Cholera V. cholerae Last reviewed: May 30, 2012.

Cholera is an infection of the small intestine that causes a large amount of watery diarrhea. Causes, incidence, and risk factors Cholera is caused by the bacterium Vibrio cholerae. The bacteria releases a toxin that causes increased release of water from cells in the intestines, which produces severe diarrhea. Cholera occurs in places with poor sanitation, crowding, war, and famine. Common locations for cholera include:
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Africa Asia India Mexico South and Central America

People get the infection by eating or drinking contaminated food or water. A type of vibrio bacteria also has been associated with shellfish, especially raw oysters. Risk factors include:
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Exposure to contaminated or untreated drinking water Living in or traveling to areas where there is cholera

Symptoms
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Abdominal cramps Dry mucus membranes or mouth Dry skin

Antibiotics may shorten the time you feel ill. or IV). Signs and tests Tests that may be done include:   Blood culture Stool culture and gram stain Treatment The goal of treatment is to replace fluid and electrolytes lost through diarrhea.            Excessive thirst Glassy or sunken eyes Lack of tears Lethargy Low urine output Nausea Rapid dehydration Rapid pulse (heart rate) Sunken "soft spots" (fontanelles) in infants Unusual sleepiness or tiredness Vomiting Watery diarrhea that starts suddenly and has a "fishy" odor Note: Symptoms can vary from mild to severe. you may be given fluids by mouth or through a vein (intravenous. Depending on your condition. . Antibiotics that may be used includetetracycline or doxycline.

most people will make a full recovery.The World Health Organization (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical IV fluid. This solution is now being used internationally. including: o o o o o o o o o o Dry mouth Dry skin "Glassy" eyes Lethargy No tears Rapid pulse Reduced or no urine Sunken eyes Thirst Unusual sleepiness or tiredness . Given adequate fluids. Complications   Severe dehydration Death Calling your health care provider Call your health care provider if :   You develop severe watery diarrhea You have signs of dehydration. Expectations (prognosis) Severe dehydration can cause death.

 Oral cholera vaccines are considered an additional means to control cholera.S.    Up to 80% of cases can be successfully treated with oral rehydration salts. Provision of safe water and sanitation is critical in reducing the impact of cholera and other waterborne diseases. preparedness and response. watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not promptly given. but should not replace conventional control measures. There are an estimated 3–5 million cholera cases and 100 000–120 000 deaths due to cholera every year. (Such a vaccine is not available in the United States. Centers for Disease Control and Prevention does not recommend cholera vaccines for most travelers.gov/pubmedhealth/PMH0001348/ Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.nlm.ncbi. When outbreaks of cholera occur.) Travelers should always take precautions with food and drinking water. Effective control measures rely on prevention.who. and produces an enterotoxin that causes a copious. even if vaccinated. http://www. food. It has a short incubation period. efforts should be directed toward establishing clean water.nih. Vomiting also occurs in most patients. .Prevention The U. painless. from less than one day to five days. http://www. and sanitation.int/topics/cholera/en/ ey facts   Cholera is an acute diarrhoeal disease that can kill within hours if left untreated. because vaccination is not very effective in managing outbreaks.

Symptoms Cholera is an extremely virulent disease. 80% have mild or moderate symptoms. there are an estimated 3–5 million cholera cases and 100 000–120 000 deaths due to cholera. Cholera is now endemic in many countries. This can lead to death if untreated. cholerae do not develop any symptoms. It affects both children and adults and can kill within hours. The current (seventh) pandemic started in South Asia in 1961. Six subsequent pandemics killed millions of people across all continents. V. Non-O1 and non-O139 V. cholerae O1 causes the majority of outbreaks. The short incubation period of two hours to five days. Every year. cholera spread across the world from its original reservoir in the Ganges delta in India. while around 20% develop acute watery diarrhoea with severe dehydration. History During the 19th century. although the bacteria are present in their faeces for 7–14 days after infection and are shed back into the environment. potentially infecting other people. People with low immunity – such as malnourished children or people living with HIV – are at a greater risk of death if infected.Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. About 75% of people infected with V. Among people who develop symptoms. Vibrio cholerae strains Two serogroups of V. cholerae can cause mild diarrhoea but do not generate epidemics. . and reached Africa in 1971 and the Americas in 1991. cholerae – O1 and O139 – cause outbreaks. enhances the potentially explosive pattern of outbreaks. while O139 – first identified in Bangladesh in 1992 – is confined to South-East Asia.

