CHOLERA

Cholera is an acute (sudden, short-term) diarrheal intestinal infection caused by the bacteria
Vibrio cholerae. Although reported cases of cholera number in the low hundreds of thousands each
year, most estimates place the actual worldwide prevalence much higher, according to a 2012
report in the Bulletin of the World Health Organization. Currently, the World Health Organization
(WHO) estimates that 2.8 million cases of cholera (with a possible range of 1.2 to 4.3 million
cases) occur annually in endemic countries, or those in which cholera is regularly found. The
illness kills about 91,000 (possible range of 28,000 to 142,000) people each year.

Cholera Bacteria

Vibrio cholerae is a type of bacteria that naturally lives in brackish and estuarine waters areas in
which the water is slightly salty. Two serotypes, or strains, of V. cholerae cause outbreaks of
cholera: O1 and O139. While inside a person's body, these strains release the cholera toxin, which
causes cells that line the intestine to release increased amounts of water. Other serotypes
collectively known as non-O1 and non-O139 V. cholerae can cause less severe diarrhea than
cholera, but don't result in epidemics.

How Do You Get Cholera?

You can get O1 or O139 bacteria in your system by eating food or drinking liquids
contaminated with them. The bacteria infect the intestines and reproduce in the body. A person
infected with the bacteria can cause a one-million-fold increase in V. cholerae numbers in the
environment through a single diarrheal episode, according to the National Institute of Allergy and
Infectious Diseases. Because of this route of transmission, cholera is most likely to be found in
places with poor water treatment, sanitation, and hygiene practices, according to the U.S. Centers
for Disease Control and Prevention (CDC).

Although there are no other animals besides humans in which the bacteria can reproduce and
spread, V. cholerae frequently attach to the shells of crabs, shrimps, and other shellfish. Raw and
undercooked shellfish have previously been sources of cholera infections in the United States.
Cholera Symptoms and Complications

Cholerae incubates between 2 hours and 5 days before causing symptoms, according to the WHO.
Most of the time, symptoms appear within 2 to 3 days of exposure to the bacteria, according to the
CDC. About 80 percent of people with cholera don't suffer from any symptoms, and the disease
resolves on its own. But they can still spread the bacteria throughout the environment, according
to the WHO.

Out of the people who do develop symptoms, about 80 percent only experience a mild form of the
disease. The other 20 percent of people with cholera symptoms experience severe diarrhea,
vomiting, and leg cramps. Other symptoms of cholera include:

1. Abdominal cramps
2. Rapid pulse
3. Unusual sleepiness
4. Lethargy
5. Excessive thirst, lack of tears, and low urine output
6. Dry skin, dry mucous membrane (such as inside the nose or eyelids), and dry mouth
7. Nausea

In people with severe cholera, rapid fluid loss can cause dehydration, septic shock, and even death
sometimes within a matter of a few hours. Other complications can include low blood sugar, low
potassium levels, and kidney failure.

Cholera Treatment

Cholera is diagnosed using stool samples, which are analyzed in a laboratory.

Treatment for the infection focuses on restoring fluids and salts lost through diarrhea (or vomiting).
This fluid replacement is typically done using a WHO-developed rehydration solution that
contains a prepackaged mixture of salts and sugars. You mix it with (clean) water and drink it in
large amounts. In the most severe cases of cholera, treatment may require intravenous (by IV) fluid
replacement. Antibiotics may also help reduce the severity of symptoms and speed up the recovery
time.
Cholera Prevention

Cholera isn't endemic to the United States, and nearly all cases of cholera in the country are
acquired when people travel internationally.

You can avoid getting the illness when travelling abroad by:

1. Drinking only beverages there were bottled, canned, boiled, or chemically treated, and
avoiding tap water, fountain drinks, and ice cubes
2. Washing your hands often with soap and (clean) water, or using a hand cleanser with at
least 60 percent alcohol — especially before eating or preparing food and after using the
bathroom
3. Eating pre-packaged food or food that's freshly cooked and served hot
4. Not eating raw or uncooked shellfish, including sushi
5. Avoiding dairy foods
6. Using bottled, boiled, or chemically treated water to brush your teeth, prepare food, wash
dishes, and make ice