Cholera

Symptoms and Causative Agent

Cholera is a diarrheal illness caused by an infection of the intestine by the Vibrio cholerae bacterium.

In about 80% of cholera infections, the person will have mild or no symptoms. However, about 20% of people with symptoms will experience profuse watery diarrhea, vomiting, and leg cramps.

Symptoms can occur within two hours to five days after initial exposure to V. cholera. 

Transmission

Cholera is transmitted by ingesting food or water contaminated with V. cholerae. The contamination occurs when fecal matter from a sick person comes into contact with food or water supplies.

In areas with poor environmental management and overcrowding, the risk of cholera increases dramatically. Ensuring that food and water supplies are clean and well managed is the easiest way to prevent the spread of cholera. The development and use of piped water systems, chlorination facilities, water filtration, safe water storage containers, and proper sewage disposal have helped reduce the spread of cholera.

Cholera is typically not spread directly from one person to another.

Treatment and Care

People who are ill with cholera can be treated with oral rehydration fluids. Intravenous fluids may be administered if the patient is severely dehydrated.

Antibiotics may be used to reduce the severity of symptoms. However, widespread antibiotic use in areas with many cases of cholera is generally not recommended. Antibiotics do not prevent the spread of the disease, and they may lead to V. cholerae’s increasing antimicrobial resistance.

Complications

In extreme cases of cholera, diarrhea can be so profuse that severe dehydration sets in, which can lead to sunken eyes, cold skin, decreased skin elasticity, wrinkling of the hands and feet, and a bluish tint to the skin.

Death can occur within hours of symptom onset if the patient does not receive treatment.

Available Vaccines and Vaccination Campaigns

Several oral cholera vaccines are available globally. The vaccines provide about 65%-85% protection from clinically significant cholera for a period, from 4 months after vaccination to up to 5 years after vaccination, depending on the vaccine. Because vaccine effectiveness is somewhat low and short-term, cholera vaccines are used mainly for outbreak control and emergency use, rather than routine vaccination.

U.S. Vaccination Recommendations

Cholera vaccination is not routinely recommended in the United States. Water-related spread of the cholera bacterium has been eliminated in the United States due to modern water and sewage treatment systems.

U.S. residents who travel to an area with epidemic cholera (that is, parts of Africa, Asia, or Latin America) should consult a travel physician about cholera vaccination. An oral cholera vaccine (Cholera Vaccine, Live, Oral, [Vaxchora® ]) is approved for adults age 18-64 traveling to cholera-afflicted areas. Travelers to such areas are also advised to practice simple safeguards, such as drinking only bottled water and washing hands frequently.

Sources

• Centers for Disease Control and Prevention. . Updated 11/09/2017. Accessed 01/17/2018.
• CDC. . Updated Oct. 20, 2017. Accessed 01/17/2018.
• Wong, K.K., Burdette, E., and Mintz, E.D. . CDC. Updated 04/31/2017. Accessed 01/17/2018.
• U.S. FDA. . (563 KB). Accessed 01/17/2018.
• World Health Organization. . Updated Dec. 2017. Accessed 01/17/2018.