What is cholera?

Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. The infection is often mild or without symptoms, but sometimes it can be severe. Approximately one in 20 infected persons has severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these persons, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

How does a person get cholera?

A person may get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water.

The cholera bacterium may also live in the environment in brackish rivers and coastal waters. Shellfish eaten raw have been a source of cholera, and a few persons in the United States have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill.

What is the risk for cholera in the United States?

In the United States, cholera was prevalent in the 1800s but has been virtually eliminated by modern sewage and water treatment systems. However, as a result of improved transportation, more persons from the United States travel to parts of Africa, Asia, or Latin America where  epidemic cholera is occurring . U.S. travelers to areas with epidemic cholera may be exposed to the cholera bacterium. In addition, travelers may bring contaminated seafood back to the United States; foodborne outbreaks have been caused by contaminated seafood brought into this country by travelers.

What should travelers do to avoid getting cholera?

The risk for cholera is very low for U.S. travelers visiting areas with epidemic cholera. When simple precautions are observed, contracting the disease is unlikely.

All travelers to areas where cholera has occured should observe the following recommendations:

A simple rule of thumb is "Boil it, cook it, peel it, or forget it. "

Is a vaccine available to prevent cholera?

A recently developed oral vaccine for cholera is licensed and available in other countries (Dukoral from SBL Vaccines). The vaccine appears to provide somewhat better immunity and have fewer adverse effects than the previously available vaccine. However, CDC does not recommend cholera vaccines for most travelers, nor is the vaccine available in the United States . Further information about Dukoral can be obtained from the manufacturers:

Like the dinosaurs, cholera is close to extinction in developed countries. There are very few cases there and one can hardly find the subject in most medical manuals. 

But in Africa, South America and Asia, the case is quite different. Cholera remains a significant health hazard in these parts of the world. 

The organism that causes cholera is called Vibrio cholerae. It's found in the patient's feces, urine and vomit, and is transmitted in contaminated food and water. This "bug" originated in India and spread along the trade routes in a series of epidemics that swept the globe. 

By the 20th century, however, the disease disappeared. Now it is no longer heard of in industrialized nations although isolated outbreaks have occurred in Japan, Australia and Europe. I wish I could say the same thing for other developing countries though. In areas with poor environmental sanitation, cholera is having a ball with dire consequences. 

Diarrhea and vomiting are the main symptoms of cholera which begin two to five days after you pick up the disease. This causes massive fluid loss over the next the few days at the rate of one litre per hour which can be fatal. 

"(Cholera) causes a toxic protein to attach itself to the cells that line the intestinal tract, resulting in a kind of diarrhea you wouldn't believe! The fluid literally pours out! This tremendous loss of water and mineralsleads to shock and collapse of the cardiovascular system. There in lies the threat to life," said Dr. IsadoreRosenfeld? of the New York Hospital - Memorial Sloan Kettering Cancer Center in "The Best Treatment." 

The disease comes in three stages. The first or evacuation stage lasts from three to 12 hours and is characterized by diarrhea, vomiting, abdominal cramps, cold, bluish skin and acute thirst. 

Twenty-four hours later, the second stage begins in which the patient has low body temperature, purple and wrinkled skin, severe cramps, dark or absent urine, low blood pressure and a weak pulse. 

If you make it to the third stage, your condition may improve as cramps and diarrhea decrease. But a secondary infection like pneumonia may occur. 

To save the patient, treatment should begin as soon as possible. Lost body fluids should be replaced with the use of an oral rehydration solution. Antibiotics are effective against the cholera organism. 

"The immediate treatment of cholera is the intrave¬nous replacement of solutions that contain the various substances excreted from the bowel in these huge amounts. Such a preparation recommended by the World Health Organization (WHO) consists basically of salt, potassium, sugar and bicarbonate, and is avail¬able wherever cholera is endemic. But if you're stuck out in the boondocks where no one has this particular WHO formula, you can make your own mixture while waiting for more sophisticated intravenous therapy. Add two tablespoons of molasses and a teaspoonful of salt to every litre of water (boiled, naturally), and drink as much of it as you can - until it virtually comes out of your ears. Do not take any antidiarrheal medications; they do no good in this particular situation and may actually hurt you," Rosenfeld said.