Dukoral Cholera Vaccine Instructions and Vaccination schedule is presented here. Dukoral is an oral cholera vaccine that is indicated in the following situations:

Dukoral Cholera Vaccine uses:

• It is used for active immunization against cholera in adults and children older than 2 years of age who plan to visit cholera-endemic areas and are at risk of contracting cholera caused by V. cholerae O1 classical and El Tor biotypes (Inaba and Ogawa serotypes)
• Dukoral Cholera Vaccine is also used for the prevention (active immunization) against travelers’ diarrhea in adults and children older than 2 years of age who plan to visit the developing and under-developed countries.
• It provides immunity against travelers’ diarrhea caused by enterotoxigenic E. coli that produces heat-labile enterotoxin(either heat-labile alone or both heat-labile and heat-stable enterotoxin together)

Dukoral Cholera Vaccine Instructions - Dosage in adults:

Cholera Vaccine Dose in the treatment of Cholera:

• Primary immunization:
  • 2 doses given orally at intervals of 1 week or more.
  • Both the doses should be administered at least one week prior to the trip to endemic areas.
  • If the interval between the doses is more than six weeks, the vaccination schedule should be restarted.
• Booster:
  • One booster dose is recommended in 2 - 5 years since the last dose.
  • The primary immunization schedule should be repeated if more than five years have passed.
  • Patients with ongoing risk of cholera, one booster dose should be administered every two yearly.

Cholera Vaccine Dose in the treatment of ETEC diarrhea:

• Primary immunization:
  • 2 doses given orally at intervals of 1 week or more.
  • Both the doses should be administered at least one week prior to the trip to endemic areas.
  • If the interval between the doses is more than six weeks, the vaccination schedule should be restarted.
• Cholera Vaccine Booster Dose:
  • One booster dose is recommended in 1 month to 5 years since the last dose.
  • The primary immunization schedule should be repeated if more than five years have passed.
  • Patients with ongoing risk of cholera, one booster dose should be administered every three months.

Dukoral Cholera Vaccine Instructions - Dosage in Children:

Cholera Vaccine Dose in the treatment of Cholera: 

• Primary immunization:
  • Children 2 years to less than 6 years:
    • Three doses are given at intervals of 1 week or more.
    • All the doses should be administered at least one week prior to the trip to endemic areas.
    • If the interval between the doses is more than six weeks, the vaccination schedule should be restarted.
  • Children older than 6 years of age:
    • Refer to adult dosing.
• Booster Dose of Cholera Vaccine:
  • Children 2 years to less than 6 years of age:
    • One booster dose is recommended in 6 months to 5 years since the last dose.
    • The primary immunization schedule should be repeated if more than five years have passed.
    • Patients with ongoing risk of cholera, one booster dose should be administered every six months.
  • Children 6 years and older:
    • Refer to adult dosing.

Cholera Vaccine Dosage for ETEC diarrhea: 

• Children older than 2 years of age:
  • Refer to adult dosing.

Pregnancy Risk Category: D

• Pregnant women should not use it as the safety and efficacy of this product are not known.
• Fetal risks are less likely if it acts in the gastrointestinal system.
• If the potential benefits are greater than the risks to the foetus, it may be given to pregnant women.

Travelers' diarrhea-cholera vaccine use during breastfeeding:

• The manufacturer states that it can be given to lactating mothers.   

Dosage in kidney disease:

The manufacturer has not recommended any adjustment in the dose in patients with kidney disease.   

Dosage in liver disease:

The manufacturer has not recommended any adjustment in the dose in patients with liver disease.   

Side effects of the Cholera Vaccine:

Mild febrile state and gastrointestinal upset may be noticed by the patient. Vaccine-associated GBS may occur.   

Dukoral Cholera Vaccine Instructions - Contraindications and warnings to Travelers’ diarrhea-cholera vaccine:

• It is possible to have severe allergic reactions to any component of the vaccine.
• Acute febrile illness, or acute gastrointestinal conditions.

Warnings and precautions

• Anaphylaxis or other Hypersensitivity reactions
  • It is possible to have severe allergic reactions.
  • It should only be administered in areas where anaphylactic reactions can be managed.
  • Epinephrine may be required for severe anaphylactic reactions.
• Acute illness:
  • It is contraindicated for acute febrile condition and other acute gastro conditions.
  • It can be administered to patients after two weeks, just like other vaccines.
  • It may be used for mild or moderate infections.
• Cholera infection:
  • It has not been proven to protect against infections caused by Vibrio cholerae serogroup O139 and other Vibrio species.
• HIV:
  • Patients who are HIV-positive may receive it.
  • It is effective in HIV patients at around 84%.

Monitoring Parameters: 

    No specific monitoring parameters are required.   

Dukoral Cholera Vaccine Instructions - How to administer?

• It is indicated for oral use only.
• Intramuscular, intravenous, and subQ administration should be avoided.
• Concomitant administration of Typhoid oral vaccine should be avoided.
• It may be administered eight hours after the cholera vaccine.
• Furthermore, oral administration of other medicines, vaccines, and food items should also be avoided within one hour of administering the vaccine.   

Mechanism of action of Dukoral (Travelers’ diarrhea-cholera vaccine):

• Dukoral Cholera vaccine kills V. cholerae O1 and recombinant Cholera toxin B (CTB).
• The ETEC toxin and the recombinant choleratoxin B component are physically and biologically related.
• The ETEC is also neutralized by antibodies that are formed against the recombinant subunit of choleratoxin B.
• The Dukoral Cholera vaccine instills immunity. Locally, the gastrointestinal tract produces IgA and antibacterial antibodies.
• This causes immunity to V. cholerae O1; classic and El Tor biotypes; Inaba, Ogawa serotypes), and ETEC.
• Within a week of vaccination, immunity against ETEC and Cholera develops.
• The immunity to ETEC lasts about three months, while the immunity to cholera lasts approximately 2 - 6 year after primary vaccination.
• It is different from the live-attenuated Cholera Vaccine.

International Brands of Travelers’ diarrhea-cholera vaccine:

• Dukoral

Brands of Travelers’ diarrhea-cholera vaccine in Pakistan:

Dukoral is not available in Pakistan.