killed, they don't cause the disease.
The other cholera vaccine is made by taking the bacteria and weakening it so that it can’t reproduce itself very well. The live weakened vaccine is given by mouth and also doesn’t cause disease.
Unfortunately, the cholera vaccine is only about 50 percent effective at preventing cholera in people who are exposed to the bacteria.
Does the cholera vaccine have side effects?
Side effects are generally mild and include pain or swelling in the area of the shot. Headache, fever and fatigue may also occur.
- 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, it is only about 50 to 60 percent effective, and 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.
- Diarrhea (five of 100 infected people)
- Severe diarrhea can lead to dehydration, shock and death
- Pain, redness and swelling at the injection site
- Headache, fever and fatigue
Plotkin SA, Orenstein W, and Offit PA. Cholera Vaccines in Vaccines, 6th Edition. 2012, 141-152.