CHOLERA

Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. (1, 2, 5)

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Key facts

  • Cholera is an extremely virulent disease which is caused by ingesting contaminated water or food (1,2)
  • The disease is endemic in Africa, Asia and Central and South America and prevalent in areas where there is poor sanitation (1,2,4)
  • It is estimated that every year, there are roughly 1.3 to 4.0 million cases, and 21,000 to 142,000 deaths per year worldwide due to cholera (1)
  • Symptomatic cholera is shown by watery diarrhoea, vomiting and severe dehydration, which can lead to death if not treated (1,2)
  • Cholera can usually be treated but the risk of contracting the disease can be reduced with vaccination (2)

What is cholera?

Cholera is an acute diarrhoeal infection which is caused by ingesting water or food that has been contaminated with Vibrio cholerae bacteria from faeces of infected people. (1) It is an extremely virulent disease, causing death in both adults and children within hours in some case. (1,2) Cholera outbreaks are mainly caused by 2 serogroups of V. cholerae, however there have also recently been new variants identified in Asia and Africa that are particularly virulent and have been associated with high death rates. (1)
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Where does cholera occur?



Adapted from: World Health Organization.
Cholera, areas reporting outbreaks, 2010 - 2014


Cholera is endemic to many parts of the world which are popular traveller destinations, including Africa, Asia, South America, and Central America. (2-4) It is most likely to occur in places where there is inadequate water treatment, hygiene and poor sanitation such as peri-urban slums and refugee camps. (1,2) Bacteria may also be contracted in brackish rivers or coastal waters and shellfish eaten raw from these areas may also be a source of cholera disease. (2)

Which travellers are at risk of contracting cholera?

Travellers visiting places with poor sanitation are at greatest risk of contracting cholera. (1,2) Volunteers, aid workers and medical personnel in disaster relief situations and those travelling to work in slums/refugee camps, areas affected by natural disasters, or countries experiencing cholera outbreaks are most vulnerable. (5) Cholera is not spread directly from person to person, therefore contact with infected people is not a risk factor. (2)

What are the symptoms of cholera?

In the majority of people (80%) who become infected with cholera, the disease is asymptomatic. However, V. cholerae will be present in the faeces of infected individuals for up to 10 days following infection and will be released into the environment to potentially infect other people. (1) People who do experience symptoms develop either mild-to-moderate symptoms (80%) or acute watery diarrhoea (known as ‘travellers’ diarrhoea’ *) (3), vomiting and leg cramps with severe dehydration (in 20% of infection cases), which can lead to death if left untreated. (1,2) 

*other organisms, parasites and virus’ may also also cause travellers’ diarrhoea

How is cholera treated?

Treatment for cholera involves rehydration following the loss of fluids from diarrhoea. Patients can be treated with large volumes of oral rehydration solution, which is a preparation of sugar and salts mixed with water.1 Severe cases may require intravenous fluid replacement and antibiotics may also be administered to shorten the length of diarrhoea episodes and decrease the excretion of V. cholerae bacteria.1 With prompt administration of rehydration fluids, less than 1% of cholera patients should die. (1-3) Any person who develops severe diarrhoea and vomiting in a country where cholera is known to occur should seek medical attention immediately.



References

  1. World Health Organization. Cholera. Factsheet no.107.
    July 2015. who.int
  2. Centers for Disease Control and Prevention. Cholera. General Information. November 2014. cdc.gov
  3. Zuckerman JN, Rombo L, Fisch A. The true burden and risk of cholera: implications for prevention and control. Lancet Infect Dis 2007; 7: 521–530.
  4. World Health Organization. Cholera, areas reporting outbreaks 2010-2014. gamapserver.who.int
  5. European Centre for Disease Prevention and Control. Health Topics. Cholera. Factsheet. ecdc.europa.eu

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