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I'm not in your class but have been added to the Padlet. This looks awesome! Keep up the good work, but please, Ms. Isler, remove me. Thanks

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"From the outside, the water purifier looks like a black box. It's about the size of a dormitory refrigerator. Inside, there's a system for purifying water that's actually quite old and common. Drug companies use the same method to purify water for use in medicines. The U.S. Navy has used the method to desalinate drinking water "

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From the outside, the water purifier looks like a black box. It's about the size of a dormitory refrigerator. Inside, there's a system for purifying water that's actually quite old and common. Drug companies use the same method to purify water for use in medicines [source: MECO]. The U.S. Navy has used the method to desalinate drinking water [source: MECO].

Drug company and submarine versions aren't practical for developing countries, though. They're too big to move and need technicians on call. The Slingshot is simpler and more portable.

All of these purifiers work by vapor compression distillation. Kamen once ran down a partial list of what this process can purify: the ocean; water laced with arsenic, poison, heavy metals, viruses and bacteria; liquid at a chemical waste site; or the contents of a latrine [source: Comedy Partners]. Remarkably, all it takes is boiling and re-liquefying water at precise temperatures. Let's see how it works.

Kamen's black box first connects to an electricity source. Next, you hook it up to a water source by dropping the hose in some water. The dirty water gets sucked into the system, where it warms to its boiling point (212 degrees Fahrenheit or 100 degrees Celsius). Then, it enters an evaporator, where it's heated a little more and boils [source: Pacella]. Already, some contaminants are lost. Anything that boils at hotter than 212 degrees F (100 degrees C) -- stones, dirt, salt -- stays in the evaporator and is drained out. Bacteria, viruses, eggs and spores get hit twice: They don't rise with the steam in the evaporator and are pasteurized by the heat in the purifier.

Steam rises from the evaporator into a compressor. The compressor squeezes the steam a little, raising its temperature a bit above 212 degrees F. The steam flows into an outer chamber whose walls are about 212 degrees F, creating another filtering step [source: Pacella]. Any contaminant that boils at colder than 212 degrees F, such as benzene, remains a gas and is vented out. Only pure water condenses on the walls.

The clean water drips into a final chamber, ready to be spouted out. But there's a problem: The water is still hot. Since hot water would be awful on a hot day, the machine cools it using a clever method. It flows incoming and outgoing streams of water past one another, so dirty water heats to 212 degrees F and outgoing water cools to the outside temperature. This heat recycling trick is called a counter-flow heat exchanger.

While the Slingshot is a powerful purifier, there's a catch. Read on to find out what it is.

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From the outside, the water purifier looks like a black box. It's about the size of a dormitory refrigerator. Inside, there's a system for purifying water that's actually quite old and common. Drug companies use the same method to purify water for use in medicines [source: MECO]. The U.S.

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http://microscopicblog.blogspot.com/2010/10/love-in-time-of-haiti.html

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Dean Kamen, who invented the Segway and several groundbreaking medical devices, has put a decade of work into a water purifier that he calls the "Slingshot."

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For plenty of people, getting a drink of water on the hottest of days is not as easy as filling a glass at the tap. Instead, they walk miles to the nearest well. Or they pay big fractions of their incomes -- more than the average person in a developed country pays -- to have a distributor truck in water, which may not even be clean. About one in six people, as of 2005, couldn't access clean water [source: United Nations]. But no one can live without water, so it's often that people without access to a clean water supply end up drinking water laced with chemicals or populated by disease-causing organisms, which can kill children and shorten adults' lives.

With this in mind, it's easy to see why the World Health Organization put access to safe drinking water on its list of Millennium Development Goals, or targets to meet by 2015 [source: WHO]. But can it be done? Each pocket of people suffering water stress needs an affordable method that fits the local conditions and lifestyle. Chlorine tablets and clay pots, boiling and cloth filters, sun barrels and rain barrels, and filter-equipped straws that can be worn on a necklace have all been tried, but some people still lack a method that works for them [sources: EPA, IDE, EAWAG, Vestergaard].

A certain well-known engineer has a product to add to the mix. Here's a hint: He rides a Segway. Dean Kamen, who invented the Segway and several groundbreaking medical devices, has put a decade of work into a water purifier that he calls the "Slingshot." The name is a reference to the story of David and Goliath -- to Kamen, waterborne disease is a Goliath of a problem, and technology is the slingshot [source: Richardson]. Read on to learn how the purifier works.

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For plenty of people, getting a drink of water on the hottest of days is not as easy as filling a glass at the tap. Instead, they walk miles to the nearest well. Or they pay big fractions of their incomes -- more than the average person in a developed country pays -- to have a distributor truck in water, which may not even be clean.

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Cholera can be treated by oral re-hydration salt if no dehydration, if some then amount in first four hours, and if severe then 6 drips of Ringer Lactate or normal saline and oral re-hydration salt on the outline.

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Cholera facts

Cholera is a disease caused by bacteria that produce a watery diarrhea that can rapidly lead to dehydration.

Cholera symptoms and signs include a rapid onset of copious, smelly diarrhea that resembles rice water and may lead to signs of dehydration (for example, vomiting, wrinkled skin, low blood pressure, dry mouth, rapid heart rate).

Cholera is most frequently transmitted by water sources contaminated with the causative bacterium Vibrio cholerae, although contaminated foods, especially raw shellfish, may also transmit the cholera-causing bacteria.

Cholera is presumptively diagnosed by patient history and examination of stool for rice-water appearance and presence of V. cholerae-like organisms microscopically; definitive diagnosis is done by isolation and identification of V. cholerae from stool samples.

The main treatment for cholera is fluid and electrolyte replacement, both oral and IV. Antibiotics usually are used in severe infections in which dehydration has occurred.

The prognosis of cholera ranges from excellent to poor. Rapid treatment with fluid and electrolytes result in better outcomes while people with other health problems beside cholera or those who are not rapidly replenished with fluid treatments tend to have a poorer prognosis.

It's possible to prevent cholera with appropriate measures such as safe drinking water and non-contaminated foods; some protection can be obtained from oral vaccines while avoiding areas where cholera commonly occurs or has had a recent outbreak.

In June 2016, the FDA approved an oral vaccine for use in the U.S. for travelers to cholera-endemic areas to protect them from getting cholera; this oral vaccine is about 80% effective three months after a single oral dose in adults 18-64 years old.

What is cholera?

Cholera is an acute infectious disease caused by a bacterium, Vibrio cholerae ( V. cholerae), which usually 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. Although symptoms may be mild, some previously healthy people will develop a copious diarrhea within about one to five days after ingesting the bacteria. Severe disease requires prompt medical care. Hydration (usually by IV for the very ill) of the patient, and antibiotics in some individuals, is the key to surviving the severe form of the disease.

The World Health Organization (WHO) has maps of current and past areas with cholera outbreaks (see WHO reference). It is estimated that about 1.4 million to 4.3 million people are infected worldwide each year, with approximately 28,000-142,000 deaths per year. Only about one in 10 people infected with cholera develop the typical signs and symptoms. Outbreaks of cholera in 2015-2016 include South Sudan, United Republic of Tanzania, and Kenya, with over 216 deaths and most recently, 121 people diagnosed with cholera in Iraq, their first outbreak since 2012 and in Cuba, the first outbreak in over 130 years.

The term cholera has a long history (see history section below) and has been assigned to several other diseases. For example, fowl or chicken cholera is a disease that can rapidly kill chickens and other avian species rapidly with a major symptom of diarrhea. However, the disease-causing agent in fowl is Pasteurella multocida, a gram-negative bacterium. Similarly, pig cholera (also termed hog or swine cholera) can cause rapid death (in about 15 days) in pigs with symptoms of fever, skin lesions, and seizures. This disease is caused by a pestivirus termed CSFV (classical swine fever virus). Neither one of these animal diseases are related to human cholera, but the terminology can be confusing.

What is the history of cholera?

Cholera has likely been affecting humans for many centuries. Reports of cholera-like disease have been found in India as early as 1000 AD. Cholera is a term derived from Greek khole (illness from bile) and later in the 14th century to colere (French) and choler (English). In the 17th century, cholera was a term used to describe a severe gastrointestinal disorder involving diarrhea and vomiting. There were many outbreaks of cholera, and by the 16th century, some were being noted in historical writings. England had several in the 19th century, the most notable being in 1854, when Dr. John Snow did a classic study in London that showed a main source of the disease (resulting in about 500 deaths in 10 days) came from at least one of the major water sources for London residents termed the "Broad Street pump." The pump handle was removed, and the cholera deaths slowed and stopped. The pump is still present as a landmark in London. Although Dr. Snow did not discover the cause of cholera, he did show how the disease could be spread and how to stop a local outbreak. This was the beginning of modern epidemiologic studies. The last reference shows the map Dr. Snow used to identify the pump site.

V. cholerae was first isolated as the cause of cholera by Filippo Pacini in 1854, but his discovery was not widely known until Robert Koch (who also discovered the cause of tuberculosis), working independently 30 years later, publicized the knowledge and the means of fighting the disease. The history of cholera repeats itself. The U.S. National Library of Medicine houses original documents about multiple cholera outbreaks in the U.S. from the 1820s to the 1900s, with the last large outbreak in 1910-1911. Since the 1800s, there have been seven cholera pandemics (worldwide outbreaks).

Cholera riots occurred in Russia and England (1831) and in Germany (1893) when the people rebelled against strict government isolation (quarantines) and burial rules. In 2008, cholera riots broke out in Zimbabwe as police tried to disperse people who tried to withdraw funds from banks and were protesting because of the collapse of the health system that began with a cholera outbreak. Similar but less violent public protests have occurred when yellow fever, typhoid fever, and tuberculosis quarantines have been enforced by health authorities.

Multiple outbreaks worldwide continue into the 21st century with outbreaks in India, Iran, Vietnam, and several African countries occurring over the last 10 years (some recent outbreaks occurred in Haiti and Nigeria in 2010-2011, and Cuba in 2016). Why is cholera history repeating itself? The answer can be traced back to Dr. Snow's studies that show a source (water or occasionally food) contaminated with V. cholerae can easily and rapidly transmit the cholera-causing bacteria to many people. Until safe water and food is available to all humans, it is likely that cholera outbreaks will continue to happen.

What are cholera symptoms and signs?

The symptoms and signs of cholera are a watery diarrhea that often contains flecks of whitish material (mucus and some gastrointestinal lining [epithelial] cells) that are about the size of pieces of rice. The diarrhea is termed "rice-water stool" (See figure 1) and smells "fishy." 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 154-pound adult can occur. People may go on to develop one or more of the following symptoms and signs:

Watery diarrhea (sometimes in large volumes)

Rice-water stools (see figure 1)

Fishy odor to stools

Vomiting

Rapid heart rate

Loss of skin elasticity (washer woman hands sign; see figure 2)

Dry mucous membranes (dry mouth)

Low blood pressure

Thirst

Muscle cramps (leg cramps, for example)

Restlessness or irritability (especially in children)

Unusual sleepiness or tiredness

Other symptoms that may occur, especially with more severe disease, include the following:

Those infected require immediate hydration to prevent these symptoms from continuing because these signs and symptoms indicate that the person is becoming or is dehydrated and may go on to develop severe cholera. People with severe cholera (about 5%-10% of previously healthy people; higher if a population is compromised by poor nutrition or has a high percentage of very young or elderly people) can develop severe dehydration, leading to acute renal failure, severe electrolyte imbalances (especially potassium and sodium), and coma. If untreated, this severe dehydration can rapidly lead to shock and death. Severe dehydration can often occur four to eight hours after the first liquid stool, ending with death in about 18 hours to a few days in undertreated or untreated people. In epidemic outbreaks in underdeveloped countries where little or no treatment is available, the mortality (death) rate can be as high as 50%-60%.

Figure 1: Rice-water stool from a patient with cholera; note the flecks of mucus precipitated at the bottom of the cup that resemble rice grains. SOURCE: CDC

Figure 2: Washer woman hands (loss of skin elasticity) are a sign of the dehydration seen in cholera. SOURCE: CDC

What causes cholera, and how is cholera transmitted?

Cholera is caused by the bacterium V. cholerae. This bacterium is Gram stain-negative, comma-shaped, and has a flagellum (a long, tapering, projecting part) for motility and pili (hairlike structures) used to attach to tissue. Although there are many V. cholerae serotypes that can produce cholera symptoms, the O groups O1 and O139, which also produce a toxin, cause the most severe symptoms of cholera. O groups consist of different lipopolysaccharides-protein structures on the surface of bacteria that are distinguished by immunological techniques.

The toxin produced by these V. cholerae serotypes is an enterotoxin composed of two subunits, A and B; the genetic information for the synthesis of these subunits is encoded on plasmids (genetic elements separate from the bacterial chromosome). In addition, another plasmid type encodes for a pilus (a hollow hairlike structure that supports bacterial attachment to human cells and facilitate the movement of toxin from V. cholerae into human cells). The enterotoxin causes human cells to extract water and electrolytes from the body (mainly the upper gastrointestinal tract) and pump it into the intestinal lumen where the fluid and electrolytes are excreted as diarrheal fluid. The enterotoxin is similar to toxin formed by bacteria that cause diphtheria in that both bacterial types secret the toxins into their surrounding environment where the toxin then enters the human cells. The bacteria are usually transmitted by drinking contaminated water, but the bacteria can also be ingested in contaminated food, especially seafood such as raw oysters.

What are risk factors for cholera, and where do cholera outbreaks occur?

Everyone who drinks or eats food that has not been treated to eliminate V. cholerae (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.

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. The Vibrio cholerae strain was closely related to a strain found in Nepal and leads some individuals to blame Nepalese troops that helped with the earthquake disaster as the source of the Haiti cholera outbreak.

In third-world countries, hunger can lead people to inadvertently eat contaminated food and/or drink contaminated water, thus raising the risk for cholera to infect malnourished populations.

There is some evidence that V. cholerae can survive in saltwater and have been isolated from shellfish; eating raw oysters is considered a risk factor for cholera, especially in underdeveloped countries and occasionally even in developed countries. A few people are diagnosed with cholera every year in the U.S. Most of the individuals diagnosed are travelers who were exposed to cholera outside the country, but occasionally, isolated cases are traced to contaminated seafood, usually from states that border the Gulf of Mexico.

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. In addition, researchers have noted that patients with blood type O are twice as likely to develop cholera as others. The reason for this blood type susceptibility is not completely understood. 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.

Is cholera contagious?

It takes about 100 million V. cholerae bacteria to infect a healthy adult. Because of this high number, significant contamination of food or water is required to transmit the disease, and direct person-to-person transmission is thought to be uncommon except in outbreaks. In outbreaks, cholera-causing bacteria become highly contagious indirectly and directly by the fecal-oral route because of widespread fecal contamination of food, water, and items like contaminated bedding and clothing.

What is the incubation period for cholera?

The incubation period (time period from exposure to the bacteria to the development of symptoms) may vary from a few hours (about six to 12 hours) to five days, with the average incubation period being about two to three days. About six to 12 hours is considered a very rapid incubation period and may suggest that rapid/immediate intervention is required for recovery.

What is the contagious period for cholera?

The contagious period for cholera begins as soon as organisms are excreted in the feces. This can occur as early as about six to 12 hours after exposure to the bacteria and can last for about seven to 14 days. Some individuals who are asymptomatic (infected but not having symptoms) will also excrete contagious organisms for about seven to 14 days.

What physicians usually treat cholera?

Because most individuals have either mild or no symptoms, these people are either not treated or treated by their primary-care physician. However, in some children and in individuals who have more severe disease, besides the primary-care physician or pediatrician, an infectious-disease specialist, a critical-care specialist, a gastroenterologist, and/or an internist may be needed to help the team manage and treat the patient.

In addition, specialists in travel medicine and/or epidemiology can help individuals avoid cholera and/or can give advice about prevention, treatment, and prognosis to those individuals traveling to or living in endemic areas.

How do health-care professionals diagnose cholera?

Preliminary diagnosis is usually done by a caregiver who takes a history from the patient and observes the characteristic rice-water diarrhea, especially if a local outbreak of cholera has identified. The diarrhea fluid is often teeming with motile, comma-shaped bacteria (presumptively V. cholerae) that can be seen with a microscope. The definitive diagnosis is made by isolation of the bacteria from diarrhea fluid. All state health department laboratories in the U.S. are able to perform tests for Vibrio cholerae. Readers may see terms like serotypes Inaba, Ogawa, and Hikojima to describe V. cholerae; they simply indicate which O antigens (O antigens designated A, B, or C) are found on these strains of V. cholerae. PCR tests have also been developed to detect the genetic material of cholera, but currently they are not as widely used as the immunologic tests based on type-specific antiserum.

Definitive diagnosis helps to distinguish cholera from other diseases caused by other bacterial, protozoal, or viral pathogens that cause dysentery (gastrointestinal inflammation with diarrhea).

What is the treatment for cholera?

The CDC (and almost every medical agency) recommends rehydration with ORS (oral rehydration salts) fluids as the primary treatment for cholera. ORS fluids are available in prepackaged containers, commercially available worldwide, and contain glucose and electrolytes. The CDC follows the guidelines developed by the WHO (World Health Organization) as follows:

Patient condition

Treatment

Treatment volume guidelines; age and weight

No dehydration

Oral rehydration salts (ORS)

Children < 2 years: 50 mL-100 mL, up to 500 mL/day
Children 2-9 years: 100 mL-200 mL, up to 1,000 mL/day
Patients > 9 years: As much as wanted, to 2,000 mL/day

Some dehydration

Oral rehydration salts (amount in first four hours)

Infants < 4 mos (< 5 kg): 200-400 mL
Infants 4 mos-11 mos (5 kg-7.9 kg): 400-600 mL
Children 1 yr-2 yrs (8 kg-10.9 kg): 600-800 mL
Children 2 yrs-4 yrs (11 kg-15.9 kg): 800-1,200 mL
Children 5 yrs-14 yrs (16 kg-29.9 kg): 1,200-2,200 mL
Patients > 14 yrs (30 kg or more): 2,200-4,000 mL

Severe dehydration

IV drips of Ringer Lactate or, if not available, normal saline and oral rehydration salts as outlined above

Age < 12 months: 30 mL/kg within one hour*, then 70 mL/kg over five hours
Age > 1 year: 30 mL/kg within 30 min*, then 70 mL/kg over two and a half hours

*Repeat once if radial pulse is still very weak or not detectable

Reassess the patient every one to two hours and continue hydrating. If hydration is not improving, give the IV drip more rapidly. 200 mL/kg or more may be needed during the first 24 hours of treatment.

After six hours (infants) or three hours (older patients), perform a full reassessment. Switch to ORS solution if hydration is improved and the patient can drink.

