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Cholera

 

Definition

Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae strains 01 and 0139. The infection is often mild or without symptoms, but can be severe in about one in 20 cases. In severe cases the fatality rate can be as high as 50 per cent, but is less than one per cent with treatment.

Cholera has been very rare in industrialized nations for the last 100 years, due to drinking water sanitation and proper sewage treatment and disposal. However, the disease is still common today in other parts of the world, including the Indian subcontinent, Asia and most of Africa.


 

Symptoms

Symptoms start in as little as a few hours after exposure, to 5 days, and average 2-3 days. Clinical signs can be absent (asymptomatic) or can range from mild to severe and include:
  • nausea 
  • vomiting (in the early stages of illness) 
  • profuse, water diarrhea
  

Causes

Cholera is caused by the ingestion of water or food contaminated by the Vibrio cholerae -01 and -0139 strains. It is a problem in parts of the world where there is little or no adequate sewage treatment and disposal and inadequate treatment of drinking water. Consumption of raw or undercooked seafood in endemic areas and overcrowding have been implicated as causes, as well.

People are the main reservoir of Vibrio cholerae, but it has also been shown to be associated with plankton in estuaries and brackish water along some coastlines, such as in the U.S., Australia and Bangladesh.  

Complications

  • severe dehydration
  • kidney failure 
  • circulatory collapse

Any or all of these can lead rapidly to death, without adequate and prompt treatment.

  

Tests and Diagnosis

Cholera is detected by culturing the pathogen from fecal specimens.  

Treatment and Drugs

The most important treatment is rehydration. If you are traveling, or have returned home to Canada and you think you or someone you know has cholera, contact medical help promptly.

 

Coping and Support

Carry rehydration salts with you when you travel.

People with cholera can infect others. Therefore, workers in high risk occupations, like cooking and caregiving must not work while infected. Day care attendees must be removed from day care until they are free from infection. A public health professional will contact you if you become infected and provide information on returning to work. Refer to the BCCDC guideline Exclusion of Enteric Cases and their Contacts from High Risk Settings.

Prevention

 When traveling, visit a travel clinic and find out what diseases are endemic in the area you are traveling to. Most travelers are at low risk, unless they will be exposed to untreated drinking water and raw or undercooked seafood. Discuss vaccination with a travel clinic, especially if you will be partaking in humanitarian relief work.

Follow these precautions:
  • eat only food from established food premises with a good reputation, if possible, and avoid street vendors
  • do not eat raw or undercooked seafood when travelling
  • remember, “Boil it, cook it, peel it or leave it”
  • avoid salads and uncooked foods, order food that will be cooked to order and well 
  • use only purified or boiled water, or bottled water in a sealed container from a reliable source/vendor; use only ice made from one of these sources 
  • eat only fruit that has a peel 
  • do not consume unpasteurized dairy products 
  • always wash your hands before eating and drinking; carry an alcohol-based hand gel with you in case you cannot wash your hands 
  • avoid swimming in polluted water

Refer to the World Health Organization map of countries with cholera.

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Last Updated: May 7, 2012