Usage
- Cholera vaccines are indicated for active immunization against disease caused by Vibrio cholerae serogroup O1 in adults and children.
- Pharmacological classification: Active bacterial vaccine.
- The vaccine induces an immune response, creating antibodies against V. cholerae, protecting against cholera infection.
Alternate Names
- Dukoral, Shanchol, Euvichol, Vaxchora are brand names for different cholera vaccines.
How It Works
- Pharmacodynamics: Cholera vaccines stimulate an immune response, leading to the production of antibodies specifically targeting V. cholerae O1. These antibodies bind to the bacteria in the intestines, preventing them from attaching to the intestinal wall and reducing the likelihood of developing cholera.
- Pharmacokinetics: The oral cholera vaccine is not absorbed systemically. The vaccine strain may be shed in the stool for up to 7 days after vaccination.
- Mode of action: The vaccine introduces inactivated or attenuated V. cholerae into the body, which is recognized as foreign by the immune system. This triggers the production of antibodies against V. cholerae, providing immunity against future infection by the bacteria.
Dosage
Standard Dosage
Adults:
- Dukoral/Vaxchora: Two doses, each containing the reconstituted vaccine and buffer, are administered orally, at least one week apart but not exceeding six weeks. For Vaxchora, the dose is 100 mL.
- Shanchol/Euvichol: Two doses of 1.5 mL are administered orally, at least two weeks apart.
- A single dose may be given in outbreak situations.
Children:
- Dukoral: Children aged 2 to 6 years receive three doses; children over 6 years receive two doses, each containing reconstituted vaccine and buffer, at least one week apart but not exceeding six weeks.
- Shanchol/Euvichol: Two doses of 1.5 mL, at least two weeks apart, are administered orally for children 1 year and older.
- Vaxchora: Children aged 2-6 years receive 50 mL; children over 6 years receive 100 mL, as a single dose. Safety and efficacy haven’t been established for children under two years with Vaxchora.
Special Cases:
- Elderly Patients: Dukoral and Shanchol/Euvichol are safe for use in adults, but Vaxchora is only approved up to age 64.
- Patients with Renal/Hepatic Impairment: Dose adjustments are not typically required.
- Patients with Comorbid Conditions: The vaccine can generally be given unless a specific contraindication exists.
Side Effects
Common Side Effects
- Tiredness, headache, abdominal pain, nausea, vomiting, loss of appetite, and diarrhea.
Rare but Serious Side Effects
- Severe allergic reactions (anaphylaxis) are rare but possible with any vaccine.
Contraindications
- History of severe allergic reaction to any component of the cholera vaccine or a previous dose of any cholera vaccine.
- Moderate or severe illness (vaccination should be postponed until recovery).
Drug Interactions
- Immunosuppressants (e.g., corticosteroids, chemotherapy) may reduce the vaccine’s effectiveness.
- Oral or injected antibiotics should be avoided during vaccination and for at least 14 days prior to receiving the live attenuated cholera vaccine.
- Antimalarial medications (e.g., chloroquine) may reduce the effectiveness of the live cholera vaccine. Chloroquine should be taken at least 10 days after cholera vaccination, and the cholera vaccine should be taken at least 10 days before chloroquine treatment.
Pregnancy and Breastfeeding
- Cholera vaccination is not routinely recommended during pregnancy or breastfeeding unless the risk of cholera infection outweighs the potential, albeit unknown, risks to the fetus or infant.
- Limited data suggest no harmful effects, and the oral vaccine is not systemically absorbed. However, the vaccine strain might be shed in stool, posing a theoretical risk of transmission.
Drug Profile Summary
- Mechanism of Action: Stimulates an immune response producing antibodies against V. cholerae.
- Side Effects: Headache, tiredness, nausea, vomiting, abdominal pain, diarrhea, loss of appetite. Rarely, severe allergic reaction.
- Contraindications: Hypersensitivity to vaccine components, moderate/severe illness.
- Drug Interactions: Immunosuppressants, antibiotics, antimalarials.
- Pregnancy & Breastfeeding: Not routinely recommended unless benefit outweighs risk.
- Dosage: See detailed section above.
- Monitoring Parameters: Observe for any allergic reactions.
Precautions
- General Precautions: Screen for contraindications and allergies.
- Pregnant Women: Assess risk/benefit carefully if considering vaccination.
- Breastfeeding Mothers: Assess risk/benefit carefully if considering vaccination.
- Children & Elderly: Follow age-specific dosing recommendations.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cholera Vaccine?
A: See detailed dosage section above.
Q2: How long does protection from the cholera vaccine last?
A: Protection can last up to two years after the primary series (and up to 5 years according to some sources), but boosters may be needed for continued risk.
Q3: Can pregnant or breastfeeding women receive the cholera vaccine?
A: Not routinely recommended, but may be considered if the risk of cholera is high.
Q4: What are the common side effects of the cholera vaccine?
A: Common side effects include headache, tiredness, nausea, vomiting, abdominal pain, diarrhea, and loss of appetite.
Q5: Are there any drug interactions I should be aware of with the cholera vaccine?
A: Yes, avoid concurrent use of immunosuppressants, antibiotics, and certain antimalarials. See drug interaction section for details.
Q6: How is the cholera vaccine administered?
A: It is administered orally as a liquid suspension or after reconstitution with buffer. Do not inject.
Q7: What should patients do in addition to getting vaccinated?
A: Patients should maintain good hand hygiene and take precautions with food and water intake, especially in areas with poor sanitation.
Q8: When should the vaccine be administered before potential exposure?
A: Complete the vaccination course at least one week (10 days for Vaxchora) before potential exposure to V. cholerae.
Q9: Are there different types of cholera vaccines?
A: Yes, there are both live attenuated and inactivated oral cholera vaccines, each with different brand names, formulations, and dosage schedules. Dukoral, Shanchol, Euvichol, and Vaxchora are some examples.
