What is cholera?

Cholera is a diarrhoeal disease caused by infection of the intestine with the bacterium Vibrio cholerae. Children as well as adults can get infected.

In most cases, infection causes only mild diarrhoea or no symptoms at all. In 5–10% of cases, however, patients develop very severe watery diarrhoea and vomiting from 6 hours to 5 days after exposure to the bacterium. In these cases, the loss of large amount of fluids can rapidly lead to severe dehydration. In the absence of adequate treatment, death can occur within hours.

How is cholera spread?

Infection is transmitted via the consumption of drinking water or food contaminated by the bacterium. Common sources of foodborne infection include raw or poorly cooked seafood, raw fruit and vegetables, and other foods contaminated during preparation or storage.

Bacteria present in the faeces of an infected person are the main source of contamination. The bacterium can also live in the environment in brackish rivers and coastal waters. The disease can thus spread rapidly in areas where sewage and drinking water supplies are inadequately treated.

 Where do outbreaks occur?

Cholera remains an ever-present risk in many countries. New outbreaks can occur sporadically in any part of the world where water supplies, sanitation, food safety, and hygiene are inadequate. The greatest risk occurs in overpopulated communities and refugee settings characterized by poor sanitation and unsafe drinking water.

Can cholera be prevented?

Yes. People living in high-risk areas can protect themselves by following few simple rules of good hygiene and safe food preparation. These include scrupulous washing of hands, especially before food preparation and eating, thorough cooking of food and consumption while hot, boiling or treatment of drinking water, and use of sanitary facilities. By taking a few basic precautions, travellers can likewise protect themselves against cholera and most other food- and water-borne diseases. Above all, travellers should be very careful with food and water, including ice, and remember this simple rule: boil it, cook it, peel it, or forget it.

What treatment are available?

The most important treatment is rehydration, which consists of prompt replacement of the water and salts lost through severe diarrhoea and vomiting. Early rehydration can save the lives of nearly all cholera patients. Most can be rehydrated quickly and easily by drinking large quantities of a solution of oral rehydration salts. Packets of these salts are available from most city pharmacies and health care facilities. WHO recommends that travellers include oral rehydration salts in their medical kits.

What about antibiotics and other drugs?

In individual cases of severe cholera, an effective antibiotic can help shorten illness, though rehydration remains the mainstay of treatment. For whole communities, however, preventive mass treatment with an antibiotic does not limit the spread of cholera and is thus not recommended. Antidiarrhoeal medicines, such as loperamide, should never be given.