Cholera

What Is It?

Cholera is a diarrheal disease caused by a bacterial infection.

Cholera is estimated to be present in 69 countries in Africa, the Americas, the Eastern Mediterranean region, Southeast Asia, and the Western Pacific region. People with cholera often have mild or no symptoms. In a subset of individuals, severe cholera may occur. In these severe cases, profuse diarrhea may occur that, without proper medical care, may lead to rapid dehydration, shock, or even death. With proper medical care, however, the likelihood of death is low.

How is it Acquired?

Cholera is spread by eating or drinking food and/or water contaminated with the cholera bacteria.

Cholera is most likely to be found and spread in places that have inadequate water treatment, poor sanitation, and inadequate hygiene. People can also get cholera by eating raw or undercooked shellfish, because cholera bacteria are naturally found in brackish (slightly salty) rivers and coastal waters.

Cholera is not likely to be spread directly from person to person, so casual contact with an infected person would not increase the likelihood for becoming ill.

Factors that may increase the likelihood of acquiring cholera include:

• Visiting friends or relatives while traveling
• Treating cholera patients (i.e. healthcare workers)
• Remaining in cholera-affected areas for long periods of time
• Not following or being unable to follow safe food and water or hygiene practices

Travelers visiting friends and relatives are particularly prone because they tend to stay longer than tourists, eat local food in people’s homes, and may not take the same precautions as other tourists. They are also less likely to see a healthcare provider prior to travel.

Factors contributing to poor outcomes may include:

• Blood type O
• Reduced stomach acids
• Chronic medical conditions (eg, cardiovascular or kidney disease)
• Lack of access to rehydration therapy or medical care

Signs and Symptoms

Although cholera can be mild, it can progress to severe disease extremely quickly.

Cholera symptoms may appear within a few hours or up to five days after infection. Most people have symptoms within two to three days.

In severe cases of cholera, profuse diarrhea may occur.

If untreated, severe cholera may lead to:

• Rapid dehydration
• Shock
• Death

With proper medical care the likelihood of death is low. Antibiotics may shorten the duration of disease, but travelers with symptomatic cholera will still suffer the consequences of their illness. Antibiotics are only recommended in severe cases.

Precautions to Take

Some cholera precautions include:

• Only drinking and using safe water for all your activities
• Washing hands often with soap and water
• Eating food that is cooked and served hot
• Only eating fruits and vegetables that have been washed in clean water and that you peeled yourself

Discuss with a healthcare provider whether you should be vaccinated for cholera.

Check out the Food and Water Safety Guidelines from the Centers for Disease Control and Prevention for more information.