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Cholera is a bacterial infection found throughout the tropics. You can get infected by eating or drinking contaminated food and water. The cross-contamination comes from faeces in areas of poor hygiene and sanitation. You might be a risk if you visit refugee camps, help out with disaster relief, such as during floods, or visit friends and relatives in countries with cholera transmission. As a traveller, your risk is generally low. Activities that increase this risk include: drinking untreated water in high risk areas, eating poorly cooked food (especially seafood) in high risk areas, and living in areas of poor sanitation.
Cholera, what is it?
Cholera vaccination
We have an effective cholera vaccine that doesn't require an injection. You can take an oral vaccine that’s not only effective for cholera but also improves your gut immunity to protect you from some forms of travellers diarrhoea. Dukoral and Vaxchora are the two licensed vaccines in the UK.
The Cholera Vaccination is £49 per dose. If you’re travelling then there’ll be a Travel Consultation fee of £30 and the vaccine cost, however, you’re not travelling then it’s only the vaccination cost you pay for.
Cholera vaccine price
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The risk of getting cholera can be considerably reduced with the following food and water hygiene advice: Wash your hands regularly (especially after visiting the toilet, changing nappies and before preparing or eating food). If hand washing facilities are not available, then use alcohol gel instead. Make sure you drink from unopened, factory produced bottles and cans, which have an intact seal. Drinks made from boiled water and served hot (e.g. tea, coffee) can generally be safe too. Do not drink tap water, or use ice. If you cannot avoid this, then there are treatments that can be used to disinfect the water instead. Recently prepared, thoroughly cooked food served hot, fruit that you can peel yourself, and pasteurised dairy produce are good options for food. Avoid foods such as salads, uncooked fruit and vegetables, food left uncovered in warm places, unpasteurised dairy produce, raw meat and fish If you're unfortunate enough to get cholera then the most important measure is to make sure you're well hydrated. If you become very sick and can't take enough fluids then you might need hospital admission and possibly antibiotics.
Prevention
Before you travel you'll need to consider whether the cholera vaccine is appropriate for you, but active prevention is also important.
Cholera treatment
The cholera bacteria produces a unique toxin that reacts with your gut to produce diarrhoea. This is the key symptom of cholera infection and produces what's known as the ‘rice water’ stool. You might also experience nausea and vomiting and in combination with the very watery diarrhoea, you can end up being very dehydrated. If you're generally fit and well then the disease is often mild, but if you have an underlying medical condition, or you’re very young or elderly then cholera can be serious. The severe dehydration can be life-threatening and you may require hospitalisation to replenish your fluids with an intravenous drip.
Cholera symptoms
Cholera is caused by a toxin producing bacteria called Vibrio cholerae. It’s mainly common in areas of poor sanitation throughout the tropics
Cholera causes
The cholera vaccine is extremely well tolerated. You might experience mild abdominal cramps and possibly bloating but this is the exception rather than the norm.
Cholera vaccine side effects
Frequently asked questions
The cholera vaccine is relatively short-lived compared to other vaccines. Dukoral should give you protection for two years but Vaxchora is a new vaccine we are not sure how long it lasts (see cholera vaccine schedule above). Once you’ve had the primary course, you’ll have to start the whole course again if you travel to an affected area again after more than two years.
Cholera is present anywhere in the tropics, so this could be potentially any country but outbreaks often occur where there’s poverty, disaster events and poor sanitation infrastructure.
Countries often reporting cases include: Afghanistan, Cameroon, Democratic Republic of Congo, Ethiopia, Zimbabwe and Haiti.As an inactivated oral vaccine, Dukoral, can be given in pregnancy following a careful risk assessment by a specialist. Please be aware that Vaxchora, a live vaccine for cholera, should not be given during pregnancy.
When you book for your cholera vaccination don’t forget that you need to fast for 1 hour before and after each vaccine. Dukoral and Vaxchora are the two licensed vaccines in the UK.
Cholera has a relatively short incubation period of a few hours to 5 days before you develop symptoms.
Although cholera is spread through food and water, you’re unlikely to catch it with casual person to person contact.
Authors:
Dr Ravi Gowda, Consultant in Infectious Diseases and Travel Medicine
MBBS, MRCP(UK), DTM&H, MRCGP, DCH, DRCOG, DFFP
Caitlin Lancaster, BSc
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