What you should know about: Cholera

What is cholera?

Cholera is an acute (sudden or severe; with limited duration) disease of the small intestine caused by the bacterium Vibrio cholerae .

What does cholera cause?

Most persons infected with V. cholerae do not become ill, although the bacterium is present in their stool for 7-14 days. About one in 20 infected persons has severe disease characterized by large amounts of watery diarrhea, vomiting, and leg cramps. The resulting loss of fluids in an infected individual can rapidly lead to severe dehydration. If not treated, death can occur within hours.

How do people get cholera?

The most common cause of cholera is by someone eating food or drinking water that has been contaminated with the bacteria.

How common is cholera?

Although only a few cases are recognized in the U.S. each year, epidemic levels of cholera are reported worldwide, particularly in parts of Africa. In 2001, there were over 180,000 cases reported in 58 countries. Cases seen today are part of a pandemic (a worldwide epidemic) that started over 40 years ago, affecting millions. Cholera reached the Americas in 1991, affecting at least a million people. In 2002, fewer than 30 cases were reported in the Americas.

In the U.S., cases are usually traced to people traveling to cholera-risk areas or to people who have eaten food brought over from cholera-risk areas. Shellfish eaten raw have been a source of cholera, and a few persons in the U.S. have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico.

Who is likely to get cholera?

The greatest risk of cholera occurs in overpopulated communities and refugee settings characterized by poor sanitation, inadequate sewage treatment, and unsafe drinking water.

How do I protect myself from cholera?

Although available in other countries, there are currently no vaccines licensed for use in the U.S. The vaccine is not recommended for travelers because the risks of acquiring cholera are generally low and because the protection it offers is brief and incomplete.

What do I do if I think I have cholera?

Prompt treatment is essential. If you have diarrhea, especially severe diarrhea, in an area where there is cholera, seek treatment immediately from a physician or other trained health care provider. Begin drinking water and other non-sweetened fluids, such as soup, on the way to getting medical treatment.

How are cholera infections diagnosed?

Cholera is diagnosed by isolating the bacteria from an infected person's stool.

How are cholera infections treated?

Cholera can be simply and successfully treated by immediate oral replacement of the fluid and salts lost through diarrhea (oral rehydration). Severe cases are treated using intravenously administered fluids and antibiotics such as tetracycline or doxycycline.

Should I worry about cholera when I travel out of the country?

Most travelers visiting an area where cholera occurs are at very low risk of acquiring infection. Travelers who may be at increased risk for acquiring cholera include health professionals working in endemic areas, aid workers in refugee camps, and travelers to remote cholera areas without access to safe water supplies.

• Drink only water that you have boiled or treated with chlorine or iodine. Avoid popsicles and flavored ices that may have been made with contaminated water.
• Other safe drinks include tea or coffee made with boiled water and carbonated, bottled beverages with no ice.
• Avoid undercooked or raw fish and shellfish.
• Avoid raw salads and vegetables.
• Eat only food that's been thoroughly cooked and is still hot, or fruit that you've peeled yourself.
• Avoid food and drinks from street vendors. If not, be sure that meals bought from street vendors are thoroughly cooked in your presence and do not contain any uncooked foods.
• Avoid unpasteurized dairy products and ice cream.

•  Practice good personal hygiene, including frequent handwashing.

Websites for the Center for Disease Control and the World Health Organization provide updates on ongoing cholera outbreaks.