What Should Pharmacists Know About Vaxchora?

Vaxchora (lyophilized CVD 103-HgR) is the only vaccine approved in the United States to prevent cholera.¹ The FDA approved the vaccine in 2016 for adults aged 18 to 64 years who travel to areas of active cholera transmission.^1,2

Cholera is spread by drinking water or eating food contaminated with cholera bacteria. Severe cholera is characterized by large amounts of watery diarrhea and may include other symptoms, such as nausea and vomiting.¹ Cholera is rare in the United States, and most cases occur among travelers to countries where the disease is active.

Vaxchora is manufactured by PaxVax. It is a single-dose oral live vaccine suspension that should be administered at least 10 days before traveling to a cholera-affected area and should be consumed within 15 minutes of reconstitution.² Avoid administering Vaxchora to patients who have a history of a severe allergic reaction (eg, anaphylaxis) to any ingredient in the vaccine or to a previous cholera vaccine. Also, because the vaccine may be shed in the stool for at least 7 days, there is a potential to transmit the vaccine strain to nonvaccinated individuals, especially patients who are immunocompromised.²

Advise patients to avoid eating or drinking for 60 minutes before and after oral ingestion of Vaxchora.² Additionally, Vaxchora should not be co-administered with systemic antibiotics, because they may reduce the efficacy of the vaccine, and it should not be given to patients who have received oral or parenteral antibiotics in the previous 14 days.² However, it is unknown how long individuals should wait after finishing an antibiotic to receive Vaxchora.³ Evidence suggests that the antimalarial medication chloroquine can decrease Vaxchora efficacy.² Therefore, it is recommended that Vaxchora be administered at least 10 days before starting chloroquine.² Advise patients that the most common adverse effects occurring with- in 7 days post vaccination are tiredness, headache, abdominal pain, nausea and vomiting, appetite loss, and diarrhea.

The Advisory Committee on Immunization Practices (ACIP) issued updated recommendations in May 2017 for the use of Vaxchora.3 ACIP defines an area of active transmission as a province, state, or other administrative subdivision within a country with endemic or epidemic cholera. It also includes areas with cholera activity within the past year. Vaxchora is not routinely recommended for travelers who are not visiting areas of active transmission.³

Evidence suggests that Vaxchora reduces the risk of severe diarrhea by 90% at 10 days and 80% at 3 months post vaccination.³ There are no recommendations for booster doses after the 3-month period, and this is an area that should be further studied. Other prevention tips include cooking food safely, drinking and using safe water, frequent handwashing with safe water and soap, and safe clean up.

REFERENCES

• CDC. Cholera-Vibrio cholera infection. CDC website. cdc.gov/ cholera/index.html. Updated May 15, 2018. Accessed December 24, 2018.
• Vaxchora [prescribing information]. Redwood City, CA: PaxVax Inc; 2016. www.paxvaxconnect.com/PDF/Vaxchora_Prescribing_ Information.pdf?rel=0” ?rel=0”. Accessed December 25, 2018.
• Wong KK, Burdette E, Mahon BE, Mintz ED, Ryan ET, Reingold AL. Recommendations of the Advisory Committee on Immunization Practices for use of cholera vaccine. MMWR Morb Mortal Wkly Rep. 2017;66(18):482-485. doi: 10.15585/mmwr.mm6618a6.