According to the World Health Organization, cholera affects 3–5 million people and kills 100,000–120,000 people worldwide annually. “Modern sewage and water treatment have virtually eliminated cholera in industrialized countries. The last major outbreak in the United States occurred in 1911. But cholera is still present in Asia, the Middle East, Latin America, India and sub-Saharan Africa. The risk of cholera epidemic is highest when poverty, war or natural disasters force people to live in crowded conditions without adequate sanitation.” (Mayo Clinic)
Symptoms of Cholera
About 75 percent of people infected with the cholera bacterium, usually through contaminated water, do not experience any symptoms. However, they can pass along the bacteria to other people through their feces, in which it can live for 7 to 14 days after infection. If symptoms do develop, about 80 percent experience mild to moderate symptoms and about 20 percent develop acute, watery diarrhea with severe dehydration, which can lead to death in a matter of hours even in previously healthy people.
Symptoms may include:
• Diarrhea which comes on suddenly and appears pale, milky white, like water in which rice has been rinsed. The diarrhea can cause a person to lose up to a quart (.95 liters) an hour.
• Nausea and vomiting can occur in the early and later stages. Vomiting may persist for hours at a time.
• Dehydration can occur within hours after the onset of symptoms. “A loss of 10 percent or more of total body weight indicates severe dehydration.” (Mayo Clinic)
• Irritability, lethargy, sunken eyes, dry mouth, extreme thirst, dry and shriveled skin with low elasticity when pinched, little to no urine output, low blood pressure, irregular heartbeat, and electrolyte imbalance as a body loses minerals.
• Children, in addition to the above symptoms, may also experience extreme drowsiness, fever, convulsions or even coma.
Containment and Treatment for Cholera
The good news is that cholera is easily treatable and curable in 80 percent of cases. This is done through the administration of oral rehydration salts, which can be provided intravenously for patients who are very severely dehydrated. Medications can also be administered to decrease the duration of the diarrhea and reduce the amount of rehydration fluids required.
The key to containment in an outbreak situation is through prevention, preparedness and response, including the provision of safe water and sanitation, which is critical to reducing the impact of cholera and other waterborne diseases. (World Health Organization) Improved food handling processes are also part of the solution.
If you are traveling to an area of the world where you might be exposed to cholera, there are effective and safe oral cholera vaccines available. Dukoral provides short-term protection of 85–90 percent against the O1 strain 4–6 months following immunization. Shanchol provides longer-term protection against O1 and O139 in children under the age of five. Both vaccines are administered in two doses given between seven days and six weeks apart. Dukoral is given in 150 milliliters of safe water.
It is important to make sure that you arrange for the vaccine at four to six months before your anticipated trip to ensure that the protection is in full effect.
As a cautionary note, “The use of the parenteral cholera vaccine has never been recommended by WHO due to its low protective efficacy and the high occurrence of severe adverse reactions.” (World Health Organization)
Cholera. World Health Organization. Web. 7, Sept. 2011.
Cholera. The Mayo Clinic. Web. 7, Sept. 2011.
Reviewed September 9, 2011
by Michele Blacksberg R.N.
Edited by Jody Smith