The Traveller and Cholera
Until the early seventies the WHO recommended cholera vaccination as a means to prevent the spread of the disease across borders. Since then the requirement has been deleted from the International Health regulations as it has been shown that vaccination does not curb the international spread of the illness. Therefore proof of vaccination against cholera should no longer be required of any traveller by ANY authority. The new International Certificate of Vaccination no longer provides a specific space for recording of cholera vaccination. South Africans may want to take note of this as they MAY be confronted by misguided border officials in this regard.
Forcing travellers from affected countries to take antibiotics such as doxycycline or ciprofloxacin will likewise not prevent the spread of the disease and has no medical justification. On the contrary it could harm persons who are allergic to such antibiotics or the unborn babies of pregnant travellers.
Vaccination against cholera has a minor role to play and is only indicated in aid workers and certain other persons who live and work in affected communities in a cholera epidemic. Mass vaccination is not indicated during an outbreak.
The traditional parenteral cholera vaccine conveys incomplete, unreliable protection of short duration, and its use, therefore, is not recommended.
Two oral cholera vaccines that provide some protection for several months against cholera caused by Vibrio cholera O1 are available in a few countries. A killed cholera bacteria vaccine is available in South Africa for use in highly selected cases. It provides limited protection for a limited period against cholera and perhaps even against the much more common ‘traveller’s diarrhoea. The use of the vaccine may be considered by persons who may be regularly exposed to contaminated water in the course of their work or participating in water sports – the Midmar mile and Duzi canoe marathon for example. These persons should bear in mind that other vaccine preventable waterborne diseases also pose a threat – Hepatitis A and less commonly but still lurking in the shallows, typhoid. These vaccines afford a higher level of protection and for much longer.
Ultimately communities and politicians bear responsibility for the provision of clean water to the inhabitants of a country.
Travellers to areas where such measures fail would do well by sticking to the old travellers’ wisdom: Cook it, peel it, boil it – or leave it!