Clinical Update
Cholera Vaccine for Travelers

In December 2020, the maker of the cholera vaccine, CVD 103-HgR, temporarily stopped making and selling this vaccine. Currently, CVD 103-HgR vaccine is in limited supply or unavailable.

Cholera Vaccine Information

In June 2016, the US Food and Drug Administration (FDA) approved the use of a single dose oral cholera vaccine (CVD 103-HgR, Vaxchora [PaxVax]) in adults, 18–64 years old. In clinical trials, CVD 103-HgR was 90% effective in preventing moderate or severe diarrhea in adults challenged with V. cholerae O1. Vaccine efficacy declined to 80% after 3 months.

In December 2020, based on results of vaccine effectiveness trials demonstrating comparable immune responses in children and adolescents as in adults1, 2, the FDA approved the use of single-dose oral cholera vaccine (CVD 103-HgR, Vaxchora [Emergent BioSolutions]) to children and adolescents aged 2–17 years.

The Advisory Committee on Immunization Practices (ACIP) recommends CVD 103-HgR vaccine for travelers 2–64 years old going to areas of toxigenic Vibrio cholerae O1 transmission. The Centers for Disease Control and Prevention (CDC) defines areas of active cholera transmission as administrative subdivisions where ≥100 cases have been reported within the past year.

The need for a booster vaccination and the optimal timing of a booster have not been established.

Areas of Active Cholera Transmission

CDC reviews cholera surveillance data monthly and then classifies countries as having “widespread,” “localized,” or “presumed” active cholera transmission. CDC updates cholera transmission information on this webpage and in the vaccine recommendations section of each country’s destination page.

CHOLERA TRANSMISSION LEVEL AT THE DESTINATION

DEFINITION

VACCINATION RECOMMENDATION

CHOLERA TRANSMISSION LEVEL AT THE DESTINATION

Widespread

DEFINITION

≥50% of jurisdictions have reported cholera in the previous 12 months

VACCINATION RECOMMENDATION

Consider vaccination for travelers going to any part of the country

CHOLERA TRANSMISSION LEVEL AT THE DESTINATION

Localized

DEFINITION

<50% of jurisdictions have reported cholera in the previous 12 months

VACCINATION RECOMMENDATION

Consider vaccination only for travelers going to affected jurisdictions

CHOLERA TRANSMISSION LEVEL AT THE DESTINATION

Presumed

DEFINITION

No reliable surveillance information exists; presence of disease is based upon expert opinion

Col 3 header

Consider vaccination for travelers going to any part of the country

CDC considers the following countries to have areas of active transmission.3

Assessing a Traveler’s Risk for Cholera Infection

Cholera in travelers is extremely rare.

Vaccination against cholera for travelers is not routinely recommended because most travelers do not visit areas of active transmission. Although rare, cholera infection can be more common among travelers who perform humanitarian aid work in outbreak settings and among those who visit friends and relatives. These groups may take longer trips and have limited access to safe food and water. In areas where there are cholera outbreaks, practicing food and water precautions and hand hygiene is critical for prevention.

When assessing a traveler's risk for infection and possible need for vaccination against cholera, clinicians should consider the following:

  • The rarity of cholera in most travelers
  • Intensity of transmission at the destination
  • Risk for exposure (e.g., performing aid work in outbreak settings)
  • Risk factors for poor outcomes (e.g., pre-existing medical conditions that would be worsened by dehydration)
  • Ability to adhere to food and water precautions
  • Availability of medical care (intravenous rehydration) at the destination

For More Information

1Safety and Immunogenicity of Live Oral Cholera Vaccine CVD 103-HgR in Children Aged 2–5 Years in the United States

2Safety and Immunogenicity of Live Oral Cholera Vaccine CVD 103-HgR in Children and Adolescents Aged 6–17 Years

3This list includes countries that 1) have current cholera outbreaks, 2) have reported >100 cases of cholera in the previous calendar year, or 3) have not reported cholera but where experts believe cholera exists. Cholera activity varies by location within each country.