Does Dukoral Work or Not? My Experiences with the Travellers’ Diarrhea vaccine

When planning a big trip no matter where it is around the world, there's always a few things you want to make sure your remember before you depart.  Do you need travel insurance?  Do you need an international driver's license?  Did you plan all the details?  And lastly, do you need any vaccines for where you're going?

That's where Dukoral comes in.  There's the region specific vaccines like yellow fever and and malaria but there's also this vaccine that is said to prevent travellers diarrhea which can occur in high probability in almost half of world.  So the question is, does Dukoral work or not?  Is this a fancy marketing scheme or is it effective to combat what's known as travellers' diarrhea?

What is Dukoral and why do you need it?

So you guys might be wondering the same thing so I figured i'd explain this piece first. What exactly is Dukoral?

In a nutshell, it's simply a vaccine you take prior to your travels to help prevent traveller's diarrhea and cholera while you're travelling.  Traveller's diarrhea is typically caused by E. Coli.

These are the countries that are known to have cholera cases in the past 10 years.

Here is another illustration of countries around the world that are considered to be high-risk according to Dukoral.

From C.Health Canoe:

This vaccine works by introducing very small amounts of dead cholera bacteria and nontoxic components of cholera toxin into the body. This allows the body to make antibodies against the bacteria and toxin so that if the bacteria does get into the body and produce the toxin, they are immediately attacked by the body's own defense system. The cholera toxin is very similar to the toxin produced by ETEC, the bacteria that causes most cases of traveller's diarrhea. Therefore, the body's defenses against cholera toxin will also work against the ETEC toxin. It generally takes one week after finishing the first course of immunization for the body's defenses to develop protection against the bacteria.

How do you buy Dukoral?

Dukoral is a prescription-based vaccination and so you'll need a doctor to write a prescription in order for you to pick up your doses from your local pharmacy.

Even in Canada, this is not something that's covered by our universal health care.  In the case of the company that I worked for at the time, their private health care plan covered this prescription 100% which was a nice bonus.  However, when I changed companies later on, I only had partial coverage so it really depends on what the policy is for elective medication.

How do you take Dukoral?

What I like about Dukoral is that it's easy to take on your own once you have it.  For full immunization, it requires 2 doses taken at least 1 week apart but can be up to 6 weeks.  The second dose should be at least 1 week before leaving your home country.

For children 2-6 years old, they have to take 3 doses.  The first dose is 3 weeks prior to travel, second dose, 2 weeks prior, and final dose, 1 week before departure.

Dukoral comes with  two sachets of powder that almost looks like Kool-Aid except white.  You mix it with 5 oz (150 mL) of water and it fizzes up.  To me it tastes kind of like gin and tonic and reminds me a lot of what Emergen-C is like.  I'll just say it's not disgusting.

By taking this vaccine, you're protected for 3 whole months.

If it's you've taken Dukoral within the last 3 months to 5 years, one single dose will renew your protection.  This is what's called a booster 1 week before trip departure.

If you're interested in reading more information about the vaccine itself, make sure to head over to the Dukoral home page.

Does Dukoral Work?

I first used Dukoral in 2012 on a big trip to Asia.  As part of my annual check up I asked my doctor whether I needed anything prior to heading out especially in the South East Asia region.   Turned out I didn't need anything for malaria despite the trekking we were going to do Chiang Mai but what I didn't expect was when he recommended Dukoral.  Since then I've used Dukoral  for my trip to Ethiopia, trekking the Inca Trail in Peru, and safari in South Africa.  Let's just say I've become a regular user.

So this is the main reason why you're here which is to answer whether it's worth it to pay for this vaccine.

Travel case studies

Now take this as a grain of salt because I've heard so many conflicting stories about Dukoral effectiveness but in looking at my big trips, I've never had any serious stomach issues save for in Ethiopia.

In the cases where I didn't get sick, it could mean that I was just really lucky and never encountered any bad foods.  Alternatively, Dukoral did its part and protected me from e-coli and cholera.

In the cases where I did get sick, the thing is that you can still get diarrhea from other forms of bacteria and overall uncleanliness in the preparation and handling of food.

That time I got sick from not taking Dukoral

I then have another story where I didn't take Dukoral on a 7 day itinerary to South Korea, I experienced some serious food  poisoning and I was out of commission for at least two days.

So what does all of this mean?

From a scientific perspective, you'd be able to say that all of these data points are inconclusive and unfortunately that will be the case when you're talking about something like diarrhea when travelling.

At the end of the day, Dukoral only protects you from E. Coli and cholera which are the most common causes of diarrhea but there are also parasites and viruses that can also cause a serious upset stomach.

What I say is that you're better off being protected for the main causes of diarrhea than to be not protected at all.  Yes, you can certainly be smart travellers and avoid drinking unclean tap water, street food, and make sure you use hand sanitizer, but sometimes you just can't control.

The key for me is that there's no side effect for taking Dukoral before you travel other than the cost behind it.  So what is there to lose when you're travelling to a high-risk area?

Conclusion

Despite not being able to make you invincible to travellers' diarrhea, I still give Dukoral my two thumbs up.  You're going to get protection from the most common causes and for me, that's enough to convince me that I should take it for every trip I make to a region that has high potential for getting serious stomach troubles.

I know it's not conclusive but I hope this answers the question of whether “Dukoral works or not”.