Alternatives to Vaxchora If You Can't Fill Your Prescription

Alternatives to Vaxchora If You Can't Fill Your Prescription

Your doctor recommended the cholera vaccine before your international trip, but you can't find Vaxchora anywhere near you. Now what?

This is a frustrating but surprisingly common situation. Vaxchora is the only FDA-approved cholera vaccine in the United States, and because of limited demand and specialty storage requirements, many pharmacies don't carry it. If your travel date is approaching and you still haven't been able to locate the vaccine, here's what you need to know about your options.

What Is Vaxchora?

Vaxchora is the brand name for Vibrio Cholerae Cvd 103-Hgr Strain Live Antigen, a live, attenuated oral cholera vaccine made by Emergent Travel Health Inc. It's approved for people ages 2 through 64 who are traveling to cholera-affected areas.

The vaccine is taken as a single oral dose — a liquid you drink — at least 10 days before potential cholera exposure. It doesn't require an injection and can be administered at a travel health clinic, hospital, or pharmacy equipped to handle medical waste.

How Does Vaxchora Work?

Vaxchora contains a weakened (attenuated) strain of Vibrio cholerae that has been genetically modified so it cannot produce active cholera toxin. When you drink the vaccine, the weakened bacteria colonize your gut and trigger your immune system to produce protective antibodies — without causing cholera disease.

In clinical challenge studies, Vaxchora demonstrated:

• 90.3% efficacy at 10 days after vaccination
• 79.5% efficacy at 3 months after vaccination
• 93.5% seroconversion rate in adults ages 18-45

It's a highly effective vaccine, which is why finding an alternative isn't straightforward.

Cholera Vaccine Alternatives

While Vaxchora is the only option available in the US, other cholera vaccines exist globally. Here's what's out there:

1. Dukoral

Dukoral is an inactivated (killed) oral cholera vaccine that combines whole cells of V. cholerae O1 with recombinant cholera toxin B subunit. It requires two doses taken 1-6 weeks apart, with a booster after 2 years for ongoing protection.

• Availability: Licensed in over 60 countries including Canada, Europe, and Australia — but not available in the United States
• Efficacy: About 85% protection in the first 6 months, decreasing to approximately 60% over 2 years
• Key difference: Uses killed bacteria rather than live attenuated organisms; requires two doses instead of one

If you're traveling through or stopping in Canada, Europe, or Australia before reaching your final destination, you may be able to receive Dukoral abroad. Discuss this option with your travel medicine provider.

2. Shanchol

Shanchol is a bivalent inactivated oral cholera vaccine that covers both V. cholerae O1 and O139 serogroups. It also requires two doses given 2 weeks apart.

• Availability: Widely used in WHO mass vaccination campaigns in cholera-endemic countries — not available in the US
• Efficacy: 58-76% observed vaccine protection with two doses
• Key difference: Does not contain cholera toxin B subunit; covers the O139 serogroup which Vaxchora does not

3. Euvichol-Plus

Euvichol-Plus is essentially equivalent to Shanchol — a bivalent inactivated oral cholera vaccine produced in South Korea. It's the most widely used vaccine in WHO's global cholera vaccine stockpile, with over 150 million doses distributed worldwide.

• Availability: Used internationally in mass vaccination campaigns — not available in the US
• Efficacy: Similar to Shanchol

What If No Cholera Vaccine Is Available to You?

If you cannot find Vaxchora in the US and won't be passing through a country where another cholera vaccine is available, focus on prevention through hygiene and food safety:

• Drink only safe water: Bottled, boiled, or chemically treated water. Avoid ice unless you're sure it was made from safe water.
• Avoid raw and undercooked food: Eat only thoroughly cooked, hot foods. Skip salads, raw vegetables, and unpeeled fruits.
• Practice hand hygiene: Wash hands frequently with soap and water, especially before eating and after using the bathroom.
• Carry oral rehydration salts (ORS): In case of severe diarrhea, ORS packets can be life-saving while you seek medical care.
• Know the warning signs: Cholera causes rapid, severe watery diarrhea ("rice water" stools), vomiting, and dehydration. Seek emergency medical care immediately if symptoms develop.

These precautions significantly reduce your risk even without vaccination. Cholera is transmitted through contaminated water and food, so careful hygiene is your strongest defense.

Don't Give Up on Finding Vaxchora

Before resigning yourself to traveling without the vaccine, try these additional steps:

• Use Medfinder to search for availability in your area
• Contact travel health clinics — they are the most likely to stock Vaxchora
• Ask your doctor to contact Emergent Travel Health Inc. about distributor availability
• Check hospital pharmacies at academic medical centers

For a complete guide, see our article on how to find Vaxchora in stock near you.

Final Thoughts

Vaxchora is the only FDA-approved cholera vaccine in the United States, and there is no true domestic substitute. Other cholera vaccines exist internationally but are not licensed here. If you can't find Vaxchora before your trip, talk to your travel medicine provider about prevention strategies and whether you might access a vaccine at your destination or during a layover.

Planning ahead is the best way to avoid this situation. Start looking for Vaxchora as soon as you book your trip, and use tools like Medfinder to streamline your search.