Risk factors and disease burden Cholera transmission is closely linked to inadequate environmental management. Prevention and control A multidisciplinary approach based on prevention. For 2011 alone. where minimum requirements of clean water and sanitation are not met. often associated with algal blooms. The consequences of a disaster – such as disruption of water and sanitation systems. the re-emergence of cholera has been noted in parallel with the everincreasing size of vulnerable populations living in unsanitary conditions. where basic infrastructure is not available. Cholera remains a global threat to public health and a key indicator of lack of social development. Many more cases were unaccounted for due to limitations in surveillance systems and fear of trade and travel sanctions. The true burden of the disease is estimated to be 3–5 million cases and 100 000–120 000 deaths annually. or the displacement of populations to inadequate and overcrowded camps – can increase the risk of cholera transmission should the bacteria be present or introduced. as well as camps for internally displaced people or refugees. Observations suggest that these strains cause more severe cholera with higher case fatality rates. new variant strains have been detected in several parts of Asia and Africa. The main reservoirs of V. Recently. Epidemics have never arisen from dead bodies. Typical at-risk areas include peri-urban slums.Recently. Careful epidemiological monitoring of circulating strains is recommended. including 7816 deaths. a total of 589 854 cases were notified from 58 countries. Recent studies indicate that global warming creates a favourable environment for the bacteria. The number of cholera cases reported to WHO continues to rise. preparedness and response. cholerae are people and aquatic sources such as brackish water and estuaries. along with an efficient surveillance system. is key for mitigating cholera outbreaks. controlling cholera in endemic areas and reducing deaths. .

The other vaccine (Shanchol) provides longer-term protection against V.Treatment Cholera is an easily treatable disease. Dukoral has been shown to provide short-term protection of 85–90% against V. Up to 80% of people can be treated successfully through prompt administration of oral rehydration salts (WHO/UNICEF ORS standard sachet). one with a recombinant B-sub unit. and shorten the duration of V. The provision of safe water and sanitation is a formidable challenge but remains the critical factor in reducing the impact of cholera. cholerae excretion. proper sanitation and health education for improved hygiene and safe food handling practices by the community. In order to ensure timely access to treatment. cholerae O1 among all age groups at 4–6 months following immunization. the usual intervention strategy is to reduce deaths by ensuring prompt access to treatment. Such patients also require appropriate antibiotics to diminish the duration of diarrhoea. With proper treatment. Both are whole-cell killed vaccines. Mass administration of antibiotics is not recommended. cholerae O1 and O139 in children under five years of age. and to control the spread of the disease by providing safe water. Both have sustained protection of over 50% lasting for two years in endemic settings. Outbreak response Once an outbreak is detected. reduce the volume of rehydration fluids needed. Very severely dehydrated patients require administration of intravenous fluids. as it has no effect on the spread of cholera and contributes to increasing antimicrobial resistance. . Both vaccines are WHO-prequalified and licensed in over 60 countries. cholera treatment centres (CTCs) should be set up among the affected populations. the case fatality rate should remain below 1%. the other without. Oral cholera vaccines There are two types of safe and effective oral cholera vaccines currently available on the market.

Vaccines provide a short term effect while longer term activities like improving water and sanitation are put in place. information should be provided to travellers and the community on the potential risks and symptoms of cholera. based on the sole fact that cholera is epidemic or endemic in a country. and when and where to report cases. When used. Isolated cases of cholera related to imported food have been associated with food in the possession of individual travellers. 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. The vaccine with the B-subunit (Dukoral) is given in 150 ml of safe water. Further.Both vaccines are administered in two doses given between seven days and six weeks apart. together with precautions to avoid cholera. WHO response Through the WHO Global Task Force on Cholera Control. Past experience shows that quarantine measures and embargoes on the movement of people and goods are unnecessary. import restrictions on food produced under good manufacturing practices. Consequently. The WHO 3-step decision making tool aims at guiding health authorities in deciding whether to use cholera vaccines in complex emergency settings. WHO recommends that immunization with currently available cholera vaccines be used in conjunction with the usually recommended control measures in areas where cholera is endemic as well as in areas at risk of outbreaks. are not justified. Countries neighbouring cholera-affected areas are encouraged to strengthen disease surveillance and national preparedness to rapidly detect and respond to outbreaks should cholera spread across borders. Travel and trade Today. no country requires proof of cholera vaccination as a condition for entry. vaccination should target vulnerable populations living in high risk areas and should not disrupt the provision of other interventions to control or prevent cholera epidemics. WHO works to:  provide technical advice and support for cholera control and prevention at country level .

regional and international levels in prevention. train health professionals at national.int/mediacentre/factsheets/fs107/en/ .who. http://www. preparedness and response of diarrhoeal disease outbreaks  disseminate information and guidelines on cholera and other epidemic-prone enteric diseases to health professionals and the general public.

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