Travel Medicine

Emerging Infectious Diseases and Other Conditions

Cholera

What is cholera?

Announcement from the Centers for Disease Control

Cholera has been reported in a small number of US residents traveling to several Latin American countries. However, the risk of infection is very low, especially for those who follow the usual tourist itineraries and stay in standard accommodations.

Cholera is a diarrheal disease caused by the consumption of water or food contaminated with the bacterium Vibrio cholerae.

Cholera is a public health concern in developing countries all over the world, especially in Africa, south Asia, and Latin America. Cases among travelers to and from developed countries are rare, however, some outbreaks in the United States have been caused by contaminated seafood brought into the country by travelers.

What causes cholera?

Vibrio cholerae is usually found in impure water supplies because of the unsanitary disposal of excrement. Person-to-person transmission is rare. It is usually transmitted by consuming contaminated food or water from:

municipal water supplies
ice made from municipal water
foods and beverages bought from street vendors
vegetables irrigated with fresh sewage
raw or inadequately cooked fish and seafood taken from sewage-polluted waters

How does the Vibrio cholerae bacterium affect the body?

The bacterium that causes cholera is usually very sensitive to the acids present in the stomach and digestive tract. Small amounts of bacteria are killed by the stomach acids before they can establish themselves in the body.

But, when large numbers of the bacteria overwhelm the body's natural defenses, they grow in the small intestine and are passed in the fecal material of the infected person. Infected persons who have mild cases or show no symptoms of the disease -- especially those who have poor personal hygiene habits -- spread the infection by direct contamination of food with infected excrement.

Can cholera be prevented?

"Boil it, cook it, peel it, or forget it."
-- Centers for Disease Control

The best preventives for cholera are:

only use water that has been boiled or chemically disinfected for:
- drinking, or preparing beverages such as tea or coffee
- brushing teeth
- washing face and hands
- washing fruits and vegetables
- washing eating utensils and food preparation equipment
- washing the surfaces of tins, cans, and bottles that contain food or beverages

do not eat food or drink beverages from unknown sources
- any raw food could be contaminated, including:
  - fruits, vegetables, salad greens
  - unpasteurized milk and milk products
  - raw meat
  - shellfish
  - any fish caught in tropical reefs rather than the open ocean

A cholera vaccine is no longer available in the United States because it is not recommended by the CDC or the World Health Organization. Currently, no country requires the cholera vaccine for entry if arriving from cholera-infected countries.

How may cholera be treated?

For diarrhea that is worse than normal and does not respond to medications, it is best for the traveler to consult a physician rather than try self-medication. Seek medical help if diarrhea becomes severe and watery, or if vomiting occurs.

Specific treatment for cholera will be determined by your physician(s) based on:

your overall health and medical history
extent of the disease
your tolerance for specific medications, procedures, or therapies
expectations for the course of the disease
your opinion or preference

Treatment for cholera may involve rehydration with:

oral rehydration solutions
intravenous solutions in the most severe cases

Treatment with antibiotics is sometimes used to decrease the duration of illness, but are not thought to be necessary for successful treatment.

This page was last updated on: February 14, 2008.

For patient inquiries, call 1-800-492-5538 or click here to make an appointment.