Dukoral

FAQ about Dukoral, a vaccine that offers protection against cholera and travellers' diarrhea caused by ETEC. Find information on dosage, efficacy & side effects.

Background

What is DUKORAL®?

DUKORAL® is an oral vaccine that helps protect against cholera and a specific type of travellers' diarrhea caused by a bacteria called Enterotoxigenic Escherichia coli (ETEC).

What is cholera, and how do people get it?

Cholera is an illness caused by bacteria found in contaminated water or food. It can lead to severe dehydration and may become life-threatening if left untreated.

What is travellers' diarrhea, and what causes it?

Travellers' diarrhea is a common health issue for people visiting other countries. It is usually caused by Enterotoxigenic Escherichia coli (ETEC) bacteria found in contaminated food or water. Most cases are mild and go away on their own.

How long does the protection from DUKORAL® last?

After getting the vaccine, protection against cholera lasts for 2 years in people aged 6 and older, and for 6 months in children aged 2 to 6 years. Protection against ETEC travellers' diarrhea may last for 3 months.

Who should get the DUKORAL® vaccine?

DUKORAL® is not recommended for most travellers. However, individuals at high risk of health complications or serious inconvenience from travellers' diarrhea may benefit from the vaccine. These include:

• People for whom a brief illness cannot be tolerated, such as elite athletes, business or political travellers who need to maintain optimal performance.

• Individuals with increased susceptibility to travellers' diarrhea, like those with achlorhydria (reduced stomach acid), gastrectomy (stomach removal), a history of repeated severe travellers' diarrhea, or young children over 2 years of age.

• People who are immunosuppressed due to HIV infection with a low CD4 count or other immunodeficiency states.

• Those with chronic illnesses, such as chronic renal failure, congestive heart failure, insulin-dependent diabetes mellitus, or inflammatory bowel disease, for whom there is an increased risk of serious consequences from travellers' diarrhea.

Why isn't the DUKORAL® vaccine the primary method for preventing cholera and travellers' diarrhea?

Preventing cholera and travellers' diarrhea mainly involves making careful food and water choices and maintaining good hygiene practices, rather than relying on immunization. A travel-related risk assessment can help determine which travellers might benefit from vaccination. Furthermore, the vaccine is not advised for children under 2 years since its effectiveness hasn't been evaluated in this age group.

What are the limitations of the DUKORAL® vaccine?

• Offering limited protection (around 6%) against travellers' diarrhea.

• Most travellers' diarrhea episodes being typically mild and self-resolving.

• The availability of alternative treatments such as oral rehydration, dietary management, anti-motility agents, and antibiotics if prevention is unsuccessful.

• The potential risk of vaccinated travellers feeling overly confident and not adhering strictly to food and water safety measures.

Is DUKORAL® safe for pregnant or breastfeeding women?

The vaccine has not been specifically studied in pregnant or breastfeeding women. However, it may be considered for pregnant women in high-risk situations after weighing the benefits and risks. DUKORAL® can be given to breastfeeding women.

Can children receive the DUKORAL® vaccine?

Children aged 2 years and older can receive the vaccine. It is not recommended for children under 2 years of age, as its effectiveness has not been studied in this age group.

Administration

How many doses of DUKORAL® are needed?

The number of doses depends on the person's age and the reason for vaccination. Generally, children between 2 and less than 6 years of age need 3 doses, while those aged 6 years and older need 2 doses. For travellers' diarrhea, 2 doses are needed for people aged 2 years and older. Booster doses may be required depending on the ongoing risk assessment.

Can DUKORAL® be self-administered?

Yes, DUKORAL® is an oral vaccine that can be self-administered. Follow the manufacturer's guidelines for preparing the vaccine and buffer solution.

Can DUKORAL® be taken with other vaccines?

DUKORAL® and oral typhoid vaccine capsules should be taken at least 8 hours apart. There is no known interaction between DUKORAL® and other common travel vaccines, such as hepatitis A, hepatitis B, meningococcal, and yellow fever vaccines, although data are limited.xp

Are there any reasons someone should not receive DUKORAL®?

DUKORAL® should not be given to people with a history of severe allergic reactions after previous administration of the vaccine or those allergic to any component of the vaccine. It should be postponed in people with moderate or severe acute illness or stomach problems.

Are there any interactions with food or medications when taking DUKORAL®?

Avoid taking any medications or consuming food or drinks for 1 hour before and 1 hour after taking DUKORAL®. Food or drinks may affect the vaccine's effectiveness.

Effectiveness

How effective is DUKORAL® against travellers' diarrhea?

The overall protection provided by DUKORAL® against travellers' diarrhea is estimated to be around 6%. It specifically protects against one type of cholera bacteria but not others. Most episodes of travellers' diarrhea are mild and self-limited, and other prevention measures, such as careful food and water selection, are important as well.

How long does protection from DUKORAL® last?

Protection against cholera lasts for about 2 years in persons 6 years of age and older, and 6 months in children 2 years to less than 6 years of age. Protection against ETEC travellers' diarrhea may last up to 3 months.

Side Effects

What common side effects can I expect from the DUKORAL® vaccine?

Some people experience abdominal pain, diarrhea, nausea, and vomiting after getting the vaccine. These side effects are usually caused by a substance called bicarbonate buffer used in the vaccine.

Are there any serious side effects from the DUKORAL® vaccine?

Severe allergic reactions, called anaphylaxis, can happen but are extremely rare.

What other rare side effects have been reported with the DUKORAL® vaccine?

Some uncommon side effects include tingling sensations, shortness of breath, hives, itching, facial swelling, stomach flu, swollen glands, flu-like symptoms, and high blood pressure.

How often do these rare side effects occur?

These rare side effects have been reported in less than 1 out of 10,000 doses. It's important to note that no direct connection has been established between these side effects and the vaccine.