In general, antibiotics are reserved for more severe cholera infections; they function to reduce fluid rehydration volumes and may speed recovery. Although good microbiological principles dictate it is best to treat a patient with antibiotics that are known to be effective against the infecting bacteria, this may take too long a time to accomplish during an initial outbreak (but it still should be attempted); meanwhile, severe infections have been effectively treated with tetracycline (Sumycin), doxycycline ( Vibramycin, Oracea, Adoxa, Atridox, and others), furazolidone ( Furoxone), erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), or ciprofloxacin ( Cipro, Cipro XR, ProQuin XR) in conjunction with the following antibiotics in conjunction with IV hydration and electrolytes:

Tetracycline (Sumycin)

Doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others)

Furazolidone (Furoxone)

Erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone)

Azithromycin (Zithromax)

Sulfamethoxazole/trimethoprim (Bactrim, Septra)

Ampicillin

Ciprofloxacin (Cipro, Cipro XR, ProQuin XR)

Norfloxacin (Noroxin)

Many antibiotics are listed; however, because of widespread antibiotic resistance, including multi-resistant Vibrio strains, antibiotic susceptibility testing is advised so the appropriate antibiotic is chosen. In addition, quinolones (for example, ciprofloxacin, norfloxacin) should not be used in children if other antibiotics can be effective because of possible musculoskeletal adverse effects.

Is it possible to prevent cholera? Are cholera vaccines available?

Yes, cholera can be prevented by several methods. Developed countries have an almost zero incidence of cholera because they have widespread water-treatment plants, food-preparation facilities that usually practice sanitary protocols, and most people have access to toilets and hand-washing facilities. Although these countries may have occasional lapses or gaps in these methods, they have prevented many disease outbreaks, including cholera.

Individuals can prevent or reduce the chance they may get cholera by thorough hand washing, avoiding areas and people with cholera, drinking treated water or similar safe fluids, and eating cleaned and well-cooked food. In addition, there are vaccines available that can help prevent cholera, although they are not available in the U.S., and their effectiveness ranges from 50%-90%, depending on the studies reported. The vaccines are oral preparations, because injected vaccines have not proved to be very effective. Two vaccines (Shanchol and Dukoral) are composed of killed V. cholerae bacteria and don't contain the enterotoxin B subunit. Unfortunately, both offer protection for only about two years, although one report suggests that Shanchol is about 65% effective over five years. Both vaccines are usually given in two doses, about one to six weeks apart. Unfortunately, the vaccines have limited availability; their recommended use is for people going to areas of known outbreaks with the likely possibility the person may be exposed to cholera. Some researchers suggest this limited oral vaccine availability should be changed and cite data that oral vaccine may help limit outbreaks, even after they have begun.

Research is ongoing; a research study in Haiti will try to determine if a two-dose vaccine in people will suffice to protect a difficult to treat (rural poor) population from cholera and thus save many lives. There are over 30 universities researching this disease (cholera's epidemiology, pathology, immunology, vaccine production, and other problems) currently worldwide.

In 2015, about 2 million doses of oral cholera vaccine were shipped to various outbreak areas, and currently available information suggests that there was a significant reduction in transmission of endemic cholera; the study will be concluded in 2018.

In June 2016, the U.S. FDA (Food and Drug Administration) approved the first vaccine available in the United States to prevent cholera. The vaccine is termed Vaxchora and is manufactured by PaxVax Bermuda LTD. It can be used in adults age 18-64 who are traveling to cholera-affected areas of the world. The vaccine is a live, attenuated (weakened) dose of V. cholerae serogroup 01, the most prominent cause of cholera worldwide. The vaccine is administered orally in about 3 ounces of fluid. It is about 80% effective in individuals challenged with Vibrio bacteria three months after vaccination. The vaccine should be administered at least 10 days before the individual travels to a cholera-endemic area.

What is the prognosis of cholera?

The prognosis (outcome) of cholera can range from excellent to poor, depending on the severity of the dehydration and how quickly the patient is given and responds to treatments. Death (mortality) rates in untreated cholera can be as high as 50%-60% during large outbreaks but can be reduced to about 1% if treatment protocols (see above treatment section) are rapidly put into action. In general, the less severe the symptoms and the less time people have dehydration symptoms, the better the prognosis; in many people, if dehydration is quickly reversed, the prognosis is often excellent.

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Medically Reviewed on 6/16/2016

REFERENCES:

Brown, Troy. "FDA Approves First Cholera Vaccine in the US." Medscape.com. June 10, 2016. <https://www.medscape.com/viewarticle/864673?nlid=106295_3901&src=wnl_newsalrt_160610_MSCPEDIT&uac=138226AY&impID=1124116&faf=1>.

Switzerland. World Health Organization. "Cholera." July 2015. <http://www.who.int/mediacentre/factsheets/fs107/en/>.

United States. Centers for Disease Control and Prevention. "Cholera." Yellowbook 3.81 July 10, 2015. <http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/cholera>.

United States. Centers for Disease Control and Prevention. "Cholera -- Vibrio cholera Infection." Nov. 27, 2014. <http://www.cdc.gov/cholera/index.html>.

Unites States. Food and Drug Administration. "Vaxchora." June 16, 2016.<http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm505866.htm>.

Complete List

Top Cholera Related Articles

Dehydration

Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. Symptoms of dehydration include:

headache,

lightheadedness,

constipation, and

bad breath.

Treatment for dehydration is to replace lost fluids and electrolytes.

Low Blood Pressure

Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include:

light-headedness,

dizziness, or

even fainting if not enough blood is getting to the brain.

Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.

Travel Medicine

Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include:

malaria,

meningococcal meningitis,

yellow fever,

hepatitis A,

typhoid fever,

polio, and

cholera.

Traveler's Diarrhea

Travelers' diarrhea is generally contracted by eating contaminated food or drinking contaminated water. Food is the primary source of travelers' diarrhea. Enterotoxigenic E. coli is the cause of up to 70% of all cases of travelers' diarrhea. There are five unique classes of E. coli that causes gastroenteritis. Other bacteria responsible for travelers' diarrhea include Campylobacter, jejuni, shigella, and salmonella. Viruses such as rotavirus and Norwalk virus (norovirus) and giardia lamblia a parasite may cause travelers' diarrhea. Prevention is careful eating and drinking of water.

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Cholera Treatment, History, Prevention & Causes

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Cholera facts Cholera is a disease caused by bacteria that produce a watery diarrhea that can rapidly lead to dehydration. Cholera symptoms and signs include a rapid onset of copious, smelly diarrhea that resembles rice water and may lead to signs of dehydration (for example, vomiting, wrinkled skin, low blood pressure, dry mouth, rapid heart rate).

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The Oregon Trail game features cholera, dysentery, and typhoid fever.

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Raise money to send filtered, clean water over there so that they have cleaner water to drink and then they can have cleaner water so that they don't drink unfiltered unclean water and then get cholera.

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cholera talking object https://www.giantmicrobes.com/uk/products/cholera.html

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Give everyone access to clean fruit and water. Also water to wash your hands with.

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Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include:

If not treated, dehydration can lead to shock and death in a matter of hours.

Cholera Treatment and Prevention

Although there is a vaccine against cholera, the CDC and World Health Organization don't normally recommend it, because it may not protect up to half of the people who receive it and it lasts only a few months. However, you can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected, or bottled water. Be sure to use the bottled, boiled, or chemically disinfected water for the following purposes:

Drinking

Preparing food or drinks

Making ice

Brushing your teeth

Washing your face and hands

Washing dishes and utensils that you use to eat or prepare food

Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant. You should also avoid raw foods, including the following:

Unpeeled fruits and vegetables

Unpasteurized milk and milk products

Raw or undercooked meat or shellfish

Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

Sources

SOURCES:

CDC: "Cholera: General Information;" "Cholera: Disease;" and "Cholera: Prevention and Control."

University of Alabama at Birmingham Health System: "Cholera."

MedlinePlus.gov: "Cholera."

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Cholera: Causes, Symptoms, Treatment, and Prevention

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Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration.

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Tell the Government to improve the America's water to make it cleaner

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We could wash our hands, and become doctors in the future.

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We can try to take care of people by making them as comfortable as we can so they feel better.

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We Americans don't have as much of a problem with cholera as some low income countries. I know that there is not as much water in third world countries as America does. We could raise money to send clean water down to those countries that don't have clean water.

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we could send people in the places where cholera is common water filters. :)

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We could try to increase the income of the areas that don't have a high income that way they can get proper sewage filtering plants to clean the water that way they will nit have to worry about Cholera in those areas. Some of the ways the countries can increase there income is by adding attractions or raising taxes some of the places they could build attractions is by national treasures or important landmarks.

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http://ocp.hul.harvard.edu/contagion/cholera.html

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What is cholera?

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Cholera is still a problem in many countries.

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Cholera cases reported: In 2016, 132 121 cholera cases and 2420 deaths were reported to WHO worldwide. Outbreaks continued to affect several countries. Overall, 54% of cases were reported from Africa, 13% from Asia and 32% from Hispaniola. Cholera remains a major public health problem and affect primarily developing world populations with no proper access to adequate water and sanitation resources.

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Cholera Epidemics - Ohio History Central

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Cholera epidemics continued in the United States until the early 1900s. As sanitation improved within the United States, including chlorination of water, the illness became less common. In modern nations, cholera cases are very rare. In developing countries, cholera remains a not-uncommon disease.

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Cholera impacts the Immune, digestive, and the urinary system

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"Cholera is a bacterial disease that directly affects the stomach and intestines. "

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The bacterium that causes cholera, or Vibrio cholerae, is ingested through infected food or water. Generally, stomach acid kills the bacteria, and in most cases the victim has little to no symptoms. If it is not killed, the cholera bacteria causes digestive problems including gastroenteritis, vomiting and diarrhea. As with any infection, a patient may also have a fever. Because of vomiting and diarrhea, patients are likely to get dehydrated if special attention is not paid to their hydration, reports Johns Hopkins. This may lead to low blood pressure, rapid heart rate, dry mucous membranes and in severe cases, shock and death.
Learn more about Conditions & Diseases

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What Part of the Body Does Cholera Damage?

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The bacterium that causes cholera, or Vibrio cholerae, is ingested through infected food or water. Generally, stomach acid kills the bacteria, and in most cases the victim has little to no symptoms. If it is not killed, the cholera bacteria causes digestive problems including gastroenteritis, vomiting and diarrhea.

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"Non-O1 and non-O139 V. cholerae can cause mild diarrhoea but do not generate epidemics." http://www.china.org.cn/world/2010-10/26/content_21202117.htm

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Yes. This is a website with the most recent cholera news in the world. I don't know how many of the outbreaks are actually here, it just shows many fro this and past years.

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30 January 2009 Efforts must be intensified to control Zimbabwe cholera outbreak [WHO PRESS RELEASE]

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"Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. An estimated 2.9 million cases and 95,000 deaths occur each year around the world. The infection is often mild or without symptoms, but can sometimes be severe." May 11, 2018 https://www.cdc.gov/cholera/general/index.html

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"Cholera, an acute infection of the small intestine caused by the bacterium Vibrio cholerae and characterized by extreme diarrhea with rapid and severe depletion of body fluids and salts." So Cholera effects the immune system, digestive system, and muscular skeletal system.

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Cholera, an acute infection of the small intestine caused by the bacterium Vibrio cholerae and characterized by extreme diarrhea with rapid and severe depletion of body fluids and salts. Cholera has often risen to epidemic proportions in sub-Saharan Africa and South Asia, particularly in India and Bangladesh. In the past two centuries, seven pandemics (global epidemics) of cholera have carried the disease to countries around the world.

Cholera is a disease that can incite populations to panic. Its reputation as a fierce and unrelenting killer is a deserved one. It has been responsible for the deaths of millions, for economic losses of immense magnitude, and for the disruption of the very fabric of society in all parts of the world. In spite of the chaos that it continues to generate, cholera is perhaps the best understood of the modern plagues. The organism that causes it has been studied extensively for well over a century; its modes of transmission have been identified; and safe, effective, and inexpensive interventions for both preventing infection and treating clinical illness have been developed.

The cholera bacterium and toxin

Vibrio cholerae is a member of the family Vibrionaceae, which includes three medically important genera of water-dwelling bacteria. It is a short, gram-negative, rod-shaped bacterium that appears curved when isolated. There are more than 200 different serogroups of V. cholerae, which are distinguished based on the structure of a protein called the O antigen in the bacterium's cell wall. Several of these serogroups are pathogenic in humans; however, only two serogroups of V. cholerae-O1 and O139 (sometimes called the Bengal serogroup)-are known to cause cholera. Pathogenic O1 and O139 V. cholerae have the ability to produce cholera toxin, a type of enterotoxin that affects intestinal cells. Pathogenic organisms in the O1 serogroup have caused the majority of cholera outbreaks and are subdivided into two biotypes: classical and El Tor. These two biotypes each contain two serotypes, called Inaba and Ogawa (some classifications recognize a third serotype, Hikojima), which are differentiated based on their biochemical properties, namely their expression of type-specific antigens. Inaba and Ogawa serotypes both express a common cholera antigen known simply as A; however, only Ogawa expresses cholera antigen B and only Inaba expresses cholera antigen C. There also exist multiple strains of Inaba and Ogawa serotypes.

The classical biotype was responsible for most, if not all, of the six great cholera pandemics that swept through the world in the 19th and early 20th centuries. The seventh pandemic, which began in the mid-20th century and continues today, is caused by the El Tor biotype. This biotype possesses two characteristics that are of great epidemiological significance. First, it is a much hardier organism than the classical biotype, and it can survive for long periods of time in aquatic environments. Second, many people infected with the El Tor biotype experience only mild symptoms or no symptoms at all. Seriously ill patients are highly effective transmitters of cholera, but persons with mild or no symptoms are more likely to travel, thereby also playing a crucial role in the spread of the disease. As barriers to commerce and to personal travel disappear, the potential for diseases to be transmitted rapidly from one continent to another increases.

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Cholera is an intestinal disease that is the archetype of waterborne illnesses. It spreads by the fecal-oral route: infection spreads through a population when feces containing the bacterium contaminate water that is then ingested by individuals. Transmission of the disease can also occur with food that has been irrigated, washed, or cooked with contaminated water. Foods that have the greatest potential to transmit the disease include shellfish and seafoods, especially if eaten raw; fruits and vegetables grown in soil that has been either fertilized with human excrement (night soil) or irrigated with raw sewage; and foods packed in contaminated ice.

Once the bacterium infects the intestine, it secretes the enterotoxin from its external coating. The enterotoxin binds to a receptor on the cells of the lining of the small intestine. Part of the toxin then enters the intestinal cells. The toxin increases the activity of an enzyme that regulates a cellular pumping mechanism that controls the movement of water and electrolytes between the intestine and the circulatory system. This pump effectively becomes locked in the "on" position, causing the outflow of enormous quantities of fluid-up to one litre (about one quart) per hour-into the intestinal tract. All of the clinical manifestations of cholera can be attributed to the extreme loss of water and salts.

Cholera is marked by the sudden onset of profuse, watery diarrhea, typically after an incubation period of 12 to 28 hours. The fluid stools, commonly referred to as "rice water" stools, often contain flecks of mucus. The diarrhea is frequently accompanied by vomiting, and the patient rapidly becomes dehydrated. The patient is very thirsty and has a dry tongue. The blood pressure falls, the pulse becomes faint, and muscular cramps may become severe. The patient's eyes become hollow and sunken, and the skin becomes wrinkled, giving the hands the appearance of "washerwoman's hands." Children may also experience fever, lethargy, and seizures as a result of the extreme dehydration. The disease ordinarily runs its course in two to seven days.

The rapid loss of fluid from the bowel can, if untreated, lead to death-sometimes within hours-in more than 50 percent of those stricken. However, with proper modern treatment, mortality can essentially be prevented, with rates kept to less than 1 percent of those requiring therapy. This treatment consists largely of replacing lost fluid and salts with the oral or intravenous administration of an alkaline solution of sodium chloride. For oral rehydration the solution is made by using oral rehydration salts (ORS)-a measured mixture of glucose, sodium chloride, potassium chloride, and trisodium citrate. The mixture can be prepackaged and administered by nonmedical personnel, allowing cholera to be treated even under the most adverse conditions. ORS can generally be used to treat all but the most severely dehydrated patients, who require intravenous rehydration.

The administration of antibiotics such as tetracycline during the first day of treatment usually shortens the period of diarrhea and decreases the amount of fluid replacement required. It is also important for patients to resume eating as soon as they are able in order to avoid malnutrition or to prevent existing malnutrition from becoming worse.

Prevention

A safe and clean supply of water is the key to cholera prevention. Adequate chlorination of public water supplies and, in some cases, the distribution of chlorine tablets to households with instructions for their proper use are often effective measures. If chemical disinfection is not possible, people can be instructed to boil water before drinking it, but this may be difficult to accomplish, especially in poor countries where fuel may be expensive or unavailable. Sometimes even simpler methods can be effective. For example, in Kolkata, where it is common for people to store water at home, cholera transmission was substantially reduced by replacing open containers, which allowed water to become easily contaminated, with narrow-necked jugs.

Methods have been developed to test and monitor environmental water supplies for the presence of V. cholerae. Such methods are generally based on the detection of bacterial nucleic acids or on the use of antibodies specific to proteins on the surface of V. cholerae cells. Rapid detection using such methods can facilitate the identification of possible sources of cholera outbreaks.

Another important intervention is the hygienic disposal of human waste. In areas lacking modern sewerage systems, the use of latrines can substantially lower the risk of infection. Ensuring the safety of food is yet another important control measure. During an epidemic of cholera, it is important that all food-including leftovers-be thoroughly cooked (to a core temperature of 70 °C [158 °F]) and that it be eaten before it cools. It is also important that stored food be covered to avoid contamination and that people always wash their hands after defecation and prior to food preparation. Foods sold by street vendors have been repeatedly implicated as sources of infection and should therefore be avoided by travelers to areas where cholera is endemic.

Vaccines have been developed against cholera, but they have not been considered effective for the prevention of cholera in large populations or during epidemics. Their usefulness is generally restricted to providing short-term protection for travelers visiting areas where cholera is endemic. Public health officials in some countries do not recommend cholera vaccination for any reason. Restrictions on travel and on food imports are among the measures that have at times been perceived as important for the prevention of cholera but have been shown to have relatively little benefit.

key people

related topics

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cholera | Cause, Symptoms, Treatment, & Prevention

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Cholera, an acute infection of the small intestine caused by the bacterium Vibrio cholerae and characterized by extreme diarrhea with rapid and severe depletion of body fluids and salts. In the past two centuries, seven pandemics of cholera have carried the disease to countries around the world.

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The symptoms are watery diarrhea containing flecks of white mucus which smells "fishy", rapid heart beat, vomiting, thirst, loss of skin elasticity, low blood pressure, muscle cramp, restlessness, or irritably, and unusual sleep or tiredness.

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Cholera facts

Cholera is a disease caused by bacteria that produce a watery diarrhea that can rapidly lead to dehydration.

Cholera symptoms and signs include a rapid onset of copious, smelly diarrhea that resembles rice water and may lead to signs of dehydration (for example, vomiting, wrinkled skin, low blood pressure, dry mouth, rapid heart rate).

Cholera is most frequently transmitted by water sources contaminated with the causative bacterium Vibrio cholerae, although contaminated foods, especially raw shellfish, may also transmit the cholera-causing bacteria.

