What is the recommended dose and administration schedule of the Dukoral oral cholera vaccine for individuals aged 2 years and older?

Dukoral Dosing and Administration

Dukoral requires a two-dose primary series administered 1 to 6 weeks apart for individuals aged 2 years and older, with each dose taken orally after dissolving in water. 1

Primary Vaccination Schedule

• The standard regimen consists of two oral doses given 1 week to 1 month apart, providing approximately 85% efficacy against cholera at 6 months post-vaccination 1, 2

• For children aged 2-5 years, the dosing schedule is the same (two doses, 1-6 weeks apart), though immunogenicity may be lower in this age group compared to older children and adults 3, 4

• Adults and children 6 years and older follow the identical two-dose schedule with 1-6 weeks between doses 1

Administration Technique

• Avoid all food and drink for 1 hour before and 1 hour after vaccine administration to optimize vaccine effectiveness 5

• The vaccine is administered orally after reconstitution in water 1

• Do not administer to patients who have received oral or parenteral antibiotics in the preceding 14 days, as antibiotics may interfere with the live vaccine strain 6, 1, 2

Booster Dosing for Ongoing Risk

• For individuals with continuous or recurrent cholera exposure risk, booster doses may be given every 6 months based on older ACIP guidance 1, 2

• For travelers visiting cholera-affected areas approximately once yearly, a booster dose before each trip (approximately yearly) is reasonable given documented waning of protection over time 1, 2

• No high-quality data exist on the optimal booster interval for the current Dukoral formulation; recommendations are based on older guidance and expert opinion 2

Critical Drug Interactions and Timing

• If chloroquine is needed for malaria prophylaxis, start it ≥10 days after Dukoral vaccination due to reduced immunogenicity when coadministered 6, 1, 2

• If oral typhoid vaccine (Ty21a/Vivotif) is also needed, take the first Ty21a dose ≥8 hours after Dukoral to minimize buffer interference with the enteric-coated typhoid formulation 6

• Dukoral can be administered simultaneously with measles, BCG, or hepatitis B vaccines 5

• Separate Dukoral from yellow fever vaccine by at least 3 weeks if possible, as simultaneous administration decreases antibody response to both vaccines 5

Age and Population Restrictions

• The vaccine is approved for individuals aged 2 years and older 3

• Note that in the United States, the CVD 103-HgR vaccine (Vaxchora, a different cholera vaccine) is only approved for adults 18-64 years, but Dukoral has broader age approval internationally 6, 1

Duration of Protection

• Protection is documented for at least 3 months after the two-dose series, with efficacy lasting up to 3 years in some individuals 1

• Efficacy is approximately 76% at 2 years in general populations when the full two-dose series is completed 6, 5

• Protection wanes more rapidly in young children (ages 2-5 years) compared to older vaccinees, likely due to lack of class-switched antibody responses and memory B-cell responses to O-specific polysaccharide 4

Essential Non-Vaccine Measures

• Vaccination is never a substitute for food and water precautions—all travelers must follow strict safe food and water practices regardless of vaccination status 5, 2

• Travelers who develop severe diarrhea should seek prompt medical attention for fluid replacement therapy 6, 2