Immunization, Vaccines and Biologicals


Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It is a disease of poverty, closely linked to poor sanitation and lack of clean drinking water. It has a short incubation period of a few hours to five days, and is characterized in the majority of cases by acute, profuse watery diarrhoea lasting from one to a few days. In its extreme form, cholera can be rapidly fatal.

The disease occurs in both endemic and epidemics patterns. Cholera incidence worldwide has increased steadily since 2005 with outbreaks affecting several continents. Further, its impact can be dramatic in areas where basic environmental infrastructures are disrupted or have been destroyed and provision of potable water and sanitation is challenging. As such, acute humanitarian emergencies are a particular risk factor for cholera outbreaks. The annual burden of cholera has been estimated at 1.3 to 4.0 million cases and 21 000 to 143 000 deaths worldwide (2017).

Currently there are three WHO pre-qualified oral cholera vaccines (OCV): Dukoral®, Shanchol™, and Euvichol®. All three vaccines require two doses for full protection. Dukoral® is administered with a buffer solution that, for adults, requires 150 ml of clean water. Dukoral can be given to all individuals over the age of 2 years. There must be a minimum of 7 days, and no more than 6 weeks, delay between each dose. Children aged 2-5 require a third dose. Dukoral® is mainly used for travellers. Two doses of Dukoral® provide protection against cholera for 2 years. Shanchol™ and Euvichol® are essentially the same vaccine produced by two different manufacturers. They do not require a buffer solution for administration. They are given to all individuals over the age of one year. There must be a minimum of two weeks delay between each dose of these vaccines. Two doses of Shanchol™ and Euvichol® provide protection against cholera for 3 years, while a single dose provides short term protection.

Shanchol™ and Euvichol® are the vaccines currently available for mass vaccination campaigns through the Global OCV Stockpile, which is supported by Gavi, the Vaccine Alliance. More than 20 million doses of OCVs have been used in mass vaccination campaigns. The campaigns have been implemented in areas experiencing an outbreak, in areas at heightened vulnerability during humanitarian crises, and among populations living in highly endemic areas, known as “hotspots”.

A mix of live, killed and conjugated vaccines are in development that have the potential of providing longer term protection with an easier-to-administer schedules.

In October 2017, partners from the Global Task Force on Cholera Control launched a strategy for cholera control: Ending Cholera: A roadmap to 2030. The country-led strategy aims to reduce cholera deaths by 90% and to eliminate cholera in as many as 20 countries by 2030.

WHO position paper

Prequalified vaccines

Disease burden and surveillance

Further information

Related WHO links on cholera

Last updated: 6 February 2018