The live Cholera vaccine is recommended for the prevention of cholera in high-risk patients. It provides active immunization against disease caused by Vibrio cholera serogroup O1 in adults 18 through 64 years of age. Routine vaccination is recommended in the following group of patients according to the ACIP (Advisory Committee on Immunization Practices) guidelines:

• Adults from the US who are travelling to a region where cholera transmission is active, ages 18 to 64.

The vaccination has not been proven to be effective in patients with incomplete immunity who have already lived in endemic areas and do not prevent the active disease. It is different from the recombinant oral Cholera Vaccine (Dukoral).

Live Cholera vaccine dose in Adults

Live Cholera vaccine dose in Cholera prevention:

• A single 100 mL dose is given 10 days or more before a possible cholera exposure.

Live Cholera vaccine dose in Childrens

Not recommended for use in Children

Pregnancy Risk Factor C

• The vaccine has not been studied in pregnant females.
• However, the vaccine is not absorbed systemically and fetal exposure is unlikely.
• The neonate may be exposed to the vaccine following vaginal delivery as bacterial shedding may occur for a week or so following vaccination.
• Maternal cholera may lead to dehydration and severe fatal adverse fetal outcomes.

Cholera vaccine use during breastfeeding:

• Breastfeeding is compatible since the vaccine is not absorbed systemically.

Live Cholera vaccine dose in Kidney Disease:

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

Live Cholera vaccine dose in Liver Disease:

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

Common side effects of Cholera vaccine:

• Central nervous system

  • Fatigue
  • headache

• Gastrointestinal

  • Abdominal pain
  • Nausea
  • Vomiting

Less common side effects of Cholera Vaccine:

• Gastrointestinal

  • Diarrhea

Contraindication to the Live-attenuated Cholera Vaccine include:

• allergy to the vaccination, a formulation component, or a dosage of a previous cholera vaccine

Warnings & Precautions

• Anaphylactoid reactions may occur
• Do not take the vaccine in acute illness
• The ACIP (advisory council on immunisation practises) recommends administering all age-appropriate vaccines (live or inactivated) for which a person is eligible at a single clinic visit at the same time, at separate anatomic locations, on the same day [Ref].
• Live vaccines should generally be avoided in immunocompromised patients. These include patients receiving chemotherapy or radiotherapy, steroids or other immunomodulators).
• When possible, live attenuated vaccinations should not be given for at least 3 months following immunosuppressive medication.
• Following vaccination, bacterial shedding in the faeces may continue for 14 days or more. After handling meals and using the restroom, the recipient should properly wash their hands.

Monitor:

Not applicable

How to take the live-attenuated Cholera Vaccine?

• .For 60 minutes before and after consumption, avoid eating or drinking anything.
• 15 minutes after reconstitution, administer the vaccination.
• Drink the entire contents of the cup in one sitting, and then throw away any leftovers.

Mechanism of action of Live Cholera Vaccine: 

• Live, attenuated cholera bacteria are included in the cholera vaccine, and these bacteria reproduce in the recipient's digestive system to produce host protection.
• In one trial, the effectiveness of the live-attenuated cholera vaccine was 90.3% and 79.5% at 10 days and 3 months following immunisation, respectively.

The oral vaccine is not absorbed systemically and is excreted via feces

Live Cholera vaccine brand Names (Interantional):

• Shanchol

Live Cholera vaccine Brand Name in Pakistan: