Dukoral Vaccine: Oral Vaccine for Cholera and Travelers diarhea

Dukoral vaccine oral Cholera vaccine (Inactivated) is a Killed vaccine containing whole cell suspension of killed Vibrio cholera. 31.25×109 bacteria* of each of the following V. cholerae O1 strains: Inaba classical biotype (heat inactivated), Inaba El Tor biotype (formalin inactivated), Ogawa classical biotype (heat inactivated), Ogawa classical biotype (formalin inactivated). Recombinant cholera toxin B subunit (rCTB) 1 mg. *bacterial content prior to inactivation. It is marketed by Valneva Sweden AB 

In developing countries due to poor sanitation and hygiene facilities combined with no access to safe drinking water, the population is exposed to huge risk of getting water borne diseases like Cholera and travelers diarrhea caused by Entero toxigenic E. coli diarrhea. This is important cause of death in endemic regions of the world especially in children aged less than 5 years old. Oral cholera vaccine can prevent 56-65 percent incidences of cholera cases.

The travelers visiting to endemic regions may suffer diarrhea due to above causes which can be dangerous and it is better to prevent them.

How is Dukoral vaccine available?

Dukoral vaccine oral Cholera vaccine (Inactivated)  is available as a suspension and effervescent granules for oral suspension. The vaccine is a whitish suspension supplied in a bottle. The effervescent granules are white with a raspberry flavour and are supplied in a sachet

How is Dukoral vaccine stored?

Recommended range to store Dukoral vaccine by manufacturer is 2-8 degree Celsius. It can be stored at 2-8 degree Celsius during its shelf life.. The temperature range should be maintained at all stages of the transport and storage. It should be kept in paper box which comes with the vaccine. The vaccine should be thawed before use. If stored as per instructions provided on leaflet with vaccine the shelf life is 1 years. The expired vaccine should not be used. The expired vaccine is to be discarded with all standard precaution suggested in biomedical waste management protocols.

How is Dukoral vaccine given?

· Dukoral vaccine oral Cholera vaccine (Inactivated) is given orally.

· To prepare buffer solution dissolve the effervescent granules in a glass of cool water (approx. 150 ml). Do not use any other liquid. Children 2-6 years: pour away half of the buffer solution.

· Shake the vaccine bottle (1 bottle = 1 dose).

· Add the vaccine to the buffer solution. Mix well and drink the mixture. Drink the vaccine within 2 hours after mixing with the buffer solution. Avoid food and drink starting 1 hour before until 1 hour after the vaccination

How dose Dukoral vaccine oral Cholera vaccine work?

Dukoral vaccine oral Cholera vaccine is active form of immunization. When given orally it goes to intestine of the individual. It is recognized by the host’s immune system. The immune response is mounted against the bacteria. When the real infection occurs the immunity fights the infection vigorously and the Cholera disease is prevented. 

The protection starts 1 week after second dose and may last for 2 years after taking the second dose.

At what age Dukoral vaccine oral Cholera vaccine is given?

Dukoral oral vaccine is given at least 15 days before visiting to endemic country.

First dose should be taken orally at least 15 days before the travel starts.

Second dose is to be taken at least 1 week of first dose.

Children between 2-6 years need to take 3 dosages.

The second dose can be given up to 6 weeks of first dose.

Single dose is enough if the last dose was taken within 2-5 years before after that entire schedule is needed to be taken..

What are side effects of Dukoral vaccine oral Cholera vaccine?

Side effects of Dukoral vaccine oral Cholera vaccine (Inactivated) are usually milder when compared to the disease caused by the V. Cholerae. Benefits outweigh the harm that’s why it is used.

· Fever can be moderate grade and usually subsides by its own. Usually fever can be managed at home with the help of oral medication like paracetamol.

· Irritability can be seen after the vaccination. Usually this side effect is self limiting and decreases by its own after some hours.

· Decreased appetite can be observed after the vaccination. This side effect also subsides with its own.

· Vomiting is known to occur in some patients after the vaccination. It can be managed at home with increasing feeding frequency to maintain hydration status and also some patients may need antiemetic drops like domstal or ondansetron.

· Diarrhea is known side effect of the vaccine and is usually self limiting. It can be managed at home by increasing the frequency of the feeding.

· Other mild side effects are stomach pain, joint pain, feeling of unwell.

· Allergic reaction may occasionally come and needs immediate medical attention.

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