Cholera: Prevention

The best form of cholera prevention is to establish good sanitation and waste treatment systems. In the absence of adequate sewage treatment, the following guidelines should be followed to reduce the possibility of infection:

• Boil it. Drink and brush teeth only with water that has been boiled or treated with chlorine or iodine tablets. Safe drinks include coffee and tea made with boiling water or carbonated bottled water and carbonated soft drinks.
• Cook it. Eat only thoroughly cooked foods, and eat them while they are still hot. Avoid eating food from street vendors.
• Peel it. Eat only fruit or nuts with a thick, intact skin or shell that is removed immediately before eating.
• Forget it. Do not eat raw foods such as oysters or ceviche. Avoid salads and raw vegetables. Do not use untreated ice cubes in otherwise safe drinks.
• Stay out of it. Do not swim or fish in polluted water.

A cholera vaccine exists that can be given to travelers and residents of areas where cholera is known to be active, but the vaccine is not highly effective. It provides only 25–50% immunity, and then only for a period of about six months. The vaccine is never given to infants under six months of age. The United States Centers for Disease Control and Prevention do not currently recommend cholera vaccination for travelers. Residents of cholera-plagued areas should discuss the value of the vaccine with their doctor.