Is cholera vaccination required for a trip to a location with high risk of cholera, especially for individuals with weakened immune systems, such as the elderly or those with chronic medical conditions?

Cholera Vaccination for Travel

Cholera vaccine is recommended only if you are traveling to an area with active cholera transmission, defined as a region with current endemic or epidemic cholera or cholera activity within the past year prone to recurrence—not areas with only sporadic or rare imported cases. 1

Determining If Vaccination Is Indicated

What Qualifies as "Active Cholera Transmission"

• Active transmission means a province, state, or administrative subdivision with endemic or epidemic cholera caused by toxigenic V. cholerae O1, including areas with cholera activity within the past year that are prone to recurrence 1
• Does NOT include areas where only rare imported or sporadic cases have been reported 1, 2
• Check the CDC travel website (https://wwwnc.cdc.gov/travel/) to determine if your specific destination qualifies 1

Age-Specific Recommendations

• Adults 18-64 years: CVD 103-HgR (Vaxchora) is recommended as a single oral dose for travel to areas with active cholera transmission 1
• Children and adolescents 2-17 years: CVD 103-HgR is now recommended for this age group traveling to areas with active transmission 3
• Infants under 2 years: The vaccine is NOT approved and no safety/efficacy data exist for this age group 2
• Adults ≥65 years: The vaccine is NOT approved for this age group 1

High-Risk Travelers Who Should Strongly Consider Vaccination

Even within areas of active transmission, certain travelers face elevated risk and warrant particular consideration for vaccination 1:

• Travelers visiting friends and relatives (higher exposure risk) 1
• Healthcare personnel working in affected areas 1
• Cholera outbreak response workers 1
• Persons traveling to or living in cholera-affected areas for extended periods 1
• Individuals with blood type O (45% of U.S. population; associated with more severe disease) 1
• Persons with low gastric acidity from antacid therapy, partial gastrectomy, or other causes 1
• Travelers without ready access to medical services 1
• Persons with cardiovascular or kidney disease who would tolerate dehydration poorly 1

Critical Caveats About Vaccination

Vaccine Is NOT a Substitute for Prevention Measures

• All travelers must follow strict food and water precautions regardless of vaccination status 1
• Safe water and food practices, proper sanitation, and frequent handwashing remain the primary prevention strategies 1
• The vaccine provides an additional layer of protection but does not eliminate the need for behavioral precautions 1

Duration of Protection

• Protection is documented for at least 3 months post-vaccination 1
• Duration beyond 3 months is unknown 1
• No data exist on booster doses, and no booster recommendation currently exists 1

For Travelers to Areas WITHOUT Active Transmission

The vaccine is NOT routinely recommended if you are not visiting areas of active cholera transmission 1. Most U.S. travelers do not visit areas with active transmission 1. However, all travelers should still:

• Follow safe food and water precautions 1
• Practice proper sanitation and personal hygiene 1
• Seek prompt medical attention if severe diarrhea develops, particularly for fluid replacement therapy 1

Special Considerations for Vulnerable Populations

Elderly and Immunocompromised Travelers

While the vaccine is not approved for adults ≥65 years, elderly travelers and those with chronic medical conditions face increased risk of complications from diarrheal disease 1. These individuals require:

• Heightened education about diarrheal disease risk specific to their individual epidemiology 1
• Strict adherence to food and water safety measures 1
• Pre-identified medical facilities at the destination with capability to provide rapid fluid replacement 2

Pregnant Women

Pregnant women have increased risk of complications with diarrheal disease and warrant specific attention to education about risk 1, though no specific vaccine recommendations exist for this population in the guidelines.

Common Pitfalls to Avoid

• Do not assume sporadic cholera cases warrant vaccination—this is a common misconception 2
• Do not rely on vaccination as a substitute for food and water precautions, even in vaccinated travelers 2
• Do not vaccinate infants under 2 years or adults ≥65 years, as the vaccine is not approved for these age groups 1, 2
• Do not forget that cholera is treatable—the key is rapid access to fluid replacement therapy, which can reduce fatality rates to <1% 3