How to Prevent Cholera
What is Cholera
Cholera is an infectious disease that causes severe
watery diarrhea, which can lead to dehydration and
even death if untreated. It is caused by eating food or
drinking water contaminated with a bacterium called
Vibrio cholerae.
Cholera was prevalent in the U.S. in the 1800s before
modern water and sewage treatment systems
eliminated its spread by contaminated water. Only
about 10 cases of cholera are reported each year in the
U.S. and half of these are acquired abroad. Rarely,
contaminated seafood has caused cholera outbreaks in
the U.S. However, cholera outbreaks are still a serious
problem in other parts of the world, where cholera
affects an estimated 3 to 5 million people and causes
more than 100,000 deaths each year.
The disease is most common in places with poor
sanitation, crowding, war, and famine. Common
locations include parts of Africa, south Asia, and Latin
America. If you are traveling to one of those areas,
knowing the following cholera facts can help protect
you and your family.
Transmission of Cholera
Cholera is typically transmitted by either contaminated
food or water. In the developed world, seafood is the
usual cause, while in the developing world it is more
often water. Cholera has been found in only two other
animal populations: shellfish and plankton.
People infected with cholera often have diarrhea, and if
this highly liquid stool, colloquially referred to as "rice-
water", contaminates water used by others, disease
transmission may occur. The source of the
contamination is typically other cholera sufferers when
their untreated diarrheal discharge is allowed to get
into waterways, groundwater or drinking water
supplies. Drinking any infected water and eating any
foods washed in the water, as well as shellfish living in
the affected waterway, can cause a person to contract
an infection. Cholera is rarely spread directly from
person to person. Both toxic and nontoxic strains exist.
Nontoxic strains can acquire toxicity through a
temperate bacteriophage. Coastal cholera outbreaks
typically follow zooplankton blooms, thus making
cholera a zoonotic disease.
Cholera Signs and Symptoms
Symptoms of cholera can begin as soon as a few hours
or as long as five days after infection. Often symptoms
are mild. But sometimes they are very serious. About
one in 20 people infected have severe watery diarrhea
accompanied by vomiting, which can quickly lead to
dehydration. Although many infected people may have
minimal or no symptoms, they can still contribute to
spread of the infection.
Signs and symptoms of dehydration include:
Rapid heart rate
Loss of skin elasticity (the ability to return to original
position quickly if pinched)
Dry mucous membranes, including the inside of the
mouth, throat, nose, and eyelids
Low blood pressure
Thirst
Muscle cramps
If not treated, dehydration can lead to shock and death
in a matter of hours.

Cholera Treatment and
Prevention
Although cholera may be life-threatening, prevention
of the disease is normally straightforward if proper
sanitation practices are followed. In developed
countries, due to nearly universal advanced water
treatment and sanitation practices, cholera is no longer
a major health threat. The last major outbreak of
cholera in the United States occurred in 1910–1911.
Effective sanitation practices, if instituted and adhered
to in time, are usually sufficient to stop an epidemic.
There are several points along the cholera transmission
path at which its spread may be halted:
Sterilization: Proper disposal and treatment of
infected fecal waste water produced by cholera victims
and all contaminated materials (e.g. clothing, bedding,
etc.) are essential. All materials that come in contact
with cholera patients should be sanitized by washing in
hot water, using chlorine bleach if possible. Hands that
touch cholera patients or their clothing, bedding, etc.,
should be thoroughly cleaned and disinfected with
chlorinated water or other effective antimicrobial
agents.
Antibiotics
Antibiotic treatments for one to three days shorten the
course of the disease and reduce the severity of the
symptoms. Use of antibiotics also reduces fluid
requirements. People will recover without them,
however, if sufficient hydration is maintained.
Doxycycline is typically used first line, although some
strains of V. Cholerae have shown resistance. Testing
Other Facts About Cholera
for resistance during an outbreak can help determine
appropriate future choices.
Water purification: All water used for drinking,
washing, or cooking should be sterilized by either
boiling, chlorination, ozone water treatment, ultraviolet
light sterilization (e.g. by solar water disinfection), or
antimicrobial filtration in any area where cholera may
be present. Chlorination and boiling are often the least
expensive and most effective means of halting
transmission. Cloth filters or sari filtration, though very
basic, have significantly reduced the occurrence of
cholera when used in poor villages in Bangladesh that
rely on untreated surface water. Better antimicrobial
filters, like those present in advanced individual water
treatment hiking kits, are most effective. Public health
education and adherence to appropriate sanitation
practices are of primary importance to help prevent and
control transmission of cholera and other diseases.
Cholera Vaccine
Cholera vaccine is a vaccine used against cholera and
traveler's diarrhea.
The first vaccines used against cholera were developed
in the late nineteenth century. These injected whole
cell vaccine became increasingly popular until they
were replaced by oral vaccines starting in the 1980s.
Although no longer in use, the injected cholera vaccines
are effective for people living where cholera is endemic.
They offer significant degrees of protection for up to
two years after a single shot, and for three to four years
with annual booster. They reduce the risk of death from
cholera by 50% in the first year after vaccination.
Bacterial strains of both Inaba and Ogawa serotypes
and of El Tor and Classical biotypes are included in the
vaccine. Dukoral is taken orally with bicarbonate buffer,
which protects the antigens from the gastric acid. The
vaccine acts by inducing antibodies against both the
bacterial components and CTB. Antibodies prevent the
cholera toxin from binding to the intestinal mucosal
surface thereby preventing the toxin-mediated
diarrhoeal symptoms. Dukoral also protects against
traveler's diarrhea. The cholera vaccine is largely used
by backpackers and persons visiting locations where
there is a high risk of cholera infection. However, since
it does not provide 100% immunity from the disease,
food hygiene precautions should also be taken into
consideration when visiting an area where there is a
high risk of becoming infected with cholera. Although
the protection observed has been described as
"moderate", herd immunity can multiply the
effectiveness of vaccination. Dukoral has been licensed
for children 2 years of age and older, Shanchol for
children 1 year of age and older. The administration of
the vaccine to adults confers additional indirect
protection (herd immunity) to children.
Where Cholera Occurs
List of Doctors that can Treat Cholera
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