Cholera is presumptively diagnosed by patient history and examination of stool for rice-water appearance and presence of V. cholerae-like organisms microscopically; definitive diagnosis is done by isolation and identification of V. cholerae from stool samples.

The main treatment for cholera is fluid and electrolyte replacement, both oral and IV. Antibiotics usually are used in severe infections in which dehydration has occurred.

The prognosis of cholera ranges from excellent to poor. Rapid treatment with fluid and electrolytes result in better outcomes while people with other health problems beside cholera or those who are not rapidly replenished with fluid treatments tend to have a poorer prognosis.

It's possible to prevent cholera with appropriate measures such as safe drinking water and non-contaminated foods; some protection can be obtained from oral vaccines while avoiding areas where cholera commonly occurs or has had a recent outbreak.

In June 2016, the FDA approved an oral vaccine for use in the U.S. for travelers to cholera-endemic areas to protect them from getting cholera; this oral vaccine is about 80% effective three months after a single oral dose in adults 18-64 years old.

What is cholera?

Cholera is an acute infectious disease caused by a bacterium, Vibrio cholerae ( V. cholerae), which usually 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. Although symptoms may be mild, some previously healthy people will develop a copious diarrhea within about one to five days after ingesting the bacteria. Severe disease requires prompt medical care. Hydration (usually by IV for the very ill) of the patient, and antibiotics in some individuals, is the key to surviving the severe form of the disease.

The World Health Organization (WHO) has maps of current and past areas with cholera outbreaks (see WHO reference). It is estimated that about 1.4 million to 4.3 million people are infected worldwide each year, with approximately 28,000-142,000 deaths per year. Only about one in 10 people infected with cholera develop the typical signs and symptoms. Outbreaks of cholera in 2015-2016 include South Sudan, United Republic of Tanzania, and Kenya, with over 216 deaths and most recently, 121 people diagnosed with cholera in Iraq, their first outbreak since 2012 and in Cuba, the first outbreak in over 130 years.

The term cholera has a long history (see history section below) and has been assigned to several other diseases. For example, fowl or chicken cholera is a disease that can rapidly kill chickens and other avian species rapidly with a major symptom of diarrhea. However, the disease-causing agent in fowl is Pasteurella multocida, a gram-negative bacterium. Similarly, pig cholera (also termed hog or swine cholera) can cause rapid death (in about 15 days) in pigs with symptoms of fever, skin lesions, and seizures. This disease is caused by a pestivirus termed CSFV (classical swine fever virus). Neither one of these animal diseases are related to human cholera, but the terminology can be confusing.

What is the history of cholera?

Cholera has likely been affecting humans for many centuries. Reports of cholera-like disease have been found in India as early as 1000 AD. Cholera is a term derived from Greek khole (illness from bile) and later in the 14th century to colere (French) and choler (English). In the 17th century, cholera was a term used to describe a severe gastrointestinal disorder involving diarrhea and vomiting. There were many outbreaks of cholera, and by the 16th century, some were being noted in historical writings. England had several in the 19th century, the most notable being in 1854, when Dr. John Snow did a classic study in London that showed a main source of the disease (resulting in about 500 deaths in 10 days) came from at least one of the major water sources for London residents termed the "Broad Street pump." The pump handle was removed, and the cholera deaths slowed and stopped. The pump is still present as a landmark in London. Although Dr. Snow did not discover the cause of cholera, he did show how the disease could be spread and how to stop a local outbreak. This was the beginning of modern epidemiologic studies. The last reference shows the map Dr. Snow used to identify the pump site.

V. cholerae was first isolated as the cause of cholera by Filippo Pacini in 1854, but his discovery was not widely known until Robert Koch (who also discovered the cause of tuberculosis), working independently 30 years later, publicized the knowledge and the means of fighting the disease. The history of cholera repeats itself. The U.S. National Library of Medicine houses original documents about multiple cholera outbreaks in the U.S. from the 1820s to the 1900s, with the last large outbreak in 1910-1911. Since the 1800s, there have been seven cholera pandemics (worldwide outbreaks).

Cholera riots occurred in Russia and England (1831) and in Germany (1893) when the people rebelled against strict government isolation (quarantines) and burial rules. In 2008, cholera riots broke out in Zimbabwe as police tried to disperse people who tried to withdraw funds from banks and were protesting because of the collapse of the health system that began with a cholera outbreak. Similar but less violent public protests have occurred when yellow fever, typhoid fever, and tuberculosis quarantines have been enforced by health authorities.

Multiple outbreaks worldwide continue into the 21st century with outbreaks in India, Iran, Vietnam, and several African countries occurring over the last 10 years (some recent outbreaks occurred in Haiti and Nigeria in 2010-2011, and Cuba in 2016). Why is cholera history repeating itself? The answer can be traced back to Dr. Snow's studies that show a source (water or occasionally food) contaminated with V. cholerae can easily and rapidly transmit the cholera-causing bacteria to many people. Until safe water and food is available to all humans, it is likely that cholera outbreaks will continue to happen.

What are cholera symptoms and signs?

The symptoms and signs of cholera are a watery diarrhea that often contains flecks of whitish material (mucus and some gastrointestinal lining [epithelial] cells) that are about the size of pieces of rice. The diarrhea is termed "rice-water stool" (See figure 1) and smells "fishy." 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 154-pound adult can occur. People may go on to develop one or more of the following symptoms and signs:

Watery diarrhea (sometimes in large volumes)

Rice-water stools (see figure 1)

Fishy odor to stools

Vomiting

Rapid heart rate

Loss of skin elasticity (washer woman hands sign; see figure 2)

Dry mucous membranes (dry mouth)

Low blood pressure

Thirst

Muscle cramps (leg cramps, for example)

Restlessness or irritability (especially in children)

Unusual sleepiness or tiredness

Other symptoms that may occur, especially with more severe disease, include the following:

Those infected require immediate hydration to prevent these symptoms from continuing because these signs and symptoms indicate that the person is becoming or is dehydrated and may go on to develop severe cholera. People with severe cholera (about 5%-10% of previously healthy people; higher if a population is compromised by poor nutrition or has a high percentage of very young or elderly people) can develop severe dehydration, leading to acute renal failure, severe electrolyte imbalances (especially potassium and sodium), and coma. If untreated, this severe dehydration can rapidly lead to shock and death. Severe dehydration can often occur four to eight hours after the first liquid stool, ending with death in about 18 hours to a few days in undertreated or untreated people. In epidemic outbreaks in underdeveloped countries where little or no treatment is available, the mortality (death) rate can be as high as 50%-60%.

Figure 1: Rice-water stool from a patient with cholera; note the flecks of mucus precipitated at the bottom of the cup that resemble rice grains. SOURCE: CDC

Figure 2: Washer woman hands (loss of skin elasticity) are a sign of the dehydration seen in cholera. SOURCE: CDC

What causes cholera, and how is cholera transmitted?

Cholera is caused by the bacterium V. cholerae. This bacterium is Gram stain-negative, comma-shaped, and has a flagellum (a long, tapering, projecting part) for motility and pili (hairlike structures) used to attach to tissue. Although there are many V. cholerae serotypes that can produce cholera symptoms, the O groups O1 and O139, which also produce a toxin, cause the most severe symptoms of cholera. O groups consist of different lipopolysaccharides-protein structures on the surface of bacteria that are distinguished by immunological techniques.

The toxin produced by these V. cholerae serotypes is an enterotoxin composed of two subunits, A and B; the genetic information for the synthesis of these subunits is encoded on plasmids (genetic elements separate from the bacterial chromosome). In addition, another plasmid type encodes for a pilus (a hollow hairlike structure that supports bacterial attachment to human cells and facilitate the movement of toxin from V. cholerae into human cells). The enterotoxin causes human cells to extract water and electrolytes from the body (mainly the upper gastrointestinal tract) and pump it into the intestinal lumen where the fluid and electrolytes are excreted as diarrheal fluid. The enterotoxin is similar to toxin formed by bacteria that cause diphtheria in that both bacterial types secret the toxins into their surrounding environment where the toxin then enters the human cells. The bacteria are usually transmitted by drinking contaminated water, but the bacteria can also be ingested in contaminated food, especially seafood such as raw oysters.

What are risk factors for cholera, and where do cholera outbreaks occur?

Everyone who drinks or eats food that has not been treated to eliminate V. cholerae (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.

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. The Vibrio cholerae strain was closely related to a strain found in Nepal and leads some individuals to blame Nepalese troops that helped with the earthquake disaster as the source of the Haiti cholera outbreak.

In third-world countries, hunger can lead people to inadvertently eat contaminated food and/or drink contaminated water, thus raising the risk for cholera to infect malnourished populations.

There is some evidence that V. cholerae can survive in saltwater and have been isolated from shellfish; eating raw oysters is considered a risk factor for cholera, especially in underdeveloped countries and occasionally even in developed countries. A few people are diagnosed with cholera every year in the U.S. Most of the individuals diagnosed are travelers who were exposed to cholera outside the country, but occasionally, isolated cases are traced to contaminated seafood, usually from states that border the Gulf of Mexico.

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. In addition, researchers have noted that patients with blood type O are twice as likely to develop cholera as others. The reason for this blood type susceptibility is not completely understood. 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.

Is cholera contagious?

It takes about 100 million V. cholerae bacteria to infect a healthy adult. Because of this high number, significant contamination of food or water is required to transmit the disease, and direct person-to-person transmission is thought to be uncommon except in outbreaks. In outbreaks, cholera-causing bacteria become highly contagious indirectly and directly by the fecal-oral route because of widespread fecal contamination of food, water, and items like contaminated bedding and clothing.

What is the incubation period for cholera?

The incubation period (time period from exposure to the bacteria to the development of symptoms) may vary from a few hours (about six to 12 hours) to five days, with the average incubation period being about two to three days. About six to 12 hours is considered a very rapid incubation period and may suggest that rapid/immediate intervention is required for recovery.

What is the contagious period for cholera?

The contagious period for cholera begins as soon as organisms are excreted in the feces. This can occur as early as about six to 12 hours after exposure to the bacteria and can last for about seven to 14 days. Some individuals who are asymptomatic (infected but not having symptoms) will also excrete contagious organisms for about seven to 14 days.

What physicians usually treat cholera?

Because most individuals have either mild or no symptoms, these people are either not treated or treated by their primary-care physician. However, in some children and in individuals who have more severe disease, besides the primary-care physician or pediatrician, an infectious-disease specialist, a critical-care specialist, a gastroenterologist, and/or an internist may be needed to help the team manage and treat the patient.

In addition, specialists in travel medicine and/or epidemiology can help individuals avoid cholera and/or can give advice about prevention, treatment, and prognosis to those individuals traveling to or living in endemic areas.

How do health-care professionals diagnose cholera?

Preliminary diagnosis is usually done by a caregiver who takes a history from the patient and observes the characteristic rice-water diarrhea, especially if a local outbreak of cholera has identified. The diarrhea fluid is often teeming with motile, comma-shaped bacteria (presumptively V. cholerae) that can be seen with a microscope. The definitive diagnosis is made by isolation of the bacteria from diarrhea fluid. All state health department laboratories in the U.S. are able to perform tests for Vibrio cholerae. Readers may see terms like serotypes Inaba, Ogawa, and Hikojima to describe V. cholerae; they simply indicate which O antigens (O antigens designated A, B, or C) are found on these strains of V. cholerae. PCR tests have also been developed to detect the genetic material of cholera, but currently they are not as widely used as the immunologic tests based on type-specific antiserum.

Definitive diagnosis helps to distinguish cholera from other diseases caused by other bacterial, protozoal, or viral pathogens that cause dysentery (gastrointestinal inflammation with diarrhea).

What is the treatment for cholera?

The CDC (and almost every medical agency) recommends rehydration with ORS (oral rehydration salts) fluids as the primary treatment for cholera. ORS fluids are available in prepackaged containers, commercially available worldwide, and contain glucose and electrolytes. The CDC follows the guidelines developed by the WHO (World Health Organization) as follows:

Patient condition

Treatment

Treatment volume guidelines; age and weight

No dehydration

Oral rehydration salts (ORS)

Children < 2 years: 50 mL-100 mL, up to 500 mL/day
Children 2-9 years: 100 mL-200 mL, up to 1,000 mL/day
Patients > 9 years: As much as wanted, to 2,000 mL/day

Some dehydration

Oral rehydration salts (amount in first four hours)

Infants < 4 mos (< 5 kg): 200-400 mL
Infants 4 mos-11 mos (5 kg-7.9 kg): 400-600 mL
Children 1 yr-2 yrs (8 kg-10.9 kg): 600-800 mL
Children 2 yrs-4 yrs (11 kg-15.9 kg): 800-1,200 mL
Children 5 yrs-14 yrs (16 kg-29.9 kg): 1,200-2,200 mL
Patients > 14 yrs (30 kg or more): 2,200-4,000 mL

Severe dehydration

IV drips of Ringer Lactate or, if not available, normal saline and oral rehydration salts as outlined above

Age < 12 months: 30 mL/kg within one hour*, then 70 mL/kg over five hours
Age > 1 year: 30 mL/kg within 30 min*, then 70 mL/kg over two and a half hours

*Repeat once if radial pulse is still very weak or not detectable

Reassess the patient every one to two hours and continue hydrating. If hydration is not improving, give the IV drip more rapidly. 200 mL/kg or more may be needed during the first 24 hours of treatment.

After six hours (infants) or three hours (older patients), perform a full reassessment. Switch to ORS solution if hydration is improved and the patient can drink.

In general, antibiotics are reserved for more severe cholera infections; they function to reduce fluid rehydration volumes and may speed recovery. Although good microbiological principles dictate it is best to treat a patient with antibiotics that are known to be effective against the infecting bacteria, this may take too long a time to accomplish during an initial outbreak (but it still should be attempted); meanwhile, severe infections have been effectively treated with tetracycline (Sumycin), doxycycline ( Vibramycin, Oracea, Adoxa, Atridox, and others), furazolidone ( Furoxone), erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), or ciprofloxacin ( Cipro, Cipro XR, ProQuin XR) in conjunction with the following antibiotics in conjunction with IV hydration and electrolytes:

Tetracycline (Sumycin)

Doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others)

Furazolidone (Furoxone)

Erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone)

Azithromycin (Zithromax)

Sulfamethoxazole/trimethoprim (Bactrim, Septra)

Ampicillin

Ciprofloxacin (Cipro, Cipro XR, ProQuin XR)

Norfloxacin (Noroxin)

Many antibiotics are listed; however, because of widespread antibiotic resistance, including multi-resistant Vibrio strains, antibiotic susceptibility testing is advised so the appropriate antibiotic is chosen. In addition, quinolones (for example, ciprofloxacin, norfloxacin) should not be used in children if other antibiotics can be effective because of possible musculoskeletal adverse effects.

Is it possible to prevent cholera? Are cholera vaccines available?

Yes, cholera can be prevented by several methods. Developed countries have an almost zero incidence of cholera because they have widespread water-treatment plants, food-preparation facilities that usually practice sanitary protocols, and most people have access to toilets and hand-washing facilities. Although these countries may have occasional lapses or gaps in these methods, they have prevented many disease outbreaks, including cholera.

Individuals can prevent or reduce the chance they may get cholera by thorough hand washing, avoiding areas and people with cholera, drinking treated water or similar safe fluids, and eating cleaned and well-cooked food. In addition, there are vaccines available that can help prevent cholera, although they are not available in the U.S., and their effectiveness ranges from 50%-90%, depending on the studies reported. The vaccines are oral preparations, because injected vaccines have not proved to be very effective. Two vaccines (Shanchol and Dukoral) are composed of killed V. cholerae bacteria and don't contain the enterotoxin B subunit. Unfortunately, both offer protection for only about two years, although one report suggests that Shanchol is about 65% effective over five years. Both vaccines are usually given in two doses, about one to six weeks apart. Unfortunately, the vaccines have limited availability; their recommended use is for people going to areas of known outbreaks with the likely possibility the person may be exposed to cholera. Some researchers suggest this limited oral vaccine availability should be changed and cite data that oral vaccine may help limit outbreaks, even after they have begun.

Research is ongoing; a research study in Haiti will try to determine if a two-dose vaccine in people will suffice to protect a difficult to treat (rural poor) population from cholera and thus save many lives. There are over 30 universities researching this disease (cholera's epidemiology, pathology, immunology, vaccine production, and other problems) currently worldwide.

In 2015, about 2 million doses of oral cholera vaccine were shipped to various outbreak areas, and currently available information suggests that there was a significant reduction in transmission of endemic cholera; the study will be concluded in 2018.

In June 2016, the U.S. FDA (Food and Drug Administration) approved the first vaccine available in the United States to prevent cholera. The vaccine is termed Vaxchora and is manufactured by PaxVax Bermuda LTD. It can be used in adults age 18-64 who are traveling to cholera-affected areas of the world. The vaccine is a live, attenuated (weakened) dose of V. cholerae serogroup 01, the most prominent cause of cholera worldwide. The vaccine is administered orally in about 3 ounces of fluid. It is about 80% effective in individuals challenged with Vibrio bacteria three months after vaccination. The vaccine should be administered at least 10 days before the individual travels to a cholera-endemic area.

What is the prognosis of cholera?

The prognosis (outcome) of cholera can range from excellent to poor, depending on the severity of the dehydration and how quickly the patient is given and responds to treatments. Death (mortality) rates in untreated cholera can be as high as 50%-60% during large outbreaks but can be reduced to about 1% if treatment protocols (see above treatment section) are rapidly put into action. In general, the less severe the symptoms and the less time people have dehydration symptoms, the better the prognosis; in many people, if dehydration is quickly reversed, the prognosis is often excellent.

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Medically Reviewed on 6/16/2016

REFERENCES:

Brown, Troy. "FDA Approves First Cholera Vaccine in the US." Medscape.com. June 10, 2016. <https://www.medscape.com/viewarticle/864673?nlid=106295_3901&src=wnl_newsalrt_160610_MSCPEDIT&uac=138226AY&impID=1124116&faf=1>.

Switzerland. World Health Organization. "Cholera." July 2015. <http://www.who.int/mediacentre/factsheets/fs107/en/>.

United States. Centers for Disease Control and Prevention. "Cholera." Yellowbook 3.81 July 10, 2015. <http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/cholera>.

United States. Centers for Disease Control and Prevention. "Cholera -- Vibrio cholera Infection." Nov. 27, 2014. <http://www.cdc.gov/cholera/index.html>.

Unites States. Food and Drug Administration. "Vaxchora." June 16, 2016.<http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm505866.htm>.

Complete List

Top Cholera Related Articles

Dehydration

Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. Symptoms of dehydration include:

headache,

lightheadedness,

constipation, and

bad breath.

Treatment for dehydration is to replace lost fluids and electrolytes.

Low Blood Pressure

Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include:

light-headedness,

dizziness, or

even fainting if not enough blood is getting to the brain.

Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.

Travel Medicine

Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include:

malaria,

meningococcal meningitis,

yellow fever,

hepatitis A,

typhoid fever,

polio, and

cholera.

