Cholera is a bacterial disease characterized by severe diarrhea. Without proper treatment where lost fluids and electrolytes are replenished, an infected person may die within a few hours from the onset of the diarrhea.
Cholera is endemic in roughly 50 countries world-wide, and most of these countries are located in Africa or South-East Asia. There are also countries in Central America and the Caribbean where cholera is endemic. Even within the endemic countries, cholera epidemics will typically only occur after a natural disaster or similar disruptive event.
In the United Kingdom, vaccination against cholera is generally only recommended for travelers to areas where cholera is widespread. Vaccination against cholera is especially important if getting adequate health care at the location would be difficult.
The cholera vaccine rarely provides 100% protection against cholera and is not a substitute for proper food and water hygiene precautions. The vaccine will decrease, not eliminate, the risk of becoming ill.
A note about the Dominican Republic
The Dominican Republic is a popular vacation destination for European travelers. While cholera is not endemic to the Dominican Republic, this country is located on the same Caribbean island as Haiti. After the major earthquake in Haiti in 2010, a cholera epidemic occurred, with the culprit being a strain of cholera of Southeast Asian origin. The USA Center for Disease Control (CDC) has warned that cholera is likely to remain in Haiti for the foreseeable future and cause sporadic local outbreaks. There was for instance a spike in cases after the rainy season of 2015.
Vaccination against cholera
Where?
In the United Kingdom, you can usually get the cholera vaccine from your GP or from the practice nurse at your GP surgery. Specialist travel clinics also have the vaccine.
Cost
The cholera vaccine is usually available on the NHS, but this can vary. Your GP may charge for travel vaccinations. Even if you have to pay, getting the cholera vaccine through your GP is usually cheaper than getting it from a private travel clinic.
How?
Drinkable cholera vaccines are available, such as Dukoral (made by the Swedish company SBL Vaccin AB) and ShanChol (made by the Indian company Shanta Biotechnics Limited). It’s important to follow the recommendations provided by the manufacturer.
Injectable cholera vaccines are also available, but they have decreased in popularity in the United Kingdom after the introduction of drinkable cholera vaccines.
Recommendations for the Dukoral vaccine
- This vaccine is taken in two doses. The second dose should be taken at a minimum of one week and a maximum of six weeks after the first dose.
- Ideally take the second dose at least one week before you need protection against cholera. For extra security, take the second dose at least three weeks before you need protection against cholera.
- To remain protected, take a booster dose within 2 years of the second dose. You will then need a new booster dose every second year to remain protected.
- Dukoral can be used from the age of 2. Children aged 2 – 6 years are given three doses instead of just two. There should be a minimum of 1 week and a maximum of 6 weeks between each dose. To keep the child protected, a fourth dose should be given within 6 months of the third dose.
Examples of common Dukoral side effects
- Headache
- Mild diarrhea
- Stomach ache
- Flatulence
Examples of very rare Dukoral side effects
- Fever
- Fatigue
- Dizziness
- Nausea
- Vomiting
- Severe diarrhea
- Loss of appetite
- Decreased sense of taste
- Nose irritation
- Sore throat
- Coughing
- Skin rash
- Itchy skin
- Joint pain
- Numbness
- Increased sweating
- Swollen lymph glands
- Difficulty sleeping
- High blood pressure
- Allergic reaction with swelling and difficulty breathing
Dukoral warnings
- Don’t take Dukoral if you are allergic to formaldehyde.
- Dukoral contains approximately 1,1 grams of sodium per dose.
- Don’t take Dukoral if you have a fever.
- Don’t take Dukoral if you’re stomach is upset.
- If you have a weakened immune system, tell your prescribing doctor before using Dukoral. You need an individual assessment of the suitability of this cholera vaccine for you.
- Being pregnant or planning to get pregnant soon will usually not preclude Dukoral use. However, you should discuss it with your prescribing medical professional to get an individual assessment.
- A breastfeeding woman should be individually assessed by a medical professional before using Dukoral. Breastfeeding will usually not preclude Dukoral use.
About cholera
Cholera is caused by a bacteria named Vibrio cholerae. This bacteria can survive in both fresh water and brackish water. An infected person sheds cholera bacteria in their feces. Cholera outbreaks are usually caused by contamination of water sources, and only to a lesser extent promulgated by more direct forms of fecal-oral route transmission from one person to another.
A small amount of infected water can infect you with Cholera. I therefore recommend that you refrain from brushing your teeth in areas where Cholera is common unless you have access to bottled water. Refraining from brushing your teeth for a couple of days while on vacation will not damage your teeth.
Avoiding infected water is especially important if you have gum disease or if you recently bleached your teeth. Tandblekning.me recommended (Dead website) that you avoid bleaching your teeth during the last week before you go on a vacation and during the first 3 days after you come home from one. This is to allow the mucous membranes time to recover before you leave. You will suffer a higher risk of infection if your mucous membranes are damaged during your vacation. This is due to the fact that they play an important role in your immune system since they help keep bacteria out of your body.
Symptoms
The incubation period for cholera is usually 2-5 days, but can be as short as a few hours.
A person needs to be infected with a fairly large number of cholera bacteria to develop symptoms. Being infected with a small number of cholera bacteria will normally cause no symptoms or only mild symptoms. If your gastric acid isn’t sufficiently plentiful and acidic, you will have an increased risk of getting sick if you are exposed to cholera bacteria.
The most significant symptom of cholera is a watery diarrhea that looks like rice water. An infected person can lose over 20 liters of fluid per 24 hour period. If fluids and electrolytes aren’t replenished, severe dehydration can set in with high pulse, low blood pressure, acute kidney failure, muscle cramps, coma and circulatory collapse. Death can occur within a few hours after the onset of diarrhea
Severe thirst, dry mucous membranes and a loss of skin elasticity are early warning signs of dehydration.
Treatment
- Replenish fluids, sugar and electrolytes. If drinking isn’t enough, fluids can be given intravenously.
- Antibiotics (although antibiotic resistance is becoming a problem)
- Children can benefit from zinc supplements.
