Oral Cholera Vaccine for Traveler’s Diarrhea Prophylaxis
While we might be through the worst of winter, many Albertans still have vacations planned for the upcoming months. What do you do when patients ask what vaccines they should get prior to traveling, and should you recommend the oral cholera vaccine to prevent traveler’s diarrhea?
Though diarrhea affects up to 50% of travelers to developing countries, most cases of traveler’s diarrhea (TD) happen because of consumption of contaminated food and water and are caused by organisms not prevented by the vaccine. TD usually resolves spontaneously in 3-4 days, but cure rates can be improved by taking antibiotics at onset. Travelers to high-risk areas can be prescribed antibiotics to self-administer should they develop diarrhea. Azithromycin 500mg twice daily for two doses is equivalent to longer courses of antibiotics, costs less than $20, and is covered by many drug plans. The oral cholera vaccine, on the other hand, is not recommended by North American guidelines, costs approximately $90, and is not covered by any provincial health care plans.
If you have a proactive traveler in the office, encourage vaccinations for other infectious diseases with high prevalence or potential morbidity, like Hepatitis A. You can also consider referring travelers to local clinics, public health units or pharmacies that specializes in travel medicine consultations.
About the Author
Tony Nickonchuk, BSc Pharm
Clinical Pharmacist, Alberta Health Services
Tony practices pharmacy in Peace River as a clinical pharmacist at the Peace River Hospital. He rotates with one other pharmacist between direct clinical care on the acute care ward and remote support for regional facilities. He is also site lead for the pharmacy team there.
Tony is a member of the Practical Evidence for Informed Practice (PEIP) Conference Planning Committee, is a contributor to Tools for Practice and the Best Science Medicine Podcast, and is a co-author of the popular Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta document.
Outside of work he is a busy dad of three kids under 12, all three being active in swimming, gymnastics, and drums. In his infinitesimal free time, he’s an avid follower of politics.