Traveler's Diarrhea

Travelers' diarrhea is generally contracted by eating contaminated food or drinking contaminated water. Food is the primary source of travelers' diarrhea. Enterotoxigenic E. coli is the cause of up to 70% of all cases of travelers' diarrhea. There are five unique classes of E. coli that causes gastroenteritis. Other bacteria responsible for travelers' diarrhea include Campylobacter, jejuni, shigella, and salmonella. Viruses such as rotavirus and Norwalk virus (norovirus) and giardia lamblia a parasite may cause travelers' diarrhea. Prevention is careful eating and drinking of water.

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Cholera Treatment, History, Prevention & Causes

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Cholera facts Cholera is a disease caused by bacteria that produce a watery diarrhea that can rapidly lead to dehydration. Cholera symptoms and signs include a rapid onset of copious, smelly diarrhea that resembles rice water and may lead to signs of dehydration (for example, vomiting, wrinkled skin, low blood pressure, dry mouth, rapid heart rate).

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Though it is very rare, animals can get cholera

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"Cholera requires immediate treatment because the disease can cause death within hours. Rehydration. The goal is to replace lost fluids and electrolytes using a simple rehydration solution, oral rehydration salts (ORS). The ORS solution is available as a powder that can be reconstituted in boiled or bottled water." Mar 9, 2017 https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293

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"  Bacterial Infections - Sharecare. When the bacteria that cause cholera enter the body, some of it can be killed by stomach acid. However, some of the bacteria travel to the small intestine, causing the loss of large amounts of salt and water in the form of watery diarrhea "

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How does cholera affect the body? | Bacterial Infections

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When the bacteria that cause cholera enter the body, some of it can be killed by stomach acid. However, some of the bacteria travel to the small intes

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http://ocp.hul.harvard.edu/contagion/cholera.html

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it affects the Digestive, Urinary, and Muscular systems
https://en.wikipedia.org/wiki/Cholera

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It is caused by eating food or drinking water infected with Vibrio Cholerae

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Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in the U.S. However, cholera outbreaks are still a serious problem in other parts of the world. The World Health Organization reports that there are 1.3 million to 4 million cases each year.

The disease is most common in places with poor sanitation, crowding, war, and famine. Common locations include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas, knowing the following cholera facts can help protect you and your family.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include:

Municipal water supplies

Ice made from municipal water

Foods and drinks sold by street vendors

Vegetables grown with water containing human wastes

Raw or undercooked fish and seafood caught in waters polluted with sewage

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea.

It is not likely you will catch cholera just from casual contact with an infected person.

Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include:

If not treated, dehydration can lead to shock and death in a matter of hours.

Continued

Cholera Treatment and Prevention

There is a vaccine for cholera. Both the CDC and the World Health Organization have specific guidelines for who should be given this vaccine.

You can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected, or bottled water. Be sure to use bottled, boiled, or chemically disinfected water for the following purposes

Drinking

Preparing food or drinks

Making ice

Brushing your teeth

Washing your face and hands

Washing dishes and utensils that you use to eat or prepare food

Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant. You should also avoid raw foods, including the following:

Unpeeled fruits and vegetables

Unpasteurized milk and milk products

Raw or undercooked meat or shellfish

Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

Sources

SOURCES:

CDC: "Cholera: General Information;" "Cholera: Disease;" and "Cholera: Prevention and Control." "Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine."

University of Alabama at Birmingham Health System: "Cholera."

MedlinePlus.gov: "Cholera."

World Health Organization: "Cholera."

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Cholera: Causes, Symptoms, Treatment, and Prevention

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Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water.

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"Requires a medical diagnosis

Key symptoms are diarrhea and dehydration. Rarely, shock and seizures may occur in severe cases."

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Mar 9, 2017 ... Symptoms of cholera infection may include: Diarrhea. Cholera-related diarrhea comes on suddenly and may quickly cause dangerous fluid loss - as much as a quart (about 1 liter) an hour. Nausea and vomiting. Occurring especially in the early stages of cholera, vomiting may persist for hours at a time.

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Love in the Time of Cholera by Gabriel Garcia Márquez is one of the greatest and most beloved love stories ever written, or at the very least the 20th century. And while its characters are captivating and its plot moving, the fact remains that the time in which the story was set was far from one to be romanticized.

Why might you ask? You need only to look at the title to figure that one out.

Set at the of end of the 19th and beginning of the 20th century in South America near the Caribbean; it is certainly a picturesque backdrop, but given it is a love story and this was the area of a massive and deadly cholera outbreak at the same time, somewhat seems to make the likelihood of thinking about anything other than cholera highly unlikely.

However, this does beg the question for our modern age as to what exactly cholera is and where did it come from? After all, the World Health Organization have estimated that each year there are 1.3 to 4.0 million cases of cholera, and 21 000 to 143 000 deaths worldwide due to cholera.

Cholera is a disease of ancient origins, having existed since the times of Buddha and Hippocrates if not earlier. The first recorded instance of cholera, however, was in 1563 in an Indian medical report, but in our modern times, the story of this disease begins in 1817. It was this year that the disease spread from its original homeland along the Ganges Delta in India and began to ravage the world. Since that time, untold millions have not only contracted this preventable disease but have perished by it.

An acute diarrheal disease, cholera can lead to severe dehydration as a result of massive bodily fluid loss and potentially death. Originally and in the early 19th century, it was believed that the disease was thought to have been transmitted by a miasma or "bad air," but we now know that the disease is caused by the type of bacterium called Vibrio cholerae, or simply V. Cholera. This bacterium flourishes in warm water and is transmitted through the intake of contaminated food and water. The bacterium can turn into cholera as quickly as two hours which, according to WHO, "enhances the potentially explosive pattern of outbreaks."

Over the course history, scholars and the medical community believe that there was a total of six separate pandemics of the disease, with a seventh one that is still currently running rampant in many developing countries around the world. From Europe to Asian, and South and North America, there are few spots across the globe that have not been impacted by this devastating disease at one point or another.

Thanks to advancements in medical practices and procedures, 80% of cholera cases today can be prevented by the ingestion of rehydration salts. And while reassuring, this sadly doesn't do much good unless you know that do in fact have cholera.

So the err on the side of caution and to promote global health, allow us to present to you the 10 most common signs and symptoms of cholera - a must read, especially if you plan on doing any traveling in the near future.

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10 Signs and Symptoms of Cholera - RM Healthy

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Love in the Time of Cholera by Gabriel Garcia Márquez is one of the greatest and most beloved love stories ever written, or at the very least the 20th century. And while its characters are captivating and its plot moving, the fact remains that the time in which the story was set was far from one to be romanticized.

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Vibrio cholerae is what causes cholera.

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Cholera is a bacterial disease usually spread through contaminated water. Cholera causes severe diarrhea and dehydration. Left untreated, cholera can be fatal within hours, even in previously healthy people.

Modern sewage and water treatment have virtually eliminated cholera in industrialized countries. But cholera still exists in Africa, Southeast Asia and Haiti. The risk of a cholera epidemic is highest when poverty, war or natural disasters force people to live in crowded conditions without adequate sanitation.

Cholera is easily treated. Death from severe dehydration can be prevented with a simple and inexpensive rehydration solution.

Most people exposed to the cholera bacterium (Vibrio cholerae) don't become ill and don't know they've been infected. But because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water.

Most cases of cholera that cause symptoms cause mild or moderate diarrhea that's often hard to tell apart from diarrhea caused by other problems. Others develop more-serious signs and symptoms of cholera, usually within a few days of infection.

Symptoms of cholera infection can include:

Diarrhea. Cholera-related diarrhea comes on suddenly and can quickly cause dangerous fluid loss - as much as a quart (about 1 liter) an hour. Diarrhea due to cholera often has a pale, milky appearance that resembles water in which rice has been rinsed.

Nausea and vomiting. Vomiting occurs especially in the early stages of cholera and can last for hours.

Dehydration. Dehydration can develop within hours after cholera symptoms start and range from mild to severe. A loss of 10% or more of body weight indicates severe dehydration.

Signs and symptoms of cholera dehydration include irritability, fatigue, sunken eyes, a dry mouth, extreme thirst, dry and shriveled skin that's slow to bounce back when pinched into a fold, little or no urinating, low blood pressure, and an irregular heartbeat.

Dehydration can lead to a rapid loss of minerals in your blood that maintain the balance of fluids in your body. This is called an electrolyte imbalance.

Electrolyte imbalance

An electrolyte imbalance can lead to serious signs and symptoms such as:

Muscle cramps. These result from the rapid loss of salts such as sodium, chloride and potassium.

Shock. This is one of the most serious complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body. If untreated, severe hypovolemic shock can cause death in minutes.

The risk of cholera is slight in industrialized nations. Even in areas where it exists you're not likely to become infected if you follow food safety recommendations. Still, cases of cholera occur throughout the world. If you develop severe diarrhea after visiting an area with active cholera, see your doctor.

If you have diarrhea, especially severe diarrhea, and think you might have been exposed to cholera, seek treatment right away. Severe dehydration is a medical emergency that requires immediate care.

A bacterium called Vibrio cholerae causes cholera infection. The deadly effects of the disease are the result of a toxin the bacteria produces in the small intestine. The toxin causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes).

Cholera bacteria might not cause illness in all people who are exposed to them, but they still pass the bacteria in their stool, which can contaminate food and water supplies.

Contaminated water supplies are the main source of cholera infection. The bacterium can be found in:

Surface or well water. Contaminated public wells are frequent sources of large-scale cholera outbreaks. People living in crowded conditions without adequate sanitation are especially at risk.

Seafood. Eating raw or undercooked seafood, especially shellfish, that comes from certain places can expose you to cholera bacteria. Most recent cases of cholera in the United States have been traced to seafood from the Gulf of Mexico.

Raw fruits and vegetables. Raw, unpeeled fruits and vegetables are a frequent source of cholera infection in areas where there's cholera. In developing countries, uncomposted manure fertilizers or irrigation water containing raw sewage can contaminate produce in the field.

Grains. In regions where cholera is widespread, grains such as rice and millet that are contaminated after cooking and kept at room temperature for several hours can grow cholera bacteria.

Everyone is susceptible to cholera, with the exception of infants who get immunity from nursing mothers who have previously had cholera. Still, certain factors can make you more vulnerable to the disease or more likely to have severe signs and symptoms.

Risk factors for cholera include:

Poor sanitary conditions. Cholera is more likely to flourish in situations where a sanitary environment - including a safe water supply - is difficult to maintain. Such conditions are common to refugee camps, impoverished countries, and areas afflicted by famine, war or natural disasters.

Reduced or nonexistent stomach acid. Cholera bacteria can't survive in an acidic environment, and ordinary stomach acid often serves as a defense against infection. But people with low levels of stomach acid - such as children, older adults, and people who take antacids, H-2 blockers or proton pump inhibitors - lack this protection, so they're at greater risk of cholera.

Household exposure. You're at increased risk of cholera if you live with someone who has the disease.

Type O blood. For reasons that aren't entirely clear, people with type O blood are twice as likely to develop cholera compared with people with other blood types.

Raw or undercooked shellfish. Although industrialized nations no longer have large-scale cholera outbreaks, eating shellfish from waters known to harbor the bacteria greatly increases your risk.

Cholera can quickly become fatal. In the most severe cases, the rapid loss of large amounts of fluids and electrolytes can lead to death within hours. In less extreme situations, people who don't receive treatment can die of dehydration and shock hours to days after cholera symptoms first appear.

Although shock and severe dehydration are the worst complications of cholera, other problems can occur, such as:

Low blood sugar (hypoglycemia). Dangerously low levels of blood sugar (glucose) - the body's main energy source - can occur when people become too ill to eat. Children are at greatest risk of this complication, which can cause seizures, unconsciousness and even death.

Low potassium levels. People with cholera lose large quantities of minerals, including potassium, in their stools. Very low potassium levels interfere with heart and nerve function and are life-threatening.

Kidney failure. When the kidneys lose their filtering ability, excess amounts of fluids, some electrolytes and wastes build up in the body - a potentially life-threatening condition. In people with cholera, kidney failure often accompanies shock.

Cholera is rare in the United States with the few cases related to travel outside the U.S. or to contaminated and improperly cooked seafood from the Gulf Coast waters.

If you're traveling to areas known to have cholera, your risk of contracting the disease is extremely low if you follow these precautions:

Wash your hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water aren't available, use an alcohol-based hand sanitizer.

Drink only safe water, including bottled water or water you've boiled or disinfected yourself. Use bottled water even to brush your teeth.

Hot beverages are generally safe, as are canned or bottled drinks, but wipe the outside before you open them. Don't add ice to your drinks unless you made it yourself using safe water.

Eat food that's completely cooked and hot and avoid street vendor food, if possible. If you do buy a meal from a street vendor, make sure it's cooked in your presence and served hot.

Avoid sushi, as well as raw or improperly cooked fish and seafood of any kind.

Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and fruits that can't be peeled, such as grapes and berries.

Cholera vaccine

People traveling from the United States to areas affected by cholera can get a cholera vaccine called Vaxchora. It's suggested for people between ages 2 and 64 who plan to travel where cholera is being spread or regularly spreads. It is a liquid dose taken by mouth at least 10 days before travel.

Several other countries offer oral vaccines as well. Contact your doctor or local office of public health for more information about these vaccines. Even with the vaccine, it's important to take the above precautions to prevent cholera.

1. Kliegman RM, et al. Cholera. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 12, 2019.

2. Ferri FF. Cholera. In: Ferri's Clinical Advisor 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 12, 2019.

3. Cholera. Centers for Disease Control and Prevention. http://www.cdc.gov/cholera/index.html. Accessed Dec. 12, 2019.

4. Cholera. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/cholera. Accessed Dec. 12, 2019.

5. LaRocque R, et al. Cholera: Clinical features, diagnosis, treatment, and prevention. https://www.uptodate.com/contents/search. Accessed Dec. 12, 2019.

6. WHO position paper on oral rehydration salts to reduce mortality from cholera. World Health Organization. https://www.who.int/cholera/technical/en/. Accessed Dec. 12, 2019.

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Cholera-Cholera - Symptoms & causes - Mayo Clinic

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Cholera is a treatable - yet potentially fatal - bacterial disease that causes diarrhea and dehydration. Learn how to lower your risk.

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A lot of countries still have Cholera outbreaks.

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A lot of countries still have Cholera outbreaks.

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January 30th, 2018
Since our last update, there are now a total of 3,635 cases with 78 deaths.
January 16th, 2018
Update from Minister of Health Chitalu Chilufya:

In the last 24 hours, they had 29 cases compared to the 68 cases recorded over the same period. There has been a cumulative total of 3,260 cases and 74 deaths.
January 12th, 2018
Authorities have closed down businesses in epicenters of the Cholera outbreak in an effort to curb the spread of the infection. This has caused mounting tension, with some people, desperate and without limited choices, protesting

The epidemic has killed 70 people, and the current reported number of infections has climbed to 3,077.

Report from CMMB Country Director, Batuke Walusiku-Mwewa

CMMB was present at the cholera meeting this morning as well as the Oral Cholera Vaccine launch by the Minister of Health.

As of today, there have been a cumulative total of 2,905 cases and 67 deaths (the last happened in the past 24 hours but apparently was due to co-morbidity. A post-mortem is being done to determine the actual cause of death).

Of the 95 cases reported in the last 24 hours, 23 are children. A very sobering situation.

Batuke went on to say,

"As a country, we are facing a very difficult time, one that creates a level of shame while also acknowledging that there are actions that we may have benefited from doing much earlier before we were hit by cholera. The fight needs to start with us, community members, at household level. We need to keep our environment clean, work on policy that provides short and long term solutions and implement it. We are in a state of public health emergency and we recognize that there is a lot we can do but we cannot do it alone. We need all hands on board so we can have clean water, acceptable sanitation and behavior that supports a cholera free environment! We cannot afford to lose another life! It is my humble plea that people, organizations and governments who have stood by us and more, will continue to join hands with us as we fight this epidemic!"

This morning, Zambia's Minister of Health, Dr. Chilufya reported that the country has now recorded a cumulative total of 2,802 cases with 218 under treatment countrywide. The death toll has reached 66 people.

The number of cholera cases continues to rise in Zambia, with 108 new cases recorded today bringing the accumulative number to 2,600.

Zambia's Minister of Health Mr. Chitalu Chilufya explained that due to the rising number of cases the government has banned all gatherings, including church services and funeral gatherings, in cholera epicenters. People living outside of these epicenters are being advised to practice preventative measures.

Government Stops Issuing Passports, Birth Certificates, NRCs Due To Cholera Outbreak

Minister of Home Affairs Stephen Kampyongo has announced the suspension of operations for the Departments of National Registration, Passport and Citizenship offices, as an enforcement of SI number 79, which restricts public gatherings in the wake of a severe Cholera outbreak.

With immediate effect, all registration offices in Lusaka will be closed to the public.
Registration officers will only attend to requests for emergency travels.
The minister said that this suspension is temporary, and the general public will be informed when the situation will be reviewed.

One hundred more cases of cholera have been recorded in the last 24 hours, according to a statement issued by Zambian Health Minister, Dr. Chitalu Chilufya on Friday morning.

The following information has been provided by the Zambia National Public Health Institute and the Zambian Ministry of Health.

Cholera Outbreak in Zambia: No Signs of Slowing

Zambia is in the midst of a cholera outbreak. Originally declared on October 6, 2017 in Lusaka, the response was escalated on December 20th and the spread shows no signs of slowing.

The cumulative number of reported cases in Lusaka as of January 2nd is 1,901, with 48 deaths, resulting in a high case fatality rate (CFR) of 2.4 percent. The CFR rate is a measure of the severity of a disease. It is defined as the proportion of reported cases of a specified disease or condition that are fatal within a specified time. With proper and timely treatment, the case fatality rate for cholera should remain below one percent.

Putting Things into Perspective

The CFR for the Spanish (1918) flu was >2.5%. This flu pandemic was the deadliest in modern history and infected approximately 500 million people worldwide and killed an estimated 20-50 million people.

What is Cholera?

According to the World Health Organization, cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. This bacterium is usually found in water or food sources contaminated by feces from a person infected with cholera. It is most likely to be found and spread in places with inadequate water treatment, poor sanitation, and inadequate hygiene.

Symptoms include diarrhea, vomiting, leg cramps, and dehydration. These typically appear within two to three days from date of infection. Cholera can be treated by replacement of lost fluids and salts. With prompt re-hydration, fewer than one percent of cholera patients die. However, it is estimated that one in ten infected persons will experience severe symptoms, leading to rapid loss of body fluids which causes dehydration and shock. Without treatment, death can occur within hours.

Researchers estimate that there are roughly 1.3 to four million cases, and 21,000 to 143,000 deaths worldwide due to cholera. It remains a global threat to public health and is an indication of inequality and lack of social development.

What's Happening in Zambia?

