Cholera: Caused by Vibrio cholerae serogroups O1 and O139, associated with poor sanitation, and primarily acquired from contaminated water or food. Severe cases can lead to life-threatening dehydration and shock.
Enterotoxigenic Escherichia coli (ETEC): Major cause of travellers' diarrhea, transmitted through contaminated food and water. Most episodes are mild and self-limited.
Vaccines Authorized for Use in Canada
DUKORAL®: Inactivated oral vaccine protecting against Vibrio cholerae O1 and ETEC. Administered in two doses for individuals 6 years and older, three doses for children 2 to 6 years.
VAXCHORA®: Live attenuated oral cholera vaccine (not yet reviewed by CATMAT).
Recommendations for Use
Cholera Protection: Recommended for travellers to endemic areas, especially humanitarian workers and healthcare providers.
Travellers' Diarrhea Protection: Limited benefit, not routinely recommended except for high-risk travellers (e.g., elite athletes, immunosuppressed individuals).
Vaccine Schedule
Cholera:
6 years and older: 2 doses orally, 1 to 6 weeks apart.
2 to less than 6 years: 3 doses orally, 1 to 6 weeks apart.
ETEC: 2 doses orally, 1 to 6 weeks apart.
Booster Doses:
Cholera: Every 6 months (2 to <6 years), every 2 years (6 years and older).
ETEC: Every 3 months.
Special Populations
Pregnancy and Breastfeeding: Consider only in high-risk situations (e.g., outbreaks).
Chronic Diseases: May be considered for those at increased risk of serious consequences from travellers' diarrhea.
Immunocompromised Persons: Vaccine may be used, though response may be suboptimal.
Administration Practices
Oral Administration: Avoid food and drink for 1 hour before and after vaccination. Separate administration from oral typhoid vaccine by at least 8 hours.
Safety and Adverse Events
Common Reactions: Abdominal pain, diarrhea, nausea, and vomiting, likely due to the bicarbonate buffer.
Serious Reactions: Rarely, anaphylaxis and other severe reactions.
