Cholera

Question 1

What organism causes cholera?

Answer 1

Vibrio cholera, gram negative bacteria

Question 2

What are the symptoms of cholera infection?

Answer 2

Profuse “rice water” diarrhea
Dehydration
Hypoglycemia

Question 3

Is cholera infection treated with antibiotics?

Answer 3

Typically, no
Management involves oral rehydration therapy (ORT)

**if severe infection, abx of choice are doxycycline or ciprofloxacin

Question 4

When is the oral cholera vaccine recommended? (5)

Answer 4

1. Backpackers
2. Individuals travelling to situations where risk is greatest eg refugee camps, relief or disaster aid workers
3. Travelers to areas where cholera is endemic
4. Persons with remote itineraries in areas where cholera epidemics are ocurring and there is limited access to medical care
5. Individuals at occupational risk, such as laboratory workers who may be regularly exposed to cholera

• there is no requirement for cholera vaccination as a condition for entry into any country
• • regardless of vaccination status, travelers to areas where cholera is endemic should take special care with food hygiene because vaccination does NOT provide complete protection

Question 5

What type of vaccine is the cholera vaccine?

Answer 5

Inactivated (live) Vibrio cholerae bacteria WITH recombinant cholera toxin

Administered orally

Question 6

What is the primary dosing schedule for the cholera vaccine?

Answer 6

Children age 2-5:
- 1 dose every 1-6 weeks for 3 doses

Children age 6-17 and adults:
- i dose every 1-6 weeks for 2 doses

• if more than 6 weeks has elapsed between doses, the primary course should be restarted
• *immunisation should be completed at least one week before potential exposure

Question 7

Is there a booster cholera vaccine?

Answer 7

Yes

Children age 2-5:
- a single booster dose can be given within 6 months after the primary course; if more than 6 months has elapsed since the last vaccination, the primary course should be restarted

Children age 6-17 and adults:
- a single dose can be given within 2 years after the primary course; if more than 2 years have elapsed since the last vaccination, the primary course should be repeated

Question 8

What antibiotics can be used to treat severe cholera infection?

Answer 8

Doxycycline and ciprofloxacin

(According to Passmedicine)

https://www.passmedicine.com/review/textbook.php?s=Cholera

Question 9

Is cholera a notifiable disease?

Answer 9

Yes

All suspected cases of cholera must be notified to the local health protection unit
Where there is community level outbreak, specialist advice should be sought from Public Health England or, in Scotland, Health Protection Scotland

Question 10

Should the cholera vaccine be offered in the management of contacts of cases or in controlling the spread of infection?

Answer 10

No

Contacts of patients with cholera should maintain high standards of personal hygiene to avoid becoming infected. The vaccine should not be offered in these cases

(Presumable because it is most effective when given at least one week prior to exposure?)

Question 11

What are the contraindications to the cholera vaccine? (2)

Answer 11

1. Severely immunosuppressed patients should not be given live vaccines (including those with severe primary immunodeficiency)
2. Acute gastro-intestinal illness

Question 12

What are side effects of the cholera vaccine? (2)

Answer 12

1. GI discomfort

2. GI disorders