Several measures are being taken in an effort to help safeguard lives and prevent further spread of this deadly disease. Schools, including universities in Lusaka and impacted areas, have been closed indefinitely. The sale of fresh foods, including meat, chicken, and fish on streets, has been banned. Several restaurants and other sites found to be contaminated have been closed until further notice.

Raising Awareness

Economic Impact

Economic analyst Chibamba Kanyama has warned that the cholera outbreak in Zambia should be treated as a real crisis that may result in an economic catastrophe. Kanyama said, "Cholera is no longer just a disease associated with high density communities of large cities but has also spread to the suburbs. For the first time since cases of cholera affected Zambia in past decades, there are now mentions of actual sources of the problem of which 'upmarket' takeaway food outlets such as Wimpy and Hungry Lion have contributed. Soweto Market, Zambia's leading farm produce distribution center has been shut, with the Zambia National Farmers Union already lamenting the huge losses that farmers are incurring. Very soon, the limiting of public gatherings will be extended to supermarkets whose daily sales are in hundreds of millions of Kwacha. Should this happen, VAT collections by the Zambia Revenue Authority will be impacted."

Public Health Actions

The Ministry of Health is collaborating with WHO and partners to control the outbreak, with six local incident command posts currently operational in Chawama, Chipata, Kanyama, Matero, Chelstone and Chilenje, each lead by a public health specialist. The Zambia National Public Health Institute (ZNPHI) is leading investigations into circulating strains and patterns of transmission among patient clusters. They are also conducting knowledge, attitude and practice surveys and residual chlorine testing in Chipata and Kanyama, a mortality review, and a case-control study in Chipata. WHO has donated oral rehydration solution, intravenous fluids and giving sets, antibiotics, diagnostic kits, cadaver bags, and gloves to cholera treatment centers. Centers will be assigned additional clinical staff to provide 24-hour staffing.

Lusaka City Council had collected more than 2,000 tons of waste and emptied nearly 100 septic tanks. More than 1,000 pit latrines will be emptied, and 148 shallow wells have been targeted for closure. One of the biggest risk factors for continued spread of cholera is the consumption of unsafe water from shallow wells. There is resistance from communities to cap them due to the lack of alternative water supplies. Inspection of premises is ongoing, along with disinfection of houses, toilets, and distribution of chlorine solution and soap. Contact tracing is ongoing and contacts of 1,032 cases have been traced so far. Human resources (medical and environmental health students and environmental health technologists) are being deployed to support water, sanitation and hygiene interventions in Chipata, Garden, and Kanyama.

There have been six press briefings, and cholera prevention information has been communicated to the public through radio broadcasts. Educational outreach to the affected communities is ongoing.

Current challenges include:

Lack of access to clean, safe water and sanitation

Insufficient waste management

Issues around sanitation with markets and street vendors
Evidence of the role of contaminated food in spread of outbreak

Lack of transport and fuel

Inadequate supplies including chlorine and personal protective gear (garments or equipment designed to protect from injury or infection)

Problems disseminating health education messages

Interventions:

Provision of safe water to all affected peri-urban areas

Environmental management: water sampling, inspection of public premises, business, and food outlets, disinfection of toilets and latrines, treatment of water sources, and waste management

Oral cholera vaccine: including the training of field supervisors and those who will administer vaccines

Health promotion: door to door campaigns, mobile PA announcements, media programs. This will also include the distribution of chlorine for cleaning water

Public communication: 24hr call center, media brief and press releases

Human resource mobilization: recruitment of staff and student involvement

Active case finding

CMMB is currently mounting a response in collaboration with Procter & Gamble and other partners. Our efforts will focus specifically on water and sanitation. Keep checking CMMB's website for updates.

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Cholera Outbreak in Lusaka, Zambia - CMMB

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January 30th, 2018 Since our last update, there are now a total of 3,635 cases with 78 deaths. January 16th, 2018 Update from Minister of Health Chitalu Chilufya: In the last 24 hours, they had 29 cases compared to the 68 cases recorded over the same period.

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"Cholera. Cholera, an acute infection of the small intestine caused by the bacterium Vibrio cholerae and characterized by extreme diarrhea with rapid and severedepletion of body fluids and salts.Mar 21, 2018" https://www.britannica.com/science/cholera

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Cholera effects the digestive system, nervous system, urinary system, muscular-skeletal system, and immune system.

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"Mar 9, 2017 - Symptoms of cholera infection may include: Diarrhea. Cholera-related diarrhea comes on suddenly and may quickly cause dangerous fluid loss — as much as a quart (about 1 liter) an hour.Nausea and vomiting. Occurring especially in the early stages of cholera, vomiting may persist for hours at a time. Dehydration." Mar 9, 2017 - Symptoms of cholera infection may include: Diarrhea. Cholera-related diarrhea comes on suddenly and may quickly cause dangerous fluid loss — as much as a quart (about 1 liter) an hour.Nausea and vomiting. Occurring especially in the early stages of cholera, vomiting may persist for hours at a time. Dehydration." https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-20355287

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Cholera is a serious disease that is spread by the Vibrio cholerae bacteria. The bacteria usually spreads through water that has been contaminated by an infected person’s fecal matter. It can also be spread through raw shellfish and raw fruits and vegetables.

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Cholera is a serious disease that is spread by the Vibrio cholerae bacteria. The bacteria usually spreads through water that has been contaminated by an infected person's fecal matter. It can also be spread through raw shellfish and raw fruits and vegetables. Not everyone who is exposed to the bacteria gets sick, but their stool may still contain traces of the bacteria. Even a tiny amount of fecal matter could contain enough of the bacteria to infect someone else.

When an individual does get sick with cholera, they'll rapidly lose fluids, which causes uncomfortable, painful, and sometimes life threatening symptoms. A severe case of cholera can lead to death within hours, and even mild or moderate cases can make you dangerously dehydrated. Fortunately, the disease is easy to treat with rehydration solutions and antibiotics. The sooner you receive medical treatment, the sooner your symptoms will clear up. Therefore, it's important to be aware of the signs and symptoms of cholera, so you can seek immediate medical attention if you become infected.
1. Diarrhea
Diarrhea is the main symptom of cholera. The majority of people who are exposed to the cholera bacteria only experience this mildly or moderately, and it's often attributed to other problems like food poisoning. About one in 10 people infected with the bacteria develop serious symptoms. In these cases, the diarrhea comes on very suddenly and can be severe. This occurs because the bacteria produces a toxin that binds to the walls of your small intestine.

There, it interferes with your body's sodium and chloride levels, and it causes the cells that line your intestine to release more water than usual. Diarrhea and other symptoms usually appear two or three days after being infected with the bacteria, but it sometimes only takes a few hours for a person to become ill. Stools usually have a pale or milky appearance. In severe cases, you may lose a quart of fluid an hour, which can lead to extreme dehydration. The disease can be fatal if you lose too much fluid or salt, so fast treatment is important. It can usually be treated by drinking lots of water and consuming a mixture of salt and sugar, but you may need intravenous solutions to replace the fluids.

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Cholera is a serious disease that is spread by the Vibrio cholerae bacteria. The bacteria usually spreads through water that has been contaminated by an infected person's fecal matter. It can also be spread through raw shellfish and raw fruits and vegetables.

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Some symptoms are diarrhea and vomiting, which can lead to dehydration and also death which is probably not good.

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Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in the U.S. However, cholera outbreaks are still a serious problem in other parts of the world. The World Health Organization reports that there are 1.3 million to 4 million cases each year.

The disease is most common in places with poor sanitation, crowding, war, and famine. Common locations include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas, knowing the following cholera facts can help protect you and your family.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include:

Municipal water supplies

Ice made from municipal water

Foods and drinks sold by street vendors

Vegetables grown with water containing human wastes

Raw or undercooked fish and seafood caught in waters polluted with sewage

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea.

It is not likely you will catch cholera just from casual contact with an infected person.

Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include:

If not treated, dehydration can lead to shock and death in a matter of hours.

Continued

Cholera Treatment and Prevention

There is a vaccine for cholera. Both the CDC and the World Health Organization have specific guidelines for who should be given this vaccine.

You can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected, or bottled water. Be sure to use bottled, boiled, or chemically disinfected water for the following purposes

Drinking

Preparing food or drinks

Making ice

Brushing your teeth

Washing your face and hands

Washing dishes and utensils that you use to eat or prepare food

Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant. You should also avoid raw foods, including the following:

Unpeeled fruits and vegetables

Unpasteurized milk and milk products

Raw or undercooked meat or shellfish

Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

Sources

SOURCES:

CDC: "Cholera: General Information;" "Cholera: Disease;" and "Cholera: Prevention and Control." "Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine."

University of Alabama at Birmingham Health System: "Cholera."

MedlinePlus.gov: "Cholera."

World Health Organization: "Cholera."

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Cholera: Causes, Symptoms, Treatment, and Prevention

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Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water.

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Cholera may cause dehydration and diarrhea. In very severe cases, shock and seizure may occur.  It is so rare that only one person caught it in the US in 2015

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Throwing up and diarrhea (there are a bunch of other things, but they are gross)
https://www.medicinenet.com/cholera/article.htm#what_are_cholera_symptoms_and_signs

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Diarrhea, dehydration, shock, seizures, abdomen pain, nausea/vomiting, and lethargy

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Cholera is a serious disease that is spread by the Vibrio cholerae bacteria. The bacteria usually spreads through water that has been contaminated by an infected person's fecal matter. It can also be spread through raw shellfish and raw fruits and vegetables. Not everyone who is exposed to the bacteria gets sick, but their stool may still contain traces of the bacteria. Even a tiny amount of fecal matter could contain enough of the bacteria to infect someone else.

When an individual does get sick with cholera, they'll rapidly lose fluids, which causes uncomfortable, painful, and sometimes life threatening symptoms. A severe case of cholera can lead to death within hours, and even mild or moderate cases can make you dangerously dehydrated. Fortunately, the disease is easy to treat with rehydration solutions and antibiotics. The sooner you receive medical treatment, the sooner your symptoms will clear up. Therefore, it's important to be aware of the signs and symptoms of cholera, so you can seek immediate medical attention if you become infected.
1. Diarrhea
Diarrhea is the main symptom of cholera. The majority of people who are exposed to the cholera bacteria only experience this mildly or moderately, and it's often attributed to other problems like food poisoning. About one in 10 people infected with the bacteria develop serious symptoms. In these cases, the diarrhea comes on very suddenly and can be severe. This occurs because the bacteria produces a toxin that binds to the walls of your small intestine.

There, it interferes with your body's sodium and chloride levels, and it causes the cells that line your intestine to release more water than usual. Diarrhea and other symptoms usually appear two or three days after being infected with the bacteria, but it sometimes only takes a few hours for a person to become ill. Stools usually have a pale or milky appearance. In severe cases, you may lose a quart of fluid an hour, which can lead to extreme dehydration. The disease can be fatal if you lose too much fluid or salt, so fast treatment is important. It can usually be treated by drinking lots of water and consuming a mixture of salt and sugar, but you may need intravenous solutions to replace the fluids.

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Cholera is a serious disease that is spread by the Vibrio cholerae bacteria. The bacteria usually spreads through water that has been contaminated by an infected person's fecal matter. It can also be spread through raw shellfish and raw fruits and vegetables.

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"Cholera requires immediate treatment because the disease can cause death within hours.

Rehydration. The goal is to replace lost fluids and electrolytes using a simple rehydration solution, oral rehydration salts (ORS). The ORS solution is available as a powder that can be reconstituted in boiled or bottled water. Without rehydration, approximately half the people with cholera die. With treatment, the number of fatalities drops to less than 1 percent.

Intravenous fluids. During a cholera epidemic, most people can be helped by oral rehydration alone, but severely dehydrated people may also need intravenous fluids.

Antibiotics. While antibiotics are not a necessary part of cholera treatment, some of these drugs may reduce both the amount and duration of cholera-related diarrhea for people who are severely ill.

Zinc supplements. Research has shown that zinc may decrease and shorten the duration of diarrhea in children with cholera. "

I copied and pasted

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Cholera - Diagnosis and treatment - Mayo Clinic

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Cholera is a treatable, yet potentially fatal bacterial disease that causes diarrhea and dehydration. Learn how to lower your risk.

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"Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae."

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Cholera: Causes, Symptoms, Treatment, and Prevention

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WebMD describes the causes, symptoms, treatment, and prevention of cholera.

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diarrhea, nausea/vomiting, and dehydration.
Also  "Signs and symptoms of cholera dehydration include irritability, lethargy, sunken eyes, a dry mouth, extreme thirst, dry and shriveled skin that's slow to bounce back when pinched into a fold, little or no urine output, low blood pressure, and an irregular heartbeat (arrhythmia). Dehydration may lead to a rapid loss of minerals in your blood (electrolytes) that maintain the balance of fluids in your body. This is called an electrolyte imbalance.  "
Electrolyte imbalance can cause severe shock and muscle cramps.

https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-20355287

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Cholera Epidemics - Ohio History Central

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Cholera epidemics continued in the United States until the early 1900s. As sanitation improved within the United States, including chlorination of water, the illness became less common. In modern nations, cholera cases are very rare. In developing countries, cholera remains a not-uncommon disease.

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I think that the main systems that are affected are the Immune System, the Digestive System, and the Nervous System

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"Dehydration,  diarrhea, and death if untreated"

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Cholera: Causes, Symptoms, Treatment, and Prevention

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WebMD describes the causes, symptoms, treatment, and prevention of cholera.

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Today, it can be prevented by regular washing hands after going potty

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"Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae." Jul 14, 2017 https://www.webmd.com/a-to-z-guides/cholera-faq

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Cholera is caused by Gram stain-negative, comma shaped, and has a flagellum which is for motility and pili used to attach to tissue.

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Cholera facts

Cholera is a disease caused by bacteria that produce a watery diarrhea that can rapidly lead to dehydration.

Cholera symptoms and signs include a rapid onset of copious, smelly diarrhea that resembles rice water and may lead to signs of dehydration (for example, vomiting, wrinkled skin, low blood pressure, dry mouth, rapid heart rate).

Cholera is most frequently transmitted by water sources contaminated with the causative bacterium Vibrio cholerae, although contaminated foods, especially raw shellfish, may also transmit the cholera-causing bacteria.

Cholera is presumptively diagnosed by patient history and examination of stool for rice-water appearance and presence of V. cholerae-like organisms microscopically; definitive diagnosis is done by isolation and identification of V. cholerae from stool samples.

The main treatment for cholera is fluid and electrolyte replacement, both oral and IV. Antibiotics usually are used in severe infections in which dehydration has occurred.

The prognosis of cholera ranges from excellent to poor. Rapid treatment with fluid and electrolytes result in better outcomes while people with other health problems beside cholera or those who are not rapidly replenished with fluid treatments tend to have a poorer prognosis.

It's possible to prevent cholera with appropriate measures such as safe drinking water and non-contaminated foods; some protection can be obtained from oral vaccines while avoiding areas where cholera commonly occurs or has had a recent outbreak.

In June 2016, the FDA approved an oral vaccine for use in the U.S. for travelers to cholera-endemic areas to protect them from getting cholera; this oral vaccine is about 80% effective three months after a single oral dose in adults 18-64 years old.

What is cholera?

Cholera is an acute infectious disease caused by a bacterium, Vibrio cholerae ( V. cholerae), which usually 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. Although symptoms may be mild, some previously healthy people will develop a copious diarrhea within about one to five days after ingesting the bacteria. Severe disease requires prompt medical care. Hydration (usually by IV for the very ill) of the patient, and antibiotics in some individuals, is the key to surviving the severe form of the disease.

The World Health Organization (WHO) has maps of current and past areas with cholera outbreaks (see WHO reference). It is estimated that about 1.4 million to 4.3 million people are infected worldwide each year, with approximately 28,000-142,000 deaths per year. Only about one in 10 people infected with cholera develop the typical signs and symptoms. Outbreaks of cholera in 2015-2016 include South Sudan, United Republic of Tanzania, and Kenya, with over 216 deaths and most recently, 121 people diagnosed with cholera in Iraq, their first outbreak since 2012 and in Cuba, the first outbreak in over 130 years.

The term cholera has a long history (see history section below) and has been assigned to several other diseases. For example, fowl or chicken cholera is a disease that can rapidly kill chickens and other avian species rapidly with a major symptom of diarrhea. However, the disease-causing agent in fowl is Pasteurella multocida, a gram-negative bacterium. Similarly, pig cholera (also termed hog or swine cholera) can cause rapid death (in about 15 days) in pigs with symptoms of fever, skin lesions, and seizures. This disease is caused by a pestivirus termed CSFV (classical swine fever virus). Neither one of these animal diseases are related to human cholera, but the terminology can be confusing.

What is the history of cholera?

Cholera has likely been affecting humans for many centuries. Reports of cholera-like disease have been found in India as early as 1000 AD. Cholera is a term derived from Greek khole (illness from bile) and later in the 14th century to colere (French) and choler (English). In the 17th century, cholera was a term used to describe a severe gastrointestinal disorder involving diarrhea and vomiting. There were many outbreaks of cholera, and by the 16th century, some were being noted in historical writings. England had several in the 19th century, the most notable being in 1854, when Dr. John Snow did a classic study in London that showed a main source of the disease (resulting in about 500 deaths in 10 days) came from at least one of the major water sources for London residents termed the "Broad Street pump." The pump handle was removed, and the cholera deaths slowed and stopped. The pump is still present as a landmark in London. Although Dr. Snow did not discover the cause of cholera, he did show how the disease could be spread and how to stop a local outbreak. This was the beginning of modern epidemiologic studies. The last reference shows the map Dr. Snow used to identify the pump site.

V. cholerae was first isolated as the cause of cholera by Filippo Pacini in 1854, but his discovery was not widely known until Robert Koch (who also discovered the cause of tuberculosis), working independently 30 years later, publicized the knowledge and the means of fighting the disease. The history of cholera repeats itself. The U.S. National Library of Medicine houses original documents about multiple cholera outbreaks in the U.S. from the 1820s to the 1900s, with the last large outbreak in 1910-1911. Since the 1800s, there have been seven cholera pandemics (worldwide outbreaks).

Cholera riots occurred in Russia and England (1831) and in Germany (1893) when the people rebelled against strict government isolation (quarantines) and burial rules. In 2008, cholera riots broke out in Zimbabwe as police tried to disperse people who tried to withdraw funds from banks and were protesting because of the collapse of the health system that began with a cholera outbreak. Similar but less violent public protests have occurred when yellow fever, typhoid fever, and tuberculosis quarantines have been enforced by health authorities.

Multiple outbreaks worldwide continue into the 21st century with outbreaks in India, Iran, Vietnam, and several African countries occurring over the last 10 years (some recent outbreaks occurred in Haiti and Nigeria in 2010-2011, and Cuba in 2016). Why is cholera history repeating itself? The answer can be traced back to Dr. Snow's studies that show a source (water or occasionally food) contaminated with V. cholerae can easily and rapidly transmit the cholera-causing bacteria to many people. Until safe water and food is available to all humans, it is likely that cholera outbreaks will continue to happen.

What are cholera symptoms and signs?

