An estimated three to 5 million people a year are affected by cholera – a disease found in contaminated food or water. While uncommon in the United States, about 140,000 people around the world succumb to the disease each year. The Military Health System is bringing attention to a vaccine newly approved by the Food and Drug Administration that has proven effective in the fight against this disease: Vaxchora.

Air Force Lt. Col. Heather Halvorson, deputy branch chief of the Defense Health Agency Immunization Healthcare Branch, said that the vaccine is now available for those age 18 through 64 and traveling to areas where cholera is present.

“All travelers to an area of active cholera transmission should use personal protective measures against exposure to cholera, which include following safe food and water recommendations and frequent handwashing, including those who are vaccinated,” said Halvorson. “We should be mindful that vaccination is not a substitute for careful selection of safe food and water and frequent handwashing.”

Vaxchora, which received its FDA license in 2016, is a single dose oral vaccine that contains live attenuated cholera bacteria, known as V. cholerae O1. The bacteria replicates in the gastrointestinal track of the recipient, providing protection from infection.

Cholera is present in more than 50 countries and can spread quickly in areas with inadequate water treatment and hygiene. The most affected regions are typically Asia, Africa and the Caribbean.

“Travelers following routine tourist itineraries and who follow safe food and water recommendations and hygiene precautions while traveling in countries with cholera have low risk of becoming infected,” said Halvorson. The disease is spread through ingestion of food or water contaminated with fecal material from an infected person, so it’s unlikely to spread from person to person by casual contact.

Most cholera-infected people show mild or no symptoms. However, one in 10 people will experience severe symptoms, including leg cramps, watery diarrhea and vomiting. These symptoms can lead to severe dehydration and shock from rapid loss of bodily fluids. As a result, death is possible within hours if the person does not receive prompt treatment.

Travelers visiting friends and relatives in cholera-affected areas, long-term travelers, and those who drink untreated water, eat poorly cooked seafood, or do not follow hygiene precautions can be at higher risk for the disease, said Halvorson. Travelers who do not have access to rehydration therapy and medical care, and travelers who are pregnant or have immune-compromising conditions, cardiovascular disease or renal failure are also at risk.

Vaxchora reduces the chance of severe diarrhea by 90 percent within 10 days after receiving the vaccine and by 80 percent within three months, said Halvorson.

The Department of Defense follows Advisory Committee on Immunization Practices (ACIP) recommendations and will release policy and guidance for use of the vaccine among military members and beneficiaries following the publication of the ACIP Vaxchora recommendations.

“Ongoing efforts are working to enhance surveillance, investigate outbreaks and implement preventive measures across the world to reduce the burden of cholera,” said Halvorson.