Cholera

Pregnancy: Use only if clearly needed.

Limited safety data in pregnancy. Oral killed whole-cell cholera vaccines (Dukoral, Shanchol) are inactivated and considered low-risk, but formal pregnancy studies are insufficient.

• WHO: "may be used in pregnant women if the potential benefit justifies the potential risk."

• Consider vaccination for pregnant women traveling to active cholera outbreak areas or refugee/disaster settings.

• Dukoral buffer contains sodium bicarbonate — no known concern for pregnancy.

Breastfeeding: Safe.

Oral cholera vaccines are inactivated and safe during breastfeeding. Maternal antibodies in breast milk may provide additional protection to the infant. No modification to breastfeeding schedule required.

Pediatric use:

• Shanchol/Euvichol: licensed from 1 year of age. 2 oral doses, 2 weeks apart.

• Dukoral: licensed from 2 years of age. Children 2–5 years: 3 doses (extra dose due to lower immune response). Children ≥6 years: 2 doses.

• Booster intervals differ: Dukoral every 6 months (children 2–5y) or every 2 years (≥6y). Shanchol: booster data limited.

• Dukoral: dissolve effervescent granules in 75 mL water (children) or 150 mL (adults). Do not eat or drink for 1 hour before and after.

Geriatric use:

• No specific age-related contraindications. Standard dosing applies.

• Efficacy may be reduced in immunocompromised elderly individuals.

• Cholera in elderly patients carries higher mortality risk — vaccination is particularly beneficial for at-risk elderly travelers.