What are the CDC recommendations for use of the oral cholera vaccine, CVD 103-HgR (Vaxchora, Emergent BioSolutions)?

The FDA-licensed cholera vaccine CVD 103-HgR (Vaxchora, by Emergent BioSolutions) is currently unavailable in the United States. The manufacturer temporarily halted production in December 2020. CDC published ACIP recommendations for its use in September 2022, available at www.cdc.gov/mmwr/volumes/71/rr/rr7102a1.htm.

CVD 103-HgR is recommended for travelers ages 2–64 years old going to areas of active toxigenic Vibrio cholerae O1 transmission. Criteria for “active” cholera transmission for a given country and a table classifying countries according to transmission levels are found at wwwnc.cdc.gov/travel/page/cholera-travel-information.

Vaccination against cholera is not routinely recommended because cholera is rare in travelers and most travelers do not visit areas of active transmission. However, disease is more likely to occur in travelers who may have limited access to safe food and water in outbreak settings, including outbreak response workers. Clinicians should consider these factors in addition to the level of cholera transmission in the destination country, length of stay, patient’s age and history of pre-existing medical conditions, and the availability of intravenous hydration when assessing a traveler’s risk for cholera infection and the need for vaccination. Other WHO-prequalified cholera vaccines not licensed in the United States may be available in the destination country.

All travelers to cholera-affected areas should follow safe food and water precautions and proper sanitation and personal hygiene measures as primary prevention strategies against cholera infection. Travelers who develop severe diarrhea should promptly seek medical attention for rehydration therapy.