Cholera in travellers: improving vaccination guidance in Europe

Background: Cholera is endemic in similar to 50 countries worldwide and remains a disease associated with poverty, causing illness and death in the poorest and most vulnerable people. In travellers, cholera is considered a low-incidence disease, but the true impact on travellers is difficult to assess. Cholera vaccination may improve safety for certain European travellers at risk. Effective vaccines are available; however, vaccination recommendations in Europe vary considerably between countries. Methods: In this review, a comparison of cholera vaccination recommendations from 29 advice reference bodies across key European countries (United Kingdom, Germany, Spain, Italy, Portugal, Switzerland, Sweden, Finland, Norway, France and Denmark) is presented. The differences in perceived cholera risk are highlighted, and a comparison with the United States Centers for Disease Control and Prevention (CDC) recommendations is included. Results: In general terms, the recommendations from European organizations are ambiguous and differ widely. This contrasts with the situation in the United States, where the CDC publishes a consistent set of guidelines. Conclusion: With the ease of intra-European travel, it would seem sensible to harmonize the recommendations for cholera vaccination and risk perception across Europe, providing pre-travel health advisers with a trusted source of information that allows them to provide consistent recommendations.