Reviewed by a GPhC-registered Pharmacist at Newdays Pharmacy
Quick Answer: Cholera is a severe diarrhoeal disease caused by the bacterium Vibrio cholerae and transmitted through contaminated water and food. The cholera vaccine available in the UK, Dukoral, is an oral vaccine taken as a drink. It is not routinely recommended for most holiday travellers but is advised for travellers to active cholera outbreak areas, humanitarian workers, and those in high-risk settings. Dukoral also provides some cross-protection against enterotoxigenic Escherichia coli (ETEC), the most common cause of traveller’s diarrhoea.
What Is Cholera?
Cholera is a potentially life-threatening acute diarrhoeal illness caused by the bacterium Vibrio cholerae, transmitted through water or food contaminated with faeces from an infected person. The illness is characterised by sudden onset of profuse watery diarrhoea (classically described as ‘rice-water stools’), vomiting, and rapid dehydration. Without prompt treatment, severe cholera can be fatal within hours. With prompt oral rehydration therapy, the majority of cases recover fully.
Cholera is most prevalent in areas with poor sanitation, inadequate water treatment, and limited access to healthcare, including parts of sub-Saharan Africa, South Asia, and Central America.
The Cholera Vaccine: Dukoral
The only cholera vaccine licensed in the UK is Dukoral (WC-rBS oral cholera vaccine), manufactured by Valneva. It is taken by mouth as a drink, not as an injection. Dukoral contains killed whole cells of Vibrio cholerae and a recombinant cholera toxin B subunit (CTB).
The B subunit of cholera toxin is structurally similar to the toxin produced by enterotoxigenic Escherichia coli (ETEC), which means Dukoral also provides approximately 60 percent cross-protection against ETEC for approximately three months. ETEC is the most common bacterial cause of traveller’s diarrhoea worldwide.
How Is Dukoral Taken?
Dukoral is an oral vaccine mixed with a bicarbonate buffer solution before drinking. The dosing schedule is:
- Primary course for adults and children aged six and over: Two doses taken one to six weeks apart. The second dose should be completed at least one week before potential cholera exposure.
- Primary course for children aged two to five: Three doses taken one to six weeks apart.
- Booster: A single booster dose is recommended after two years for adults and children aged six and over, or after six months for children aged two to five, if continued protection is required.
Do not eat or drink anything (including other medicines) for one hour before and one hour after taking each dose.
Who Should Consider the Cholera Vaccine?
Dukoral is recommended for:
- Aid workers, healthcare workers, and humanitarian responders travelling to areas with active cholera outbreaks
- Travellers visiting refugee camps, disaster relief areas, or other humanitarian crisis settings
- Travellers to areas with an active cholera outbreak (as reported by the WHO or UKHSA)
- Some adventure travellers visiting remote areas with very limited access to safe water and sanitation in high-risk countries
It is not routinely recommended for standard tourist travel to stable destinations, even in cholera-endemic regions, as safe food and water practices are the primary protective measure for most travellers.
How Effective Is Dukoral Against Cholera?
In clinical trials in endemic populations, Dukoral provided approximately 85 percent protection against cholera during the first six months after vaccination. Protection declines over time. The vaccine is most effective against the El Tor biotype of Vibrio cholerae O1, the strain responsible for the current global pandemic.
How Effective Is Dukoral Against Traveller’s Diarrhoea?
Dukoral provides approximately 60 percent protection against traveller’s diarrhoea caused by ETEC for approximately three months after the primary course. This is not sufficient to recommend it as a routine traveller’s diarrhoea vaccine for all travellers, but it adds meaningful value for those already requiring it for cholera prevention or for travellers at particularly high risk of ETEC diarrhoea.
Get the Cholera Vaccine at Newdays Pharmacy
Newdays Pharmacy can supply and administer Dukoral oral cholera vaccine at our travel health clinic branches in Eton (Windsor) and Twyford. Our travel health pharmacists will assess whether Dukoral is appropriate for your specific itinerary and provide comprehensive pre-travel advice.
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Clinical Disclaimer: This article is intended for general information only and does not constitute medical advice. Always consult a qualified healthcare professional before starting any treatment or medication. Information is accurate as of the date of publication and reviewed by a GPhC-registered pharmacist.
Frequently Asked Questions
Cholera is endemic in parts of South Asia, but Dukoral is not routinely recommended for standard tourist travel. Strict food and water hygiene is the most important prevention measure. Dukoral may be considered for travellers with significant risk factors or those visiting humanitarian settings. Your travel health pharmacist will advise.
Dukoral can generally be given at the same time as other travel vaccines. It should not be taken in the same hour as other oral medicines or food. Always inform your pharmacist of all medicines you are taking.