OralActive immunisation against choleraAdult: As inactivated/killed modified whole cell bivalent (Vibrio cholerae O1 and O139 strains) vaccine: 2 doses (1.5 mL each) given at intervals of at least 2 weeks. As 4 x 108 to 2 x 109 viable cells of live attenuated V. cholerae CVD 103-HgR per packet of active component: 1 packet (100 mL of reconstituted suspension) as a single dose given at least 10 days prior to potential exposure. Vaccine content and treatment recommendations may vary among countries or available products (refer to latest local or specific product guidelines).
Child: As inactivated/killed modified whole cell bivalent (V. cholerae O1 and O139 strains) vaccine: ≥1 year Same as adult dose. As 4 x 108 to 2 x 109 viable cells of live attenuated V. cholerae CVD 103-HgR per packet of active component: 2-<6 years 1 packet (50 mL of reconstituted suspension) as a single dose given at least 10 days prior to potential exposure; ≥6 years Same as adult dose. Vaccine content and treatment recommendations may vary among countries or available products (refer to latest local or specific product guidelines).
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Live attenuated vaccine: First, dissolve the supplied buffer component in 100 mL of cold or room temperature (≤25°C) purified, spring or sparkling water to make the buffer solution. For children aged 2-<6 years, discard half (50 mL) of the buffer solution before proceeding to the next step. Second, add the entire contents of the active component (V. cholerae CVD 103-HgR) to the buffer solution. Stir for at least 30 seconds and until the reconstituted vaccine forms a slightly cloudy suspension (may contain some white particulates). If desired, sucrose (Max: 4 g or 1 teaspoon) or stevia sweetener (Max: 1 g or 1/4 teaspoon) may be added to the mixture. If the buffer component and active component are reconstituted in improper order, the vaccine must be discarded.
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Patient with immunocompromised close contacts. Immunocompromised patients (e.g. patients receiving chemotherapy, radiation therapy or other immunosuppressive treatment) may have reduced response to cholera vaccine. Postpone immunisation in patients with moderate or severe acute illness with or without fever. Bacteria may be shed in patient's stool for at least 7 days after live attenuated cholera vaccination. Children. Pregnancy and lactation.
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Gastrointestinal disorders: Abdominal pain, nausea, vomiting, diarrhoea, acute gastroenteritis.
General disorders and administration site conditions: Fatigue, fever.
Metabolism and nutrition disorders: Decreased appetite.
Musculoskeletal and connective tissue disorders: Arthralgia.
Nervous system disorders: Headache, dizziness.
Respiratory, thoracic and mediastinal disorders: Cough.
Skin and subcutaneous tissue disorders: Rash, itching.
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Live attenuated vaccine: Avoid eating and drinking for 60 minutes before and after administration.
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Monitor patient for hypersensitivity reaction for at least 30 minutes following vaccination.
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May diminish therapeutic effect with antibiotics and chloroquine. Immunosuppressive treatment (e.g. antimetabolites, alkylating agents, high-dose corticosteroids, cytotoxic agents) may reduce the immune response to cholera vaccine.
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Description:
Mechanism of Action: Cholera vaccine contains either live attenuated or inactivated/killed strains of Vibrio cholerae. Live attenuated (V. cholerae strain CVD 103-HgR) vaccine replicates in the gastrointestinal tract and produces serum vibriocidal antibody and memory B cell responses. The exact immunologic mechanism is still unknown; however, increases in serum vibriocidal antibody 10 days following vaccination were associated with protection in a study. Inactivated/killed modified whole cell bivalent (V. cholerae O1 and O139 strains) vaccine acts locally in the gastrointestinal tract to induce antibodies, which prevents the bacteria from attaching to the intestinal wall, thereby impeding colonisation of V. cholerae O1 and O139.
Onset: Within 10 days.
Pharmacokinetics:
Excretion: Via faeces.
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Store between 2-8°C. Do not freeze. Follow standard procedures for the preparation of cholera vaccine and proper disposal of any unused portions or waste material. Refer to specific product guidelines for detailed storage recommendations.
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J07AE02 - cholera, live attenuated ; Belongs to the class of cholera bacterial vaccines.
J07AE01 - cholera, inactivated, whole cell ; Belongs to the class of cholera bacterial vaccines.
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Anon. Cholera Vaccine Live Oral. AHFS Clinical Drug Information [online]. Bethesda, MD. American Society of Health-System Pharmacists, Inc. https://www.ahfscdi.com. Accessed 24/10/2023. Anon. Cholera Vaccine. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 24/10/2023. Buckingham R (ed). Cholera Vaccines. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 24/10/2023. Cholera - Vibrio cholerae Infection: Vaccines. Centers for Disease Control and Prevention. https://www.cdc.gov. Accessed 07/02/2024. Cholera Vaccine. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 24/10/2023. Cholera Vaccines: WHO Position Paper - August 2017. World Health Organization. https://www.who.int. Accessed 07/02/2024. Euvichol-Plus Suspension Oral Cholera Vaccine (Averroes Pharmaceutical Sdn. Bhd.). National Pharmaceutical Regulatory Agency - Ministry of Health Malaysia. https://www.npra.gov.my. Accessed 24/10/2023. Joint Formulary Committee. Cholera Vaccine (Live). British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 24/10/2023. Shanchol (Sanofi Pasteur, Inc). MIMS Philippines. http://www.mims.com/philippines. Accessed 07/02/2024. Vaxchora Effervescent Powder and Powder for Oral Suspension (Emergent BioSolutions UK Ltd). MHRA. https://products.mhra.gov.uk. Accessed 24/10/2023. Vaxchora Live, Oral (Emergent Travel Health Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 24/10/2023.
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