Ref: CHB/HB/037/15                                                                          



Cholera is an acute infectious disease caused by a bacterium,Vibrio cholerae (V. cholerae), which results in a painless, watery diarrhea in humans. Some affected individuals have copious amounts of diarrhea and develop dehydration so severe it can lead to death. Most people who get the disease ingest the organisms through food or water sources contaminated with V. cholerae.
What are the Symptoms & Signs?

The symptoms and signs of cholera are a watery diarrhea that often contains flecks of whitish material (mucus and some epithelial cells) that are about the size of pieces of rice.

The volume of diarrhea can be enormous; high levels of diarrheal fluid such as 250 cc per kg or about 10 to 18 liters over 24 hours for a 70 kg adult can occur. People may go on to develop one or more of the following symptoms and signs:

  • Vomiting
  • Rapid heart rate
  • Dry mucous membranes
  • Low blood pressure
  • Thirst
  • Muscle cramps
  • Restlessness or Irritability

Who is at risk for cholera, and where do cholera outbreaks occur?

Everyone who drinks or eats food that has not been treated to eliminate V. cholera (liquids need to be chemically treated, boiled, or pasteurized, and foods need to be cleaned and cooked), especially in areas of the world where cholera is present, is at risk for cholera.

There has been an ongoing global pandemic in Asia, Africa (in Zimbabwe in 2008-2009), and Latin America for the last four decades.

Outbreaks occur when there are disasters or other reasons for a loss of sanitary human waste disposal and the lack of safe fluids and foods for people to ingest. Haiti, a country that had not seen a cholera outbreak in over 50 years, had such circumstances develop in 2010 after a massive earthquake destroyed sanitary facilities and water and food treatment facilities for many Haitians. V. cholerae bacteria eventually contaminated primary water sources, resulting in over 530,000 people diagnosed with cholera that resulted in over 7,000 deaths. This cholera outbreak spread to Haiti's neighbor, the Dominican Republic.
Some individuals are at higher risk to become infected than others. People who are malnourished or immune-compromised are more likely to get the disease. Children ages 2-4 seem more susceptible than older children, according to some investigators. People with achlorhydria (reduced acid secretion in the stomach) and people taking medicines to reduce stomach acid (H2 blockers and others) are also more likely to develop cholera because stomach acid kills many types of bacteria, including V. cholerae.
Rehydration is the first priority in the treatment of cholera. Use of oral rehydration solution (ORS) as much as possible is recommended. At time, dehydration may be severe enough to require intravenous fluids.
In cases where dehydration is severe and resolving quickly, oral antibiotics may be given if the person is older than 2 years and is not vomiting.
Normal feeding (including breastfeeding for children) should continue once vomiting has stopped.

Drinking safe water e.g. by boiling is very important, together with hand washing. Do not use impure water for cooking food or washing fruits and vegetables. Be on alert, especially during rainy seasons, where this disease is more prevalent and outbreaks occur.


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