The symptoms and signs of cholera are a watery diarrhea that often contains flecks of whitish material (mucus and some gastrointestinal lining [epithelial] cells) that are about the size of pieces of rice. The diarrhea is termed "rice-water stool" (See figure 1) and smells "fishy." 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 154-pound adult can occur. People may go on to develop one or more of the following symptoms and signs:

Watery diarrhea (sometimes in large volumes)

Rice-water stools (see figure 1)

Fishy odor to stools

Vomiting

Rapid heart rate

Loss of skin elasticity (washer woman hands sign; see figure 2)

Dry mucous membranes (dry mouth)

Low blood pressure

Thirst

Muscle cramps (leg cramps, for example)

Restlessness or irritability (especially in children)

Unusual sleepiness or tiredness

Other symptoms that may occur, especially with more severe disease, include the following:

Those infected require immediate hydration to prevent these symptoms from continuing because these signs and symptoms indicate that the person is becoming or is dehydrated and may go on to develop severe cholera. People with severe cholera (about 5%-10% of previously healthy people; higher if a population is compromised by poor nutrition or has a high percentage of very young or elderly people) can develop severe dehydration, leading to acute renal failure, severe electrolyte imbalances (especially potassium and sodium), and coma. If untreated, this severe dehydration can rapidly lead to shock and death. Severe dehydration can often occur four to eight hours after the first liquid stool, ending with death in about 18 hours to a few days in undertreated or untreated people. In epidemic outbreaks in underdeveloped countries where little or no treatment is available, the mortality (death) rate can be as high as 50%-60%.

Figure 1: Rice-water stool from a patient with cholera; note the flecks of mucus precipitated at the bottom of the cup that resemble rice grains. SOURCE: CDC

Figure 2: Washer woman hands (loss of skin elasticity) are a sign of the dehydration seen in cholera. SOURCE: CDC

What causes cholera, and how is cholera transmitted?

Cholera is caused by the bacterium V. cholerae. This bacterium is Gram stain-negative, comma-shaped, and has a flagellum (a long, tapering, projecting part) for motility and pili (hairlike structures) used to attach to tissue. Although there are many V. cholerae serotypes that can produce cholera symptoms, the O groups O1 and O139, which also produce a toxin, cause the most severe symptoms of cholera. O groups consist of different lipopolysaccharides-protein structures on the surface of bacteria that are distinguished by immunological techniques.

The toxin produced by these V. cholerae serotypes is an enterotoxin composed of two subunits, A and B; the genetic information for the synthesis of these subunits is encoded on plasmids (genetic elements separate from the bacterial chromosome). In addition, another plasmid type encodes for a pilus (a hollow hairlike structure that supports bacterial attachment to human cells and facilitate the movement of toxin from V. cholerae into human cells). The enterotoxin causes human cells to extract water and electrolytes from the body (mainly the upper gastrointestinal tract) and pump it into the intestinal lumen where the fluid and electrolytes are excreted as diarrheal fluid. The enterotoxin is similar to toxin formed by bacteria that cause diphtheria in that both bacterial types secret the toxins into their surrounding environment where the toxin then enters the human cells. The bacteria are usually transmitted by drinking contaminated water, but the bacteria can also be ingested in contaminated food, especially seafood such as raw oysters.

What are risk factors for cholera, and where do cholera outbreaks occur?

Everyone who drinks or eats food that has not been treated to eliminate V. cholerae (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.

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. The Vibrio cholerae strain was closely related to a strain found in Nepal and leads some individuals to blame Nepalese troops that helped with the earthquake disaster as the source of the Haiti cholera outbreak.

In third-world countries, hunger can lead people to inadvertently eat contaminated food and/or drink contaminated water, thus raising the risk for cholera to infect malnourished populations.

There is some evidence that V. cholerae can survive in saltwater and have been isolated from shellfish; eating raw oysters is considered a risk factor for cholera, especially in underdeveloped countries and occasionally even in developed countries. A few people are diagnosed with cholera every year in the U.S. Most of the individuals diagnosed are travelers who were exposed to cholera outside the country, but occasionally, isolated cases are traced to contaminated seafood, usually from states that border the Gulf of Mexico.

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. In addition, researchers have noted that patients with blood type O are twice as likely to develop cholera as others. The reason for this blood type susceptibility is not completely understood. 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.

Is cholera contagious?

It takes about 100 million V. cholerae bacteria to infect a healthy adult. Because of this high number, significant contamination of food or water is required to transmit the disease, and direct person-to-person transmission is thought to be uncommon except in outbreaks. In outbreaks, cholera-causing bacteria become highly contagious indirectly and directly by the fecal-oral route because of widespread fecal contamination of food, water, and items like contaminated bedding and clothing.

What is the incubation period for cholera?

The incubation period (time period from exposure to the bacteria to the development of symptoms) may vary from a few hours (about six to 12 hours) to five days, with the average incubation period being about two to three days. About six to 12 hours is considered a very rapid incubation period and may suggest that rapid/immediate intervention is required for recovery.

What is the contagious period for cholera?

The contagious period for cholera begins as soon as organisms are excreted in the feces. This can occur as early as about six to 12 hours after exposure to the bacteria and can last for about seven to 14 days. Some individuals who are asymptomatic (infected but not having symptoms) will also excrete contagious organisms for about seven to 14 days.

What physicians usually treat cholera?

Because most individuals have either mild or no symptoms, these people are either not treated or treated by their primary-care physician. However, in some children and in individuals who have more severe disease, besides the primary-care physician or pediatrician, an infectious-disease specialist, a critical-care specialist, a gastroenterologist, and/or an internist may be needed to help the team manage and treat the patient.

In addition, specialists in travel medicine and/or epidemiology can help individuals avoid cholera and/or can give advice about prevention, treatment, and prognosis to those individuals traveling to or living in endemic areas.

How do health-care professionals diagnose cholera?

Preliminary diagnosis is usually done by a caregiver who takes a history from the patient and observes the characteristic rice-water diarrhea, especially if a local outbreak of cholera has identified. The diarrhea fluid is often teeming with motile, comma-shaped bacteria (presumptively V. cholerae) that can be seen with a microscope. The definitive diagnosis is made by isolation of the bacteria from diarrhea fluid. All state health department laboratories in the U.S. are able to perform tests for Vibrio cholerae. Readers may see terms like serotypes Inaba, Ogawa, and Hikojima to describe V. cholerae; they simply indicate which O antigens (O antigens designated A, B, or C) are found on these strains of V. cholerae. PCR tests have also been developed to detect the genetic material of cholera, but currently they are not as widely used as the immunologic tests based on type-specific antiserum.

Definitive diagnosis helps to distinguish cholera from other diseases caused by other bacterial, protozoal, or viral pathogens that cause dysentery (gastrointestinal inflammation with diarrhea).

What is the treatment for cholera?

The CDC (and almost every medical agency) recommends rehydration with ORS (oral rehydration salts) fluids as the primary treatment for cholera. ORS fluids are available in prepackaged containers, commercially available worldwide, and contain glucose and electrolytes. The CDC follows the guidelines developed by the WHO (World Health Organization) as follows:

Patient condition

Treatment

Treatment volume guidelines; age and weight

No dehydration

Oral rehydration salts (ORS)

Children < 2 years: 50 mL-100 mL, up to 500 mL/day
Children 2-9 years: 100 mL-200 mL, up to 1,000 mL/day
Patients > 9 years: As much as wanted, to 2,000 mL/day

Some dehydration

Oral rehydration salts (amount in first four hours)

Infants < 4 mos (< 5 kg): 200-400 mL
Infants 4 mos-11 mos (5 kg-7.9 kg): 400-600 mL
Children 1 yr-2 yrs (8 kg-10.9 kg): 600-800 mL
Children 2 yrs-4 yrs (11 kg-15.9 kg): 800-1,200 mL
Children 5 yrs-14 yrs (16 kg-29.9 kg): 1,200-2,200 mL
Patients > 14 yrs (30 kg or more): 2,200-4,000 mL

Severe dehydration

IV drips of Ringer Lactate or, if not available, normal saline and oral rehydration salts as outlined above

Age < 12 months: 30 mL/kg within one hour*, then 70 mL/kg over five hours
Age > 1 year: 30 mL/kg within 30 min*, then 70 mL/kg over two and a half hours

*Repeat once if radial pulse is still very weak or not detectable

Reassess the patient every one to two hours and continue hydrating. If hydration is not improving, give the IV drip more rapidly. 200 mL/kg or more may be needed during the first 24 hours of treatment.

After six hours (infants) or three hours (older patients), perform a full reassessment. Switch to ORS solution if hydration is improved and the patient can drink.

In general, antibiotics are reserved for more severe cholera infections; they function to reduce fluid rehydration volumes and may speed recovery. Although good microbiological principles dictate it is best to treat a patient with antibiotics that are known to be effective against the infecting bacteria, this may take too long a time to accomplish during an initial outbreak (but it still should be attempted); meanwhile, severe infections have been effectively treated with tetracycline (Sumycin), doxycycline ( Vibramycin, Oracea, Adoxa, Atridox, and others), furazolidone ( Furoxone), erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), or ciprofloxacin ( Cipro, Cipro XR, ProQuin XR) in conjunction with the following antibiotics in conjunction with IV hydration and electrolytes:

Tetracycline (Sumycin)

Doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others)

Furazolidone (Furoxone)

Erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone)

Azithromycin (Zithromax)

Sulfamethoxazole/trimethoprim (Bactrim, Septra)

Ampicillin

Ciprofloxacin (Cipro, Cipro XR, ProQuin XR)

Norfloxacin (Noroxin)

Many antibiotics are listed; however, because of widespread antibiotic resistance, including multi-resistant Vibrio strains, antibiotic susceptibility testing is advised so the appropriate antibiotic is chosen. In addition, quinolones (for example, ciprofloxacin, norfloxacin) should not be used in children if other antibiotics can be effective because of possible musculoskeletal adverse effects.

Is it possible to prevent cholera? Are cholera vaccines available?

Yes, cholera can be prevented by several methods. Developed countries have an almost zero incidence of cholera because they have widespread water-treatment plants, food-preparation facilities that usually practice sanitary protocols, and most people have access to toilets and hand-washing facilities. Although these countries may have occasional lapses or gaps in these methods, they have prevented many disease outbreaks, including cholera.

Individuals can prevent or reduce the chance they may get cholera by thorough hand washing, avoiding areas and people with cholera, drinking treated water or similar safe fluids, and eating cleaned and well-cooked food. In addition, there are vaccines available that can help prevent cholera, although they are not available in the U.S., and their effectiveness ranges from 50%-90%, depending on the studies reported. The vaccines are oral preparations, because injected vaccines have not proved to be very effective. Two vaccines (Shanchol and Dukoral) are composed of killed V. cholerae bacteria and don't contain the enterotoxin B subunit. Unfortunately, both offer protection for only about two years, although one report suggests that Shanchol is about 65% effective over five years. Both vaccines are usually given in two doses, about one to six weeks apart. Unfortunately, the vaccines have limited availability; their recommended use is for people going to areas of known outbreaks with the likely possibility the person may be exposed to cholera. Some researchers suggest this limited oral vaccine availability should be changed and cite data that oral vaccine may help limit outbreaks, even after they have begun.

Research is ongoing; a research study in Haiti will try to determine if a two-dose vaccine in people will suffice to protect a difficult to treat (rural poor) population from cholera and thus save many lives. There are over 30 universities researching this disease (cholera's epidemiology, pathology, immunology, vaccine production, and other problems) currently worldwide.

In 2015, about 2 million doses of oral cholera vaccine were shipped to various outbreak areas, and currently available information suggests that there was a significant reduction in transmission of endemic cholera; the study will be concluded in 2018.

In June 2016, the U.S. FDA (Food and Drug Administration) approved the first vaccine available in the United States to prevent cholera. The vaccine is termed Vaxchora and is manufactured by PaxVax Bermuda LTD. It can be used in adults age 18-64 who are traveling to cholera-affected areas of the world. The vaccine is a live, attenuated (weakened) dose of V. cholerae serogroup 01, the most prominent cause of cholera worldwide. The vaccine is administered orally in about 3 ounces of fluid. It is about 80% effective in individuals challenged with Vibrio bacteria three months after vaccination. The vaccine should be administered at least 10 days before the individual travels to a cholera-endemic area.

What is the prognosis of cholera?

The prognosis (outcome) of cholera can range from excellent to poor, depending on the severity of the dehydration and how quickly the patient is given and responds to treatments. Death (mortality) rates in untreated cholera can be as high as 50%-60% during large outbreaks but can be reduced to about 1% if treatment protocols (see above treatment section) are rapidly put into action. In general, the less severe the symptoms and the less time people have dehydration symptoms, the better the prognosis; in many people, if dehydration is quickly reversed, the prognosis is often excellent.

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Medically Reviewed on 6/16/2016

REFERENCES:

Brown, Troy. "FDA Approves First Cholera Vaccine in the US." Medscape.com. June 10, 2016. <https://www.medscape.com/viewarticle/864673?nlid=106295_3901&src=wnl_newsalrt_160610_MSCPEDIT&uac=138226AY&impID=1124116&faf=1>.

Switzerland. World Health Organization. "Cholera." July 2015. <http://www.who.int/mediacentre/factsheets/fs107/en/>.

United States. Centers for Disease Control and Prevention. "Cholera." Yellowbook 3.81 July 10, 2015. <http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/cholera>.

United States. Centers for Disease Control and Prevention. "Cholera -- Vibrio cholera Infection." Nov. 27, 2014. <http://www.cdc.gov/cholera/index.html>.

Unites States. Food and Drug Administration. "Vaxchora." June 16, 2016.<http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm505866.htm>.

Complete List

Top Cholera Related Articles

Dehydration

Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. Symptoms of dehydration include:

headache,

lightheadedness,

constipation, and

bad breath.

Treatment for dehydration is to replace lost fluids and electrolytes.

Low Blood Pressure

Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include:

light-headedness,

dizziness, or

even fainting if not enough blood is getting to the brain.

Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.

Travel Medicine

Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include:

malaria,

meningococcal meningitis,

yellow fever,

hepatitis A,

typhoid fever,

polio, and

cholera.

Traveler's Diarrhea

Travelers' diarrhea is generally contracted by eating contaminated food or drinking contaminated water. Food is the primary source of travelers' diarrhea. Enterotoxigenic E. coli is the cause of up to 70% of all cases of travelers' diarrhea. There are five unique classes of E. coli that causes gastroenteritis. Other bacteria responsible for travelers' diarrhea include Campylobacter, jejuni, shigella, and salmonella. Viruses such as rotavirus and Norwalk virus (norovirus) and giardia lamblia a parasite may cause travelers' diarrhea. Prevention is careful eating and drinking of water.

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Cholera Treatment, History, Prevention & Causes

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Cholera facts Cholera is a disease caused by bacteria that produce a watery diarrhea that can rapidly lead to dehydration. Cholera symptoms and signs include a rapid onset of copious, smelly diarrhea that resembles rice water and may lead to signs of dehydration (for example, vomiting, wrinkled skin, low blood pressure, dry mouth, rapid heart rate).

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Now day it can be caused by unwashed fruits and vegetables.

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Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include:

If not treated, dehydration can lead to shock and death in a matter of hours.

Cholera Treatment and Prevention

Although there is a vaccine against cholera, the CDC and World Health Organization don't normally recommend it, because it may not protect up to half of the people who receive it and it lasts only a few months. However, you can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected, or bottled water. Be sure to use the bottled, boiled, or chemically disinfected water for the following purposes:

Drinking

Preparing food or drinks

Making ice

Brushing your teeth

Washing your face and hands

Washing dishes and utensils that you use to eat or prepare food

Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant. You should also avoid raw foods, including the following:

Unpeeled fruits and vegetables

Unpasteurized milk and milk products

Raw or undercooked meat or shellfish

Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

Sources

SOURCES:

CDC: "Cholera: General Information;" "Cholera: Disease;" and "Cholera: Prevention and Control."

University of Alabama at Birmingham Health System: "Cholera."

MedlinePlus.gov: "Cholera."

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Cholera: Causes, Symptoms, Treatment, and Prevention

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Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration.

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"Cholera infection is often mild or without symptoms, but can sometimes be severe. Approximately one in ten (10%) infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours." says https://www.cdc.gov/cholera/general/index.html

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Most common symptoms are diarrhea and dehydration. Though you can also have shock and seizures.

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Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and muscle cramps may also occur.

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There are 8 main symptoms of Cholera.

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Cholera is a serious disease that is spread by the Vibrio cholerae bacteria. The bacteria usually spreads through water that has been contaminated by an infected person's fecal matter. It can also be spread through raw shellfish and raw fruits and vegetables. Not everyone who is exposed to the bacteria gets sick, but their stool may still contain traces of the bacteria. Even a tiny amount of fecal matter could contain enough of the bacteria to infect someone else.

When an individual does get sick with cholera, they'll rapidly lose fluids, which causes uncomfortable, painful, and sometimes life threatening symptoms. A severe case of cholera can lead to death within hours, and even mild or moderate cases can make you dangerously dehydrated. Fortunately, the disease is easy to treat with rehydration solutions and antibiotics. The sooner you receive medical treatment, the sooner your symptoms will clear up. Therefore, it's important to be aware of the signs and symptoms of cholera, so you can seek immediate medical attention if you become infected.
1. Diarrhea
Diarrhea is the main symptom of cholera. The majority of people who are exposed to the cholera bacteria only experience this mildly or moderately, and it's often attributed to other problems like food poisoning. About one in 10 people infected with the bacteria develop serious symptoms. In these cases, the diarrhea comes on very suddenly and can be severe. This occurs because the bacteria produces a toxin that binds to the walls of your small intestine.

There, it interferes with your body's sodium and chloride levels, and it causes the cells that line your intestine to release more water than usual. Diarrhea and other symptoms usually appear two or three days after being infected with the bacteria, but it sometimes only takes a few hours for a person to become ill. Stools usually have a pale or milky appearance. In severe cases, you may lose a quart of fluid an hour, which can lead to extreme dehydration. The disease can be fatal if you lose too much fluid or salt, so fast treatment is important. It can usually be treated by drinking lots of water and consuming a mixture of salt and sugar, but you may need intravenous solutions to replace the fluids.

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Cholera is a serious disease that is spread by the Vibrio cholerae bacteria. The bacteria usually spreads through water that has been contaminated by an infected person's fecal matter. It can also be spread through raw shellfish and raw fruits and vegetables.

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At least 150,000 cases are reported to the world health organization each year for the whole world, but only about 10 cases are repored in the U.S. each year.

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Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in the U.S. However, cholera outbreaks are still a serious problem in other parts of the world. The World Health Organization reports that there are 1.3 million to 4 million cases each year.

The disease is most common in places with poor sanitation, crowding, war, and famine. Common locations include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas, knowing the following cholera facts can help protect you and your family.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include:

Municipal water supplies

Ice made from municipal water

Foods and drinks sold by street vendors

Vegetables grown with water containing human wastes

Raw or undercooked fish and seafood caught in waters polluted with sewage

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea.

It is not likely you will catch cholera just from casual contact with an infected person.

Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include:

If not treated, dehydration can lead to shock and death in a matter of hours.

Continued

Cholera Treatment and Prevention

There is a vaccine for cholera. Both the CDC and the World Health Organization have specific guidelines for who should be given this vaccine.

You can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected, or bottled water. Be sure to use bottled, boiled, or chemically disinfected water for the following purposes

Drinking

Preparing food or drinks

Making ice

Brushing your teeth

Washing your face and hands

Washing dishes and utensils that you use to eat or prepare food

Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant. You should also avoid raw foods, including the following:

Unpeeled fruits and vegetables

Unpasteurized milk and milk products

Raw or undercooked meat or shellfish

Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

Sources

SOURCES:

CDC: "Cholera: General Information;" "Cholera: Disease;" and "Cholera: Prevention and Control." "Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine."

University of Alabama at Birmingham Health System: "Cholera."

MedlinePlus.gov: "Cholera."

World Health Organization: "Cholera."

# data[].attributes.attachment_link.title
Cholera: Causes, Symptoms, Treatment, and Prevention

# data[].attributes.attachment_link.description
Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water.

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cholera is an infectious disease that causes severe watery  diarrhea.

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Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in the U.S. However, cholera outbreaks are still a serious problem in other parts of the world. The World Health Organization reports that there are 1.3 million to 4 million cases each year.

The disease is most common in places with poor sanitation, crowding, war, and famine. Common locations include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas, knowing the following cholera facts can help protect you and your family.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include:

Municipal water supplies

Ice made from municipal water

Foods and drinks sold by street vendors

Vegetables grown with water containing human wastes

Raw or undercooked fish and seafood caught in waters polluted with sewage

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea.

It is not likely you will catch cholera just from casual contact with an infected person.

Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include:

If not treated, dehydration can lead to shock and death in a matter of hours.

Continued

Cholera Treatment and Prevention

There is a vaccine for cholera. Both the CDC and the World Health Organization have specific guidelines for who should be given this vaccine.

You can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected, or bottled water. Be sure to use bottled, boiled, or chemically disinfected water for the following purposes

Drinking

Preparing food or drinks

Making ice

Brushing your teeth

Washing your face and hands

Washing dishes and utensils that you use to eat or prepare food

Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant. You should also avoid raw foods, including the following:

Unpeeled fruits and vegetables

Unpasteurized milk and milk products

Raw or undercooked meat or shellfish

Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

Sources

SOURCES:

CDC: "Cholera: General Information;" "Cholera: Disease;" and "Cholera: Prevention and Control." "Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine."

University of Alabama at Birmingham Health System: "Cholera."

MedlinePlus.gov: "Cholera."

World Health Organization: "Cholera."

# data[].attributes.attachment_link.title
Cholera: Causes, Symptoms, Treatment, and Prevention

# data[].attributes.attachment_link.description
Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water.

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"Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. " Says https://www.cdc.gov/cholera/general/index.html

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Yes it is still a problem in low income country's.

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At 65, Moolchand, bandy-legged and white-haired, has no problem rising for his predawn hunts. In fact he revels in them.

"I hide along the lane with my flashlight," he says in a low, excited voice, gesturing down the main road of Gaji Khedi village, in India's Madhya Pradesh state. "And I look for people walking with a lota."

A lota is a water container, traditionally made of brass but these days more often of plastic. Spied outdoors in the early morning, it all but screams that its owner is headed for a field or roadside to move his or her bowels-the water is for rinsing.

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Nearly a Billion People Still Defecate Outdoors. Here's Why.

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At 65, Moolchand, bandy-legged and white-haired, has no problem rising for his predawn hunts. In fact he revels in them. "I hide along the lane with my flashlight," he says in a low, excited voice, gesturing down the main road of Gaji Khedi village, in India's Madhya Pradesh state.

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Diarrhea, Nausea, Vomiting, Dehydration.

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Cholera is a bacterial disease usually spread through contaminated water. Cholera causes severe diarrhea and dehydration. Left untreated, cholera can be fatal within hours, even in previously healthy people.

Modern sewage and water treatment have virtually eliminated cholera in industrialized countries. But cholera still exists in Africa, Southeast Asia and Haiti. The risk of a cholera epidemic is highest when poverty, war or natural disasters force people to live in crowded conditions without adequate sanitation.

Cholera is easily treated. Death from severe dehydration can be prevented with a simple and inexpensive rehydration solution.

Most people exposed to the cholera bacterium (Vibrio cholerae) don't become ill and don't know they've been infected. But because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water.

Most cases of cholera that cause symptoms cause mild or moderate diarrhea that's often hard to tell apart from diarrhea caused by other problems. Others develop more-serious signs and symptoms of cholera, usually within a few days of infection.

Symptoms of cholera infection can include:

Diarrhea. Cholera-related diarrhea comes on suddenly and can quickly cause dangerous fluid loss - as much as a quart (about 1 liter) an hour. Diarrhea due to cholera often has a pale, milky appearance that resembles water in which rice has been rinsed.

Nausea and vomiting. Vomiting occurs especially in the early stages of cholera and can last for hours.

Dehydration. Dehydration can develop within hours after cholera symptoms start and range from mild to severe. A loss of 10% or more of body weight indicates severe dehydration.

Signs and symptoms of cholera dehydration include irritability, fatigue, sunken eyes, a dry mouth, extreme thirst, dry and shriveled skin that's slow to bounce back when pinched into a fold, little or no urinating, low blood pressure, and an irregular heartbeat.

Dehydration can lead to a rapid loss of minerals in your blood that maintain the balance of fluids in your body. This is called an electrolyte imbalance.

Electrolyte imbalance

An electrolyte imbalance can lead to serious signs and symptoms such as:

Muscle cramps. These result from the rapid loss of salts such as sodium, chloride and potassium.

Shock. This is one of the most serious complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body. If untreated, severe hypovolemic shock can cause death in minutes.

The risk of cholera is slight in industrialized nations. Even in areas where it exists you're not likely to become infected if you follow food safety recommendations. Still, cases of cholera occur throughout the world. If you develop severe diarrhea after visiting an area with active cholera, see your doctor.

If you have diarrhea, especially severe diarrhea, and think you might have been exposed to cholera, seek treatment right away. Severe dehydration is a medical emergency that requires immediate care.

A bacterium called Vibrio cholerae causes cholera infection. The deadly effects of the disease are the result of a toxin the bacteria produces in the small intestine. The toxin causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes).

Cholera bacteria might not cause illness in all people who are exposed to them, but they still pass the bacteria in their stool, which can contaminate food and water supplies.

Contaminated water supplies are the main source of cholera infection. The bacterium can be found in:

Surface or well water. Contaminated public wells are frequent sources of large-scale cholera outbreaks. People living in crowded conditions without adequate sanitation are especially at risk.

Seafood. Eating raw or undercooked seafood, especially shellfish, that comes from certain places can expose you to cholera bacteria. Most recent cases of cholera in the United States have been traced to seafood from the Gulf of Mexico.

Raw fruits and vegetables. Raw, unpeeled fruits and vegetables are a frequent source of cholera infection in areas where there's cholera. In developing countries, uncomposted manure fertilizers or irrigation water containing raw sewage can contaminate produce in the field.

Grains. In regions where cholera is widespread, grains such as rice and millet that are contaminated after cooking and kept at room temperature for several hours can grow cholera bacteria.

Everyone is susceptible to cholera, with the exception of infants who get immunity from nursing mothers who have previously had cholera. Still, certain factors can make you more vulnerable to the disease or more likely to have severe signs and symptoms.

Risk factors for cholera include:

Poor sanitary conditions. Cholera is more likely to flourish in situations where a sanitary environment - including a safe water supply - is difficult to maintain. Such conditions are common to refugee camps, impoverished countries, and areas afflicted by famine, war or natural disasters.

Reduced or nonexistent stomach acid. Cholera bacteria can't survive in an acidic environment, and ordinary stomach acid often serves as a defense against infection. But people with low levels of stomach acid - such as children, older adults, and people who take antacids, H-2 blockers or proton pump inhibitors - lack this protection, so they're at greater risk of cholera.

Household exposure. You're at increased risk of cholera if you live with someone who has the disease.

Type O blood. For reasons that aren't entirely clear, people with type O blood are twice as likely to develop cholera compared with people with other blood types.

Raw or undercooked shellfish. Although industrialized nations no longer have large-scale cholera outbreaks, eating shellfish from waters known to harbor the bacteria greatly increases your risk.

Cholera can quickly become fatal. In the most severe cases, the rapid loss of large amounts of fluids and electrolytes can lead to death within hours. In less extreme situations, people who don't receive treatment can die of dehydration and shock hours to days after cholera symptoms first appear.

Although shock and severe dehydration are the worst complications of cholera, other problems can occur, such as:

Low blood sugar (hypoglycemia). Dangerously low levels of blood sugar (glucose) - the body's main energy source - can occur when people become too ill to eat. Children are at greatest risk of this complication, which can cause seizures, unconsciousness and even death.

Low potassium levels. People with cholera lose large quantities of minerals, including potassium, in their stools. Very low potassium levels interfere with heart and nerve function and are life-threatening.

Kidney failure. When the kidneys lose their filtering ability, excess amounts of fluids, some electrolytes and wastes build up in the body - a potentially life-threatening condition. In people with cholera, kidney failure often accompanies shock.

Cholera is rare in the United States with the few cases related to travel outside the U.S. or to contaminated and improperly cooked seafood from the Gulf Coast waters.

If you're traveling to areas known to have cholera, your risk of contracting the disease is extremely low if you follow these precautions:

Wash your hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water aren't available, use an alcohol-based hand sanitizer.

Drink only safe water, including bottled water or water you've boiled or disinfected yourself. Use bottled water even to brush your teeth.

Hot beverages are generally safe, as are canned or bottled drinks, but wipe the outside before you open them. Don't add ice to your drinks unless you made it yourself using safe water.

Eat food that's completely cooked and hot and avoid street vendor food, if possible. If you do buy a meal from a street vendor, make sure it's cooked in your presence and served hot.

Avoid sushi, as well as raw or improperly cooked fish and seafood of any kind.

Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and fruits that can't be peeled, such as grapes and berries.

Cholera vaccine

People traveling from the United States to areas affected by cholera can get a cholera vaccine called Vaxchora. It's suggested for people between ages 2 and 64 who plan to travel where cholera is being spread or regularly spreads. It is a liquid dose taken by mouth at least 10 days before travel.

Several other countries offer oral vaccines as well. Contact your doctor or local office of public health for more information about these vaccines. Even with the vaccine, it's important to take the above precautions to prevent cholera.

1. Kliegman RM, et al. Cholera. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 12, 2019.

2. Ferri FF. Cholera. In: Ferri's Clinical Advisor 2020. Elsevier; 2020. https://www.clinicalkey.com. Accessed Dec. 12, 2019.

3. Cholera. Centers for Disease Control and Prevention. http://www.cdc.gov/cholera/index.html. Accessed Dec. 12, 2019.

4. Cholera. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/cholera. Accessed Dec. 12, 2019.

5. LaRocque R, et al. Cholera: Clinical features, diagnosis, treatment, and prevention. https://www.uptodate.com/contents/search. Accessed Dec. 12, 2019.

6. WHO position paper on oral rehydration salts to reduce mortality from cholera. World Health Organization. https://www.who.int/cholera/technical/en/. Accessed Dec. 12, 2019.

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Cholera-Cholera - Symptoms & causes - Mayo Clinic

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Cholera is a treatable - yet potentially fatal - bacterial disease that causes diarrhea and dehydration. Learn how to lower your risk.

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Cholera is caused by a bacteria called Vibrio Cholerae.

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Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in the U.S. However, cholera outbreaks are still a serious problem in other parts of the world. The World Health Organization reports that there are 1.3 million to 4 million cases each year.

The disease is most common in places with poor sanitation, crowding, war, and famine. Common locations include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas, knowing the following cholera facts can help protect you and your family.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include:

Municipal water supplies

Ice made from municipal water

Foods and drinks sold by street vendors

Vegetables grown with water containing human wastes

Raw or undercooked fish and seafood caught in waters polluted with sewage

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea.

It is not likely you will catch cholera just from casual contact with an infected person.

Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include:

If not treated, dehydration can lead to shock and death in a matter of hours.

Continued

Cholera Treatment and Prevention

There is a vaccine for cholera. Both the CDC and the World Health Organization have specific guidelines for who should be given this vaccine.

You can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected, or bottled water. Be sure to use bottled, boiled, or chemically disinfected water for the following purposes

Drinking

Preparing food or drinks

Making ice

Brushing your teeth

Washing your face and hands

Washing dishes and utensils that you use to eat or prepare food

Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant. You should also avoid raw foods, including the following:

Unpeeled fruits and vegetables

Unpasteurized milk and milk products

Raw or undercooked meat or shellfish

Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

Sources

SOURCES:

CDC: "Cholera: General Information;" "Cholera: Disease;" and "Cholera: Prevention and Control." "Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine."

University of Alabama at Birmingham Health System: "Cholera."

MedlinePlus.gov: "Cholera."

World Health Organization: "Cholera."

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Cholera: Causes, Symptoms, Treatment, and Prevention

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Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water.

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Cholera is a disease that is caused by bacteria in water.

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Cholera

Other names

Asiatic cholera, epidemic cholera[1]

A person with severe dehydration due to cholera, causing sunken eyes and wrinkled hands and skin.

Specialty
Infectious disease

Symptoms

Large amounts of watery diarrhea, vomiting, muscle cramps[2][3]

Complications

Dehydration, electrolyte imbalance[2]

Usual onset

2 hours to 5 days after exposure[3]

Duration

A few days[2]

Causes

Vibrio cholerae spread by fecal-oral route[2][4]

Risk factors

Poor sanitation, not enough clean drinking water, poverty[2]

Diagnostic method
Stool test[2]

Prevention

Improved sanitation, clean water, hand washing, cholera vaccines[2][5]

Treatment

Oral rehydration therapy, zinc supplementation, intravenous fluids, antibiotics[2][6]

Frequency

3-5 million people a year[2]

Deaths

28,800 (2015)[7]

Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and muscle cramps may also occur. Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance. This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish. Symptoms start two hours to five days after exposure.

Cholera is caused by a number of types of Vibrio cholerae, with some types producing more severe disease than others. It is spread mostly by unsafe water and unsafe food that has been contaminated with human feces containing the bacteria. Undercooked seafood is a common source. Humans are the only known host for the bacteria. Risk factors for the disease include poor sanitation, not enough clean drinking water, and poverty. Cholera can be diagnosed by a stool test. A rapid dipstick test is available but is not as accurate.

Prevention methods against cholera include improved sanitation and access to clean water. Cholera vaccines that are given by mouth provide reasonable protection for about six months. They have the added benefit of protecting against another type of diarrhea caused by . The primary treatment is oral rehydration therapy-the replacement of fluids with slightly sweet and salty solutions. Rice-based solutions are preferred. Zinc supplementation is useful in children. In severe cases, intravenous fluids, such as Ringer's lactate, may be required, and antibiotics may be beneficial. Testing to see which antibiotic the cholera is susceptible to can help guide the choice.

Cholera affects an estimated 3-5 million people worldwide and causes 28,800-130,000 deaths a year. Although it is classified as a pandemic as of 2010, it is rare in high income countries. Children are mostly affected. Cholera occurs as both outbreaks and chronically in certain areas. Areas with an ongoing risk of disease include Africa and Southeast Asia. The risk of death among those affected is usually less than 5% but may be as high as 50%. No access to treatment results in a higher death rate. Descriptions of cholera are found as early as the 5th century BC in Sanskrit. The study of cholera in England by John Snow between 1849 and 1854 led to significant advances in the field of epidemiology. Seven large outbreaks have occurred over the last 200 years with millions of deaths.

Signs and symptoms

The primary symptoms of cholera are profuse diarrhea and vomiting of clear fluid. These symptoms usually start suddenly, half a day to five days after ingestion of the bacteria. The diarrhea is frequently described as "rice water" in nature and may have a fishy odor. An untreated person with cholera may produce 10 to 20 litres (3 to 5 US gal) of diarrhea a day. Severe cholera, without treatment, kills about half of affected individuals. If the severe diarrhea is not treated, it can result in life-threatening dehydration and electrolyte imbalances. Estimates of the ratio of asymptomatic to symptomatic infections have ranged from 3 to 100. Cholera has been nicknamed the "blue death" because a person's skin may turn bluish-gray from extreme loss of fluids.

Fever is rare and should raise suspicion for secondary infection. Patients can be lethargic and might have sunken eyes, dry mouth, cold clammy skin, or wrinkled hands and feet. Kussmaul breathing, a deep and labored breathing pattern, can occur because of acidosis from stool bicarbonate losses and lactic acidosis associated with poor perfusion. Blood pressure drops due to dehydration, peripheral pulse is rapid and thready, and urine output decreases with time. Muscle cramping and weakness, altered consciousness, seizures, or even coma due to electrolyte imbalances are common, especially in children.

Transmission

Cholera bacteria have been found in shellfish and plankton.

Transmission is usually through the fecal-oral route of contaminated food or water caused by poor sanitation. Most cholera cases in developed countries are a result of transmission by food, while in developing countries it is more often water. Food transmission can occur when people harvest seafood such as oysters in waters infected with sewage, as Vibrio cholerae accumulates in planktonic crustaceans and the oysters eat the zooplankton.

People infected with cholera often have diarrhea, and disease transmission may occur if this highly liquid stool, colloquially referred to as "rice-water", contaminates water used by others. A single diarrheal event can cause a one-million fold increase in numbers of V. cholerae in the environment. The source of the contamination is typically other cholera sufferers when their untreated diarrheal discharge is allowed to get into waterways, groundwater or drinking water supplies. Drinking any contaminated water and eating any foods washed in the water, as well as shellfish living in the affected waterway, can cause a person to contract an infection. Cholera is rarely spread directly from person to person.

V. cholerae also exists outside the human body in natural water sources, either by itself or through interacting with phytoplankton, zooplankton, or biotic and abiotic detritus. Drinking such water can also result in the disease, even without prior contamination through fecal matter. Selective pressures exist however in the aquatic environment that may reduce the virulence of V. cholerae. Specifically, animal models indicate that the transcriptional profile of the pathogen changes as it prepares to enter an aquatic environment. This transcriptional change results in a loss of ability of V. cholerae to be cultured on standard media, a phenotype referred to as ' viable but non-culturable' (VBNC) or more conservatively ' active but non-culturable' (ABNC). One study indicates that the culturability of V. cholerae drops 90% within 24 hours of entering the water, and furthermore that this loss in culturability is associated with a loss in virulence.

Both toxic and non-toxic strains exist. Non-toxic strains can acquire toxicity through a temperate bacteriophage.

