Cholera

What is cholera? 

Cholera is an acute diarrheal illness caused by certain strains of the bacterium Vibrio cholerae. 

Who gets cholera? 

People who live in crowded conditions with poor sanitation are the most likely to get cholera. The disease is not a threat in the U.S. and other countries with advanced water and sanitation systems. In the U.S., cases of cholera are reported in persons who travel to foreign countries where outbreaks of cholera are occurring and who drink contaminated water and food there, or those who eat undercooked seafood, including seafood from the Gulf of Mexico.

How is cholera spread? 

People with cholera shed the bacteria in their feces (stool). The main way cholera is spread is when feces from a person with cholera get into the water. People can get sick from swallowing the contaminated water. Food can also be contaminated; this can happen if food is washed with unclean water, or fertilized with sewage or contaminated soil. If shellfish are harvested from water that has been contaminated, people can get sick from eating the shellfish if it is raw or undercooked. The disease is not usually spread directly from one person to another because a relatively large dose of bacteria, more than a person usually has on his/her hands, has to enter the mouth to cause illness. Proper water treatment and sanitation minimize the risk of cholera.

What are the symptoms of cholera? 

Most people exposed to the cholera bacteria will not develop any symptoms. The most common symptoms are mild to severe watery diarrhea, vomiting, weakness, and leg cramps. In severe cases, when treatment is unavailable or delayed, death can occur within a few hours due to loss of large amounts of fluid. With rapid, proper treatment, very few people will die from cholera.

How soon after exposure do symptoms appear? 

Symptoms may appear anywhere from six hours to five days after exposure, but usually appear within two to three days after exposure.

How is cholera diagnosed? 

Special laboratory testing of a stool sample is needed to confirm that a person has cholera. Cholera January 2013 – page 2 

What is the treatment for cholera? 

Persons with symptoms of cholera should seek medical care immediately. The most important treatment is replacement of fluid lost from the body due to diarrhea. It is very important that special replacement fluids containing the right balance of electrolytes (sodium, chloride, and potassium), sugar and water are used to replace the fluids lost due to diarrhea. In severe illness, intravenous (I.V.) fluids may be necessary. Antibiotics are also sometimes used.

How can cholera be prevented? 

Safe drinking water and proper sanitation are the keys to cholera prevention. When traveling in countries where cholera is present, eat only thoroughly cooked hot foods or fruits/vegetables that you peel just before eating. Use only bottled beverages or water that has been boiled or treated with chlorine for drinking, brushing teeth, or cleaning food preparation surfaces. Thorough hand washing with soap after using the bathroom and before preparing or eating food is always important. Seafood should be cooked thoroughly before it is eaten.

Two vaccines for cholera have been developed, but they are not available in the U.S. and are not recommended for travelers. The vaccines require two doses over several weeks, and provide only partial protection of short duration. Prospective travelers to areas where cholera is common should carefully follow recommendations for obtaining safe food and water at their destination, and seek medical attention promptly if they develop symptoms of cholera.

How can I get more information about cholera? 

1) If you have concerns about disease, contact your healthcare provider.

2) Call your local health department. A directory of local health departments is located at http://www.vdh.virginia.gov/local-health-districts/.

3) Visit the Centers for Disease Control and Prevention website at http://www.cdc.gov/cholera/index.html.