Preventing cholera through vaccination

Although cholera isn't prevalent in Australia, with only about two to six cases a year, it remains a notifiable and quarantine-necessary disease in all Australian states and territories.

In Australia the risk of infection has been estimated at 0.2 cases per 100,000 travellers from western countries. Though there is a vaccine for cholera, it offers limited immunity and the jury is out about whether or not travellers should be vaccinated.

While some doctors recommend it, others doubt its efficacy and suggest that travellers should rather take precautions by taking healthy food and drinking water.

According to the Australian Immunisation Handbook, "vaccination against cholera isn't an official requirement for entry into any foreign country and routine cholera vaccination isn't recommended as the risk to travellers is very low, despite the endemicity of cholera in some countries often visited by Australians".

During cholera epidemics, vaccination isn't effective and the best way to tackle the disease is to educate the community on how to make water and food safe and use proper sanitation, or to provide clean water.

What vaccine is available?
In Australia, the vaccine available for cholera is Dukoral, which is administered in a 3.0ml liquid vaccine dose.

• In children between two and six years, three doses are required, given up to six weeks apart.
• In children over six years, and in adults, two doses are required, given a minimum of up to six weeks apart.
• Booster doses are advised for people who may be at an ongoing risk of exposure.

Who should be vaccinated?
• Travellers to cholera-risk areas.
• People at increased risk of acquiring diarrhoeal disease, such as those with achlorhydria.
• People at increased risk of severe or complicated diarrhoeal disease, such as those with poorly controlled or otherwise complicated diabetes, inflammatory bowel disease, HIV/Aids or other conditions resulting in immunocompromise, or significant cardiovascular disease.
• Humanitarian disaster workers deployed to regions with endemic or epidemic cholera.

Who should not be vaccinated? 
People who shouldn't receive the cholera vaccine include:

• People who have had a reaction to a previous dose of the vaccine
• People who suffer anaphylaxis following any vaccine component.
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