cholera vaccine

Available forms
Available by prescription only
Injection: Suspension of killed Vibrio cholerae (each ml contains 8 units of Inaba and Ogawa serotypes) in 1.5-ml and 20-ml vials

Indications and dosages
 Primary immunization. Adults and children older than age 10: Two doses of 0.5 ml I.M. or S.C., 1 week to 1 month apart, before traveling in cholera area. Booster dosage is 0.5 ml q 6 months for as long as protection is needed.
Children ages 5 to 10: 0.3 ml I.M. or S.C. Boosters of same dose should be given q 6 months for as Children ages 5 to 10: 0.3 ml I.M. or S.C. Boosters of same dose should be given q 6 months for as long as protection is needed.
Children ages 6 months to 4 years: 0.2 ml I.M. or S.C. Boosters of same dose should be given q 6 months for as long as protection is needed.

Pharmacodynamics
Cholera prophylaxis: Promotes active immunity to cholera in about 50% of those immunized.

Pharmacokinetics
Absorption: No information available.
Distribution: No information available. Virus-induced immunity begins to taper off within 3 to 6 months.
Metabolism: No information available.
Excretion: No information available.

Contraindications and precautions
Contraindicated in patients with acute illness or history of severe systemic reaction or allergic response to vaccine.

Interactions
Drug-drug. Corticosteroids, immunosuppressants: May impair immune response to cholera vaccine. Avoid use together.
Yellow fever vaccine: Simultaneous administration may decrease response to both. Avoid concurrent administration.

Adverse reactions
CNS: headache, malaise, fever.
Skin: erythema, swelling, pain, and induration at injection site.

Effects on lab test results
None reported.

Overdose and treatment
No information available.

Special considerations
• Obtain a thorough history of allergies and reactions to immunizations.
• Epinephrine solution 1:1,000 should be available to treat allergic reactions.
• When possible, cholera and yellow fever vaccines should be administered at least 3 weeks apart; however, they may be administered simultaneously if time constraints make this necessary.
• Cholera vaccine may be given intradermally (0.2 ml) in people older than age 5, but higher levels of antibody may be achieved in children younger than age 5 by the S.C. or I.M. route.
• Shake vial well before removing a dose.
• Administer I.M. in deltoid muscle in adults and children older than age 3 and in the anterolateral thigh in children younger than age 3.
• Don’t use I.M. route in patients with thrombocytopenia or other coagulation disorders that would contraindicate I.M. injection. Cholera vaccine shouldn’t be administered I.V. Aspirate before S.C. or I.M. injection.
• Store vaccine at 36° to 46° F (2° to 8° C). Don’t freeze.
Breast-feeding patients
• It’s unknown whether cholera vaccine appears in breast milk or whether transmission of cholera vaccine to a breast-fed infant presents any unusual risk.
Pediatric patients
• Drug isn’t recommended for infants younger than age 6 months.
Geriatric patients
• Elderly patients may be more sensitive to drug’s effects.

Patient education
• Tell patient to report skin changes, difficulty breathing, fever, or joint pain.
• Inform patient that acetaminophen may be taken to relieve minor adverse effects, such as pain and tenderness at injection site.
• Tell patient that use of vaccine doesn’t prevent infection.
• Advise patient to avoid consumption of contaminated food or water.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use