Cholera is an infection of the small intestine caused by Vibrio cholerae bacteria and often results in diarrhea. About 3 to 5 million cases of cholera occur each year around the world, resulting in more than 100,000 deaths annually. Cholera spreads when the feces of an infected person contaminate food or drinking water. The disease is most prevalent in parts of the world that lack adequate sanitation, hygiene, and water treatment methods. Less commonly, the bacteria are also found in the environment in brackish rivers and coastal waters. The consumption of raw shellfish has caused cholera, including a few cases in the United States where people contracted the disease after they ate raw shellfish from the Gulf of Mexico.
Most cholera infections have only mild symptoms and some infections have no symptoms at all. However, about one in ten infections (5%-10%) will lead to profuse diarrhea, vomiting, and leg cramps. The diarrhea is usually painless and watery, but can lead to severe dehydration that can cause death if not treated promptly.
The most important and successful treatment of cholera is the replacement of the water and salts lost through diarrhea. Patients should drink water continuously and can also consume prepackaged oral rehydration solutions of sugar and salts. Intravenous fluid replacement may be necessary for severe cases of cholera. Less than 1 percent of patients die if properly and quickly rehydrated. Antibiotics can be used to shorten the duration of a cholera infection and lessen its severity; however, they are usually not necessary.
A cholera infection can be avoided by following precautions that help prevent the ingestion of microscopic contaminated feces. If you are living or traveling in an area where cholera has occurred, drink only bottled, boiled, or chemically treated beverages. Wash your hands frequently with soap, and use sanitary methods of feces disposal. Peel fruits and vegetables that you will be eating raw, and make sure that other foods, especially meat, are well cooked.
There are two cholera vaccines currently available, DUKOROL® and Shanchol™, but neither is offered in the United States. These vaccines take several weeks to become effective, so they are not recommended for most travelers.