Cholera

What is cholera?

Cholera is a bacterial infection in your gut that can cause severe, watery diarrhea. It can cause you to quickly lose electrolytes (important minerals that help your body work) and become dehydrated.

Cholera can be fatal if left untreated. Start drinking plenty of fluids if you have diarrhea. Go to the emergency room if you have severe diarrhea, severe vomiting or signs of dehydration.

Cholera most often spreads in areas without access to clean water or toileting facilities. But you can also get it from eating raw shellfish. Outbreaks can happen after heavy rainfalls and natural disasters, like earthquakes and hurricanes.

Where is cholera found?

Throughout history, there’ve been cholera outbreaks in almost every part of the world. In recent years, most outbreaks have happened in:

• Asia.
• Sub-Saharan Africa.
• The Caribbean.

How common is cholera?

About 1 to 4 million people around the world get cholera every year. Anywhere from 20,000 people to over 100,000 people die from it each year.

What are the symptoms of cholera?

The main symptom of cholera is watery diarrhea. It’s usually gray and slightly cloudy with bits of mucus in it (often called “rice water stool”). Episodes of diarrhea can quickly become severe and lead to life-threatening dehydration. Other symptoms include:

• Vomiting.
• Extreme thirst.
• Fatigue.
• Muscle cramps or weakness.
• Dizziness.
• Peeing very little.
• Fast heart rate.

Many people with cholera don’t have symptoms.

What causes cholera?

The bacteria Vibrio cholerae (V. cholerae) causes cholera. V. cholerae live in warm, mildly salty (brackish) water. When you drink water or eat food contaminated with V. cholerae, the bacteria stick to the walls of your small intestine. There, they release toxins that cause diarrhea.

How do you get cholera?

You can get cholera from:

• Eating raw shellfish.
• Drinking water contaminated with poop (feces) containing V. cholerae.
• Eating food prepared with water containing V. cholerae.

Can cholera spread from person to person?

Cholera spreads from person to person indirectly (it doesn’t spread through casual contact, coughing or sneezing, like many contagious diseases). In areas without running water or ways to sanitize water, infected poop can contaminate water. When people drink the water, use it to prepare food or use it to wash their hands, the infection spreads.

What are the risk factors for cholera?

Outbreaks of cholera are more likely to happen in areas without running water, toileting facilities or ways to sanitize drinking and cooking water. They can also happen in areas affected by a natural disaster (like an earthquake or flood).

While anyone who ingests V. cholerae can get infected, some people are at higher risk. You might be at increased risk for cholera if you:

• Were assigned female at birth.
• Have type O blood.
• Have low stomach acid, or hypochlorhydria (for example, if you take antacids or proton pump inhibitors).
• Have had a gastrectomy.
• Have an H. pylori infection.

What are the complications of cholera?

Cholera is dangerous because of the risk of dehydration and losing electrolytes. This can cause complications that can quickly be fatal, including:

• Hypovolemic shock.
• Heart rhythm issues.
• Organ failure.

How is cholera diagnosed?

Healthcare providers diagnose cholera by testing a stool (poop) sample for V. cholerae. Your provider may also get blood tests done.

How is cholera treated?

Treatment for cholera includes drinking plenty of fluids or getting intravenous fluids to prevent dehydration. Healthcare providers also sometimes prescribe antibiotics like doxycycline, erythromycin or azithromycin to help you feel better.

Providers also treat kids between the ages of 6 months and 5 years with zinc supplements.

Antidiarrheal medicines aren’t recommended for cholera and could make symptoms worse.

Can cholera be prevented?

Drinking water that’s been sanitized and washing your hands with clean water and soap are the best ways to reduce your risk of cholera. Drink and cook with bottled water if you’re unsure whether the water where you are is safe to consume.

If you live in or a traveling to a place where you’ll be at higher risk for cholera, there are oral vaccines available. These include:

• Vaxchora®.
• Dukoral.
• Euvichol/Euvichol-Plus/Euvichol-S.

Vaxchora is the only cholera vaccine available in the U.S. Vaccines can help you reduce your risk of getting sick, but they don’t eliminate the risk entirely.

On a larger scale, the best way to prevent cholera is for people to have access to clean drinking water and toilet facilities. This requires global humanitarian and public health efforts.

What happens if you get cholera?

If you have cholera — or any illness that causes diarrhea or vomiting — it’s critical that you drink plenty of fluids before you get dehydrated. Water, broth and oral rehydration solutions (like Pedialyte® or Ceralyte®) are the best choices to keep you hydrated. Avoid sports drinks, fruit juices and soda — the high sugar content can make diarrhea worse. You should also avoid anti-diarrheal medications.

When should I go to the ER?

Diarrhea can quickly dehydrate you. If you have severe bouts of diarrhea or vomiting, don’t hesitate to go to the emergency room or seek emergency medical attention. Call 911 or get to the ER right away if you’ve had diarrhea or vomiting and experience:

• Muscle cramps.
• Extreme thirst.
• Peeing very little or not peeing at all.
• Dizziness.
• Weakness.
• Fast heart rate.
• Confusion or altered mental state.

Can cholera go away on its own?

Yes, you can recover from cholera without antibiotics. But you do need to manage the symptoms by getting plenty of fluids and replacing electrolytes to avoid getting severely ill.

What’s the mortality rate for cholera?

With treatment — managing fluids to prevent dehydration — the mortality (death) rate of cholera is less than 1%. Without treatment, it’s over 50%.

What questions should I ask my doctor?

It might be helpful to ask your provider:

• What’s the best way to stay hydrated?
• What should I do if I think I’m getting dehydrated?
• How can I prevent spreading cholera?

How can I protect myself if I plan to be in an area with cholera?

The U.S. Centers for Disease Control and Prevention (CDC) has a website where travelers can check for outbreaks of cholera and other diseases. (Visit their Travel Health Notices website.)

If you live in an area with cholera or plan to travel to one, make sure you’re careful about the water you drink. Wash your hands and prepare food carefully. The following supplies might help:

• Bottled water.
• Chlorine tablets.
• Household bleach.
• Iodine tablets.
• Prepackaged foods.

If you have severe diarrhea from cholera or another cause, contact a healthcare provider immediately. You must replace fluids and electrolytes to avoid dehydration. This complication can cause serious health problems and even death.