Cholera

What is cholera?

Cholera is an acute (sudden and severe) illness caused by the bacterium Vibrio cholera infecting a person’s intestines. Between 1 and 4 million people worldwide are affected by cholera each year. People can get very bad diarrhea from cholera. Some 21,000 to 143,000 die, most often from dehydration.

How common is cholera?

Cholera occurs in areas without clean water. It is rare in industrialized countries, such as the United States, ever since modern sewer and water systems appeared about 200 years ago. Although cholera usually occurs in areas of poor sanitation and unclean water, outbreaks can also take place after natural disasters, such as hurricanes, earthquakes, etc.

Unfortunately, cholera is on the rise in other parts of the world, and the rate has increased steadily since 2005. Cholera is believed to exist in about 60 countries today, mostly in Africa, Southeast Asia, and Haiti. Areas in which there are large numbers of refugees can have more cases, as refugee camps often do not have proper sanitation. Recent studies also show that climate change creates a favorable environment for cholera-causing bacteria to live.

With these factors, and with an increase in travel around the world today, Americans need to be aware of cholera. It can be life-threatening if not treated properly.

What are the symptoms of cholera?

Cholera infection can be mild, and some people have no symptoms. However, in about 1 in 10 infected people, the symptoms can be very severe. These patients will have a lot of watery diarrhea, vomiting, and leg cramps. They can lose bodily fluids very quickly, leading to dehydration and shock. Severe dehydration can be fatal, sometimes very quickly (within hours).

Symptoms usually appear 2 to 3 days after a person has been exposed to cholera. They can also appear within hours, or take up to 5 days to develop.

How does a person get cholera?

People usually come in contact with cholera bacteria from consuming food or water that has been contaminated by feces from a person who has cholera. This often happens in areas in which there is inadequate water treatment, poor sanitation, and poor hygiene. Areas near water sources that are somewhat salty and warm, such as coastal areas, are more likely to have cholera outbreaks than other areas.

Cholera typically does not spread from one person to another directly, so you are unlikely to get it from casual contact with a person with cholera. Person-to-person transmission can occur, however. It is important to observe very careful hand hygiene and disposal of sewage, waste water, and anything that might be contaminated.

How is cholera diagnosed?

The only way to make a definite diagnosis of cholera is to send a stool sample or a rectal swab to a laboratory that can test for the cholera bacterium.

In remote areas where cholera is widespread but there are few laboratories, a rapid “dipstick” can be used to test a stool sample. Studies have found such tests to be highly accurate.

How is cholera treated?

If you are having severe diarrhea, especially if you think you may have been exposed to cholera, seek medical attention right away. A person with a severe diarrhea can become dehydrated very quickly, and can die. To prevent this, you may need to have an intravenous (through a needle) injection of fluids.

If there is not a medical facility nearby (which is often the case in poorer areas that are most likely to have cholera), oral rehydration solution (ORS), a prepackaged blend of sugars and salts mixed with water, can help most people. Do not stop drinking it until you have seen a medical professional. Almost all cholera patients who get fluids promptly will survive.

If you have an infant who may have cholera, continue breastfeeding if possible. This will provide important nutrition to the child.

Antibiotics can help cholera patients recover more quickly and reduce their symptoms. However, antibiotics are less important than getting enough hydration.

Am I at risk for getting cholera?

People who do not live in or visit areas where sanitation is poor have almost no risk of getting cholera. Even for people who do live in or visit such areas, the risks are not great.

Here are some precautions that can reduce your risk of getting cholera if you are in an area where it is widespread:

• Drink only bottled, boiled, or chemically treated water or carbonated beverages. When using bottled drinks, make sure that the seal has not already been broken.
• Avoid tap water and ice cubes made from tap water.
• If bottled water is not available, you can disinfect water by boiling it for one minute or filtering it, and then adding two drops of household bleach or half of an iodine tablet per liter of water.
• Wash your hands with soap and clean water every time you use the bathroom, and before you eat or prepare food. If soap and water are not available, use an alcohol-based hand cleaner that is at least 60% alcohol.
• Eat foods that are pre-packaged or that are freshly cooked and served hot. Avoid raw and undercooked meats and seafood or unpeeled fruits and vegetables.
• Dispose of feces in a place away from water that is used for drinking or food, especially if you have had cholera.

Is there a vaccine for cholera?

In 2016, the U.S. Food and Drug Administration approved a single-dose live oral cholera vaccine called Vaxchora® for adults 18 to 64 years old who are traveling to areas known to be affected by the most common bacterial strain of cholera. The vaccine is not recommended for most travelers from the United States, as most tourists do not visit areas with active cholera transmission. The vaccine is not 100% effective, so people who get it still need to use caution when traveling to areas known to have cholera.

There are 2 other oral vaccines for cholera, but they are they not available in the United States. If you work for an organization that is based outside the United States and travel to areas known to have cholera, you may be able to access 1 of them. Both require 2 doses to be most effective.