Cholera Vaccines

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Last reviewed
September 6, 2023
Content Overview
Cholera vaccines are FDA-approved but unavailable in the U.S. The Dukoral vaccine is available in various countries in 2023.

Cholera Vaccines 2023

The U.S. Food and Drug Administration (FDA), the European Medicine Agency (EMA), and the U.K. NHS recommend oral cholera vaccines (OCV) for specific conditions in outbreak countries in 2023. Vaccination against cholera is not generally recommended because most international travelers do not visit cholera outbreaks. As of September 5, 2023, 28 countries have reported cholera cases in 2023, according to the World Health Organization (WHO). Currently, there are three WHO pre-qualified OCVs: Dukoral®, Shanchol™, and Euvichol®. In August 2023, the U.S. Centers for Disease Control and Prevention (CDC) published Cholera Vaccine: Recommendations, highlighting CVD 103-HgR (Vaxchora) for travelers ages 2–64 years old going to areas of active toxigenic Vibrio cholerae O1 transmission.

Cholera Vaccine Availability 2023

The International Coordinating Group (ICG) for OCVs was created in 1997 to manage the global stockpile. Since its establishment until October 2022, the WHO, UNICEF, and Médecins sans Frontières have facilitated 73 million doses of OCV for 23 countries. The OCV worldwide supply in 2022 was 36 million doses. A global shortage of cholera vaccines continues as of September 2023. Since the start of 2023 and as of July 2023, a total of 49.9 million doses have been requested, of which 19.3 million (39%) have been approved for 11 countries, according to the WHO report #6. The available (not yet allocated) global OCV stockpile in July was 2.7 OCV million doses. In the current outbreak context, only one-dose courses have been validated and implemented in these reactive campaigns. Doses for preventive campaigns cannot be supplied due to the low global stockpile. Gavi, the Vaccine Alliance, published a roadmap on May 22, 2023, that outlines actions needed to ensure the supply of OCV can meet growing international demand. GAVI stated that its roadmap forecasts that OCV supply could meet the demand for preventive vaccination by 2026.

Cholera Vaccines WHO-Qualified

All OCVs require two doses for complete protection against cholera for up to three years, while a single dose provides short-term protection, says the WHO.

Dukoral® is administered with a buffer solution that, for adults, requires 150 ml of clean water. Dukoral can be given to all individuals over the age of 2 years. There must be at least seven days and no more than six weeks between each dose. Children aged 2-5 require a third dose.

Shanchol™ and Euvichol® are essentially the same vaccines produced by two different manufacturers. They are given to all individuals over the age of one year with a minimum of two weeks delay between each dose of these vaccines. Euvichol® is an oral vaccine jointly developed by Eubiologics and the International Vaccine Institute for cholera prevention. Euvichol obtained WHO Prequalification in 2015, and since starting to supply to UNICEF in 2016, the total cumulative supply of the vaccine as of 2022 has exceeded 100 million doses.

Vaxchora® was a U.S. FDA-approved live attenuated recombinant V. cholerae O1 Inaba Vaccine Strain CVD 103-HgR in June 2016. Unfortunately, in December 2020, the maker of Vaxchora® temporarily discontinued production. Therefore, Vaxchora is unavailable in the U.S. as of August 2023.

Cholera Outbreaks

Cholera outbreaks continue in 2023. The WHO African Region remains the most affected region, with 16 countries reporting cholera outbreaks since the beginning of the year.  

Cholera Vaccine News 2023

August 28, 2023 - The Republic of Kenya vaccinated about 1.6 million people with OCVs in August 2023.

August 4, 2023 - The WHO published a Multi-country cholera outbreak, External Situation Report #5.

June 1, 2023 - The WHO published a Multi-country cholera outbreak, External Situation Report #3.

May 15, 2023 - The WHO published a Multi-country cholera outbreak, External Situation Report #2.

March 22, 2023 - The WHO published - Multi-country Cholera Outbreaks, External Situation Report #1.

December 5, 2022 - The U.S. CDC published Travelers Returning to the U.S. with Cholera – Information and CDC Guidance for Healthcare Providers.

October 19, 2022 - The WHO Director-General stated four agencies decided to suspend the two-dose OCV vaccination strategy in favor of a one-dose approach so that more people receive some protection from limited stocks.