Cholera is an acute, diarrheal illness caused by infection of
the intestine with the bacterium
infection is often mild or without symptoms, but sometimes it can
be severe. Approximately one in 20 infected persons has severe
disease characterized by profuse watery diarrhea, vomiting, and leg
cramps. In these persons, rapid loss of body fluids leads to
dehydration and shock. Without treatment, death can occur within
How does a person get cholera?
A person may get cholera by drinking water or eating food
contaminated with the cholera bacterium. In an epidemic, the source
of the contamination is usually the feces of an infected person.
The disease can spread rapidly in areas with inadequate treatment
of sewage and drinking water. The cholera bacterium may also live
in the environment in brackish rivers and coastal waters. Shellfish
eaten raw have been a source of cholera, and a few persons in the
United States have contracted cholera after eating raw or
undercooked shellfish from the Gulf of Mexico. The disease is not
likely to spread directly from one person to another; therefore,
casual contact with an infected person is not a risk for becoming
What is the risk for cholera in the United States?
In the United States, cholera was prevalent in the 1800s but has
been virtually eliminated by modern sewage and water treatment
systems. However, as a result of improved transportation, more
persons from the United States travel to parts of Latin America,
Africa, or Asia where epidemic cholera is occurring. U.S. travelers
to areas with epidemic cholera may be exposed to the cholera
bacterium. In addition, travelers may bring contaminated seafood
back to the United States. Foodborne outbreaks have been caused by
contaminated seafood brought into this country by travelers.
What should travelers do to avoid getting cholera?
The risk for cholera is very low for U.S. travelers visiting
areas with epidemic cholera. When simple precautions are observed,
contracting the disease is unlikely. All travelers to areas where
cholera has occured should observe the following
Drink only water that you have boiled or treated with chlorine
Other safe beverages include tea and coffee made with boiled
water and carbonated, bottled beverages with no ice.
Eat only foods that have been thoroughly cooked and are still
hot, or fruit that you have peeled yourself.
Avoid undercooked or raw fish or shellfish, including
Make sure all vegetables are cooked.
Avoid foods and beverages from street vendors.
Do not bring perishable seafood back to the United States.
A simple rule of thumb is "Boil it, cook it, peel it, or forget
Is a vaccine available to prevent cholera?
At the present time, the manufacture and sale of the only
licensed cholera vaccine in the United States (Wyeth-Ayerst) has
been discontinued. It has not been recommended for travelers
because of the brief and incomplete immunity if offers. No cholera
vaccination requirements exist for entry or exit in any country.
Two recently developed vaccines for cholera are licensed and
available in other countries (Dukoral®, Biotec AB and
Mutacol®, Berna). Both vaccines appear to provide a somewhat
better immunity and fewer side-effects than the previously
available vaccine. However, neither of these two vaccines is
recommended for travelers nor are they available in the United
Can cholera be treated?
Cholera can be simply and successfully treated by immediate
replacement of the fluid and salts lost through diarrhea. Patients
can be treated with oral rehydration solution, a prepackaged
mixture of sugar and salts to be mixed with water and drunk in
large amounts. This solution is used throughout the world to treat
diarrhea. Severe cases also require intravenous fluid replacement.
With prompt rehydration, fewer than 1% of cholera patients die.
Antibiotics shorten the course and diminish the severity of the
illness, but they are not as important as rehydration. Persons who
develop severe diarrhea and vomiting in countries where cholera
occurs should seek medical attention promptly.
Centers for Disesae Control and
Prevention, November 2000
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a