Susceptibility

About 100million bacteria must typically be ingested to cause cholera in a normal healthy adult. This dose, however, is less in those with lowered gastric acidity (for instance those using proton pump inhibitors). Children are also more susceptible, with two- to four-year-olds having the highest rates of infection. Individuals' susceptibility to cholera is also affected by their blood type, with those with type O blood being the most susceptible. Persons with lowered immunity, such as persons with AIDS or malnourished children, are more likely to experience a severe case if they become infected. Any individual, even a healthy adult in middle age, can experience a severe case, and each person's case should be measured by the loss of fluids, preferably in consultation with a professional health care provider.

The cystic fibrosis genetic mutation known as delta-F508 in humans has been said to maintain a selective heterozygous advantage: heterozygous carriers of the mutation (who are thus not affected by cystic fibrosis) are more resistant to V. cholerae infections. In this model, the genetic deficiency in the cystic fibrosis transmembrane conductance regulator channel proteins interferes with bacteria binding to the intestinal epithelium, thus reducing the effects of an infection.

When consumed, most bacteria do not survive the acidic conditions of the human stomach. The few surviving bacteria conserve their energy and stored nutrients during the passage through the stomach by shutting down protein production. When the surviving bacteria exit the stomach and reach the small intestine, they must propel themselves through the thick mucus that lines the small intestine to reach the intestinal walls where they can attach and thrive.

Once the cholera bacteria reach the intestinal wall, they no longer need the flagella to move. The bacteria stop producing the protein flagellin to conserve energy and nutrients by changing the mix of proteins that they express in response to the changed chemical surroundings. On reaching the intestinal wall, V. cholerae start producing the toxic proteins that give the infected person a watery diarrhea. This carries the multiplying new generations of V. cholerae bacteria out into the drinking water of the next host if proper sanitation measures are not in place.

The cholera toxin (CTX or CT) is an oligomeric complex made up of six protein subunits: a single copy of the A subunit (part A), and five copies of the B subunit (part B), connected by a disulfide bond. The five B subunits form a five-membered ring that binds to GM1 gangliosides on the surface of the intestinal epithelium cells. The A1 portion of the A subunit is an enzyme that ADP-ribosylates G proteins, while the A2 chain fits into the central pore of the B subunit ring. Upon binding, the complex is taken into the cell via receptor-mediated endocytosis. Once inside the cell, the disulfide bond is reduced, and the A1 subunit is freed to bind with a human partner protein called ADP-ribosylation factor 6 (Arf6). Binding exposes its active site, allowing it to permanently ribosylate the Gs alpha subunit of the heterotrimeric G protein. This results in constitutive cAMP production, which in turn leads to the secretion of water, sodium, potassium, and bicarbonate into the lumen of the small intestine and rapid dehydration. The gene encoding the cholera toxin was introduced into V. cholerae by horizontal gene transfer. Virulent strains of V. cholerae carry a variant of a temperate bacteriophage called CTXφ.

Microbiologists have studied the genetic mechanisms by which the V. cholerae bacteria turn off the production of some proteins and turn on the production of other proteins as they respond to the series of chemical environments they encounter, passing through the stomach, through the mucous layer of the small intestine, and on to the intestinal wall. Of particular interest have been the genetic mechanisms by which cholera bacteria turn on the protein production of the toxins that interact with host cell mechanisms to pump chloride ions into the small intestine, creating an ionic pressure which prevents sodium ions from entering the cell. The chloride and sodium ions create a salt-water environment in the small intestines, which through osmosis can pull up to six liters of water per day through the intestinal cells, creating the massive amounts of diarrhea. The host can become rapidly dehydrated unless treated properly.

By inserting separate, successive sections of V. cholerae DNA into the DNA of other bacteria, such as that would not naturally produce the protein toxins, researchers have investigated the mechanisms by which V. cholerae responds to the changing chemical environments of the stomach, mucous layers, and intestinal wall. Researchers have discovered a complex cascade of regulatory proteins controls expression of V. cholerae virulence determinants. In responding to the chemical environment at the intestinal wall, the V. cholerae bacteria produce the TcpP/TcpH proteins, which, together with the ToxR/ToxS proteins, activate the expression of the ToxT regulatory protein. ToxT then directly activates expression of virulence genes that produce the toxins, causing diarrhea in the infected person and allowing the bacteria to colonize the intestine. Current research aims at discovering "the signal that makes the cholera bacteria stop swimming and start to colonize (that is, adhere to the cells of) the small intestine."

Genetic structure

Amplified fragment length polymorphism fingerprinting of the pandemic isolates of V. cholerae has revealed variation in the genetic structure. Two clusters have been identified: Cluster I and Cluster II. For the most part, Cluster I consists of strains from the 1960s and 1970s, while Cluster II largely contains strains from the 1980s and 1990s, based on the change in the clone structure. This grouping of strains is best seen in the strains from the African continent.

Antibiotic resistance

In many areas of the world, antibiotic resistance is increasing within cholera bacteria. In Bangladesh, for example, most cases are resistant to tetracycline, trimethoprim-sulfamethoxazole, and erythromycin. Rapid diagnostic assay methods are available for the identification of multi-drug resistant cases. New generation antimicrobials have been discovered which are effective against cholera bacteria in in vitro studies.

A rapid dipstick test is available to determine the presence of V. cholerae. In those samples that test positive, further testing should be done to determine antibiotic resistance. In epidemic situations, a clinical diagnosis may be made by taking a patient history and doing a brief examination. Treatment is usually started without or before confirmation by laboratory analysis.

Stool and swab samples collected in the acute stage of the disease, before antibiotics have been administered, are the most useful specimens for laboratory diagnosis. If an epidemic of cholera is suspected, the most common causative agent is V. cholerae O1. If V. cholerae serogroup O1 is not isolated, the laboratory should test for V. cholerae O139. However, if neither of these organisms is isolated, it is necessary to send stool specimens to a reference laboratory.

Infection with V. cholerae O139 should be reported and handled in the same manner as that caused by V. cholerae O1. The associated diarrheal illness should be referred to as cholera and must be reported in the United States.

Prevention

The World Health Organization (WHO) recommends focusing on prevention, preparedness, and response to combat the spread of cholera. They also stress the importance of an effective surveillance system. Governments can play a role in all of these areas.

Water, sanitation and hygiene

Although cholera may be life-threatening, prevention of the disease is normally straightforward if proper sanitation practices are followed. In developed countries, due to nearly universal advanced water treatment and sanitation practices present there, cholera is rare. For example, the last major outbreak of cholera in the United States occurred in 1910-1911. Cholera is mainly a risk in developing countries in those areas where access to WASH (water, sanitation and hygiene) infrastructure is still inadequate.

Effective sanitation practices, if instituted and adhered to in time, are usually sufficient to stop an epidemic. There are several points along the cholera transmission path at which its spread may be halted:

Sterilization: Proper disposal and treatment of all materials that may have come into contact with cholera victims' feces (e.g., clothing, bedding, etc.) are essential. These should be sanitized by washing in hot water, using chlorine bleach if possible. Hands that touch cholera patients or their clothing, bedding, etc., should be thoroughly cleaned and disinfected with chlorinated water or other effective antimicrobial agents.

Sewage and fecal sludge management: In cholera-affected areas, sewage and fecal sludge need to be treated and managed carefully in order to stop the spread of this disease via human excreta. Provision of sanitation and hygiene is an important preventative measure. Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrines or septic tanks into the environment need to be prevented. In many cholera affected zones, there is a low degree of sewage treatment. Therefore, the implementation of dry toilets that do not contribute to water pollution, as they do not flush with water, may be an interesting alternative to flush toilets.

Sources: Warnings about possible cholera contamination should be posted around contaminated water sources with directions on how to decontaminate the water (boiling, chlorination etc.) for possible use.

Water purification: All water used for drinking, washing, or cooking should be sterilized by either boiling, chlorination, ozone water treatment, ultraviolet light sterilization (e.g., by solar water disinfection), or antimicrobial filtration in any area where cholera may be present. Chlorination and boiling are often the least expensive and most effective means of halting transmission. Cloth filters or sari filtration, though very basic, have significantly reduced the occurrence of cholera when used in poor villages in Bangladesh that rely on untreated surface water. Better antimicrobial filters, like those present in advanced individual water treatment hiking kits, are most effective. Public health education and adherence to appropriate sanitation practices are of primary importance to help prevent and control transmission of cholera and other diseases.

Handwashing with soap or ash after using a toilet and before handling food or eating is also recommended for cholera prevention by WHO Africa.

Surveillance

Surveillance and prompt reporting allow for containing cholera epidemics rapidly. Cholera exists as a seasonal disease in many endemic countries, occurring annually mostly during rainy seasons. Surveillance systems can provide early alerts to outbreaks, therefore leading to coordinated response and assist in preparation of preparedness plans. Efficient surveillance systems can also improve the risk assessment for potential cholera outbreaks. Understanding the seasonality and location of outbreaks provides guidance for improving cholera control activities for the most vulnerable. For prevention to be effective, it is important that cases be reported to national health authorities.

Vaccination

Spanish physician Jaume Ferran i Clua developed a cholera inoculation in 1885, the first to immunize humans against a bacterial disease. However, his vaccine and inoculation was rather controversial and was rejected by his peers and several investigation commissions. Russian-Jewish bacteriologist Waldemar Haffkine successfully developed the first human cholera vaccine in July 1892. He conducted a massive inoculation program in British India.

A number of safe and effective oral vaccines for cholera are available. The World Health Organization (WHO) has three prequalified oral cholera vaccines (OCVs): Dukoral, Sanchol, and Euvichol. Dukoral, an orally administered, inactivated whole cell vaccine, has an overall efficacy of about 52% during the first year after being given and 62% in the second year, with minimal side effects. It is available in over 60 countries. However, it is not currently recommended by the Centers for Disease Control and Prevention (CDC) for most people traveling from the United States to endemic countries. The vaccine that the US Food and Drug Administration (FDA) recommends, Vaxchora, is an oral attenuated live vaccine, that is effective as a single dose.

One injectable vaccine was found to be effective for two to three years. The protective efficacy was 28% lower in children less than five years old. However, as of 2010, it has limited availability. Work is under way to investigate the role of mass vaccination. The WHO recommends immunization of high-risk groups, such as children and people with HIV, in countries where this disease is endemic. If people are immunized broadly, herd immunity results, with a decrease in the amount of contamination in the environment.

WHO recommends that oral cholera vaccination be considered in areas where the disease is endemic (with seasonal peaks), as part of the response to outbreaks, or in a humanitarian crisis during which the risk of cholera is high. Oral Cholera Vaccine (OCV) has been recognized as an adjunct tool for prevention and control of cholera. The World Health Organization (WHO) has prequalified three bivalent cholera vaccines-Dukoral (SBL Vaccines), containing a non-toxic B-subunit of cholera toxin and providing protection against V. cholerae O1; and two vaccines developed using the same transfer of technology-ShanChol (Shantha Biotec) and Euvichol (EuBiologics Co.), which have bivalent O1 and O139 oral killed cholera vaccines. Oral cholera vaccination could be deployed in a diverse range of situations from cholera-endemic areas and locations of humanitarian crises, but no clear consensus exists.

Sari filtration

Developed for use in Bangladesh, the "sari filter" is a simple and cost-effective appropriate technology method for reducing the contamination of drinking water. Used sari cloth is preferable but other types of used cloth can be used with some effect, though the effectiveness will vary significantly. Used cloth is more effective than new cloth, as the repeated washing reduces the space between the fibers. Water collected in this way has a greatly reduced pathogen count-though it will not necessarily be perfectly safe, it is an improvement for poor people with limited options. In Bangladesh this practice was found to decrease rates of cholera by nearly half. It involves folding a sari four to eight times. Between uses the cloth should be rinsed in clean water and dried in the sun to kill any bacteria on it. A nylon cloth appears to work as well but is not as affordable.

Continued eating speeds the recovery of normal intestinal function. The WHO recommends this generally for cases of diarrhea no matter what the underlying cause. A CDC training manual specifically for cholera states: "Continue to breastfeed your baby if the baby has watery diarrhea, even when traveling to get treatment. Adults and older children should continue to eat frequently."

The most common error in caring for patients with cholera is to underestimate the speed and volume of fluids required. In most cases, cholera can be successfully treated with oral rehydration therapy (ORT), which is highly effective, safe, and simple to administer. Rice-based solutions are preferred to glucose-based ones due to greater efficiency. In severe cases with significant dehydration, intravenous rehydration may be necessary. Ringer's lactate is the preferred solution, often with added potassium. Large volumes and continued replacement until diarrhea has subsided may be needed. Ten percent of a person's body weight in fluid may need to be given in the first two to four hours. This method was first tried on a mass scale during the Bangladesh Liberation War, and was found to have much success. Despite widespread beliefs, fruit juices and commercial fizzy drinks like cola are not ideal for rehydration of people with serious infections of the intestines, and their excessive sugar content may even harm water uptake.

If commercially produced oral rehydration solutions are too expensive or difficult to obtain, solutions can be made. One such recipe calls for 1 liter of boiled water, 1/2 teaspoon of salt, 6 teaspoons of sugar, and added mashed banana for potassium and to improve taste.

Electrolytes

As there frequently is initially acidosis, the potassium level may be normal, even though large losses have occurred. As the dehydration is corrected, potassium levels may decrease rapidly, and thus need to be replaced. This may be done by consuming foods high in potassium, like bananas or coconut water.

Antibiotics

Antibiotic treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms. Use of antibiotics also reduces fluid requirements. People will recover without them, however, if sufficient hydration is maintained. The WHO only recommends antibiotics in those with severe dehydration.

Doxycycline is typically used first line, although some strains of V. cholerae have shown resistance. Testing for resistance during an outbreak can help determine appropriate future choices. Other antibiotics proven to be effective include cotrimoxazole, erythromycin, tetracycline, chloramphenicol, and furazolidone. Fluoroquinolones, such as ciprofloxacin, also may be used, but resistance has been reported.

Antibiotics improve outcomes in those who are both severely and not severely dehydrated. Azithromycin and tetracycline may work better than doxycycline or ciprofloxacin.

Zinc supplementation

In Bangladesh zinc supplementation reduced the duration and severity of diarrhea in children with cholera when given with antibiotics and rehydration therapy as needed. It reduced the length of disease by eight hours and the amount of diarrhea stool by 10%. Supplementation appears to be also effective in both treating and preventing infectious diarrhea due to other causes among children in the developing world.

If people with cholera are treated quickly and properly, the mortality rate is less than 1%; however, with untreated cholera, the mortality rate rises to 50-60%.

For certain genetic strains of cholera, such as the one present during the 2010 epidemic in Haiti and the 2004 outbreak in India, death can occur within two hours of becoming ill.

Epidemiology

Cholera affects an estimated 2.8 million people worldwide, and causes approximately 95,000 deaths a year (uncertainty range: 21,000-143,000) as of 2015. This occurs mainly in the developing world. In the early 1980s, death rates are believed to have been greater than three million a year. It is difficult to calculate exact numbers of cases, as many go unreported due to concerns that an outbreak may have a negative impact on the tourism of a country. Cholera remains both epidemic and endemic in many areas of the world. In October 2016, an outbreak of cholera began in war-ravaged Yemen. WHO called it "the worst cholera outbreak in the world". Recent major outbreaks are the 2010s Haiti cholera outbreak and the 2016-2021 Yemen cholera outbreak. In 2019, 93% of the reported 923,037 cholera cases were from Yemen (with 1911 deaths reported). Between September 2019 and September 2020, a global total of over 450,000 cases and over 900 deaths was reported; however these numbers suffer from over-reporting from countries that report suspected cases (and not laboratory confirmed cases) as well as under-reporting from countries that do not report official cases (such as Bangladesh, India and Philippines).

Although much is known about the mechanisms behind the spread of cholera, this has not led to a full understanding of what makes cholera outbreaks happen in some places and not others. Lack of treatment of human feces and lack of treatment of drinking water greatly facilitate its spread, but bodies of water can serve as a reservoir, and seafood shipped long distances can spread the disease.

Cholera was not known in the Americas for most of the 20th century, but it reappeared towards the end of that century. After the end of the 2010s Haiti cholera outbreak, there have not been any cholera cases in the Americas since February 2019. As of August 2021 the disease is endemic in Africa and some areas of Asia (Bangladesh, India and Yemen). Cholera is not endemic in Europe, all reported cases had a travel history to endemic areas.

History of outbreaks

The word cholera is from Greek: χολέρα kholera from χολή kholē "bile". Cholera likely has its origins in the Indian subcontinent as evidenced by its prevalence in the region for centuries.

The disease appears in the European literature as early as 1642, from the Dutch physician Jakob de Bondt's description it in his De Medicina Indorum. (The "Indorum" of the title refers to the East Indies. He also gave first European descriptions of other diseases.)

Early outbreaks in the Indian subcontinent are believed to have been the result of poor living conditions as well as the presence of pools of still water, both of which provide ideal conditions for cholera to thrive. The disease first spread by trade routes (land and sea) to Russia in 1817, later to the rest of Europe, and from Europe to North America and the rest of the world, (hence the name "Asiatic cholera"). Seven cholera pandemics have occurred in the past 200 years, with the seventh pandemic originating in Indonesia in 1961.

The first cholera pandemic occurred in the Bengal region of India, near Calcutta starting in 1817 through 1824. The disease dispersed from India to Southeast Asia, the Middle East, Europe, and Eastern Africa. The movement of British Army and Navy ships and personnel is believed to have contributed to the range of the pandemic, since the ships carried people with the disease to the shores of the Indian Ocean, from Africa to Indonesia, and north to China and Japan. The second pandemic lasted from 1826 to 1837 and particularly affected North America and Europe due to the result of advancements in transportation and global trade, and increased human migration, including soldiers. The third pandemic erupted in 1846, persisted until 1860, extended to North Africa, and reached South America, for the first time specifically affecting Brazil. The fourth pandemic lasted from 1863 to 1875 spread from India to Naples and Spain. The fifth pandemic was from 1881-1896 and started in India and spread to Europe, Asia, and South America. The sixth pandemic started 1899-1923. These epidemics were less fatal due to a greater understanding of the cholera bacteria. Egypt, the Arabian peninsula, Persia, India, and the Philippines were hit hardest during these epidemics, while other areas, like Germany in 1892 (primarily the city of Hamburg where more than 8.600 people died) and Naples from 1910-1911, also experienced severe outbreaks. The seventh pandemic originated in 1961 in Indonesia and is marked by the emergence of a new strain, nicknamed El Tor, which still persists (as of 2018) in developing countries.

Cholera became widespread in the 19th century. Since then it has killed tens of millions of people. In Russia alone, between 1847 and 1851, more than one million people perished of the disease. It killed 150,000 Americans during the second pandemic. Between 1900 and 1920, perhaps eight million people died of cholera in India. Cholera became the first reportable disease in the United States due to the significant effects it had on health. John Snow, in England, was the first to identify the importance of contaminated water as its cause in 1854. Cholera is now no longer considered a pressing health threat in Europe and North America due to filtering and chlorination of water supplies, but still heavily affects populations in developing countries.

In the past, vessels flew a yellow quarantine flag if any crew members or passengers were suffering from cholera. No one aboard a vessel flying a yellow flag would be allowed ashore for an extended period, typically 30 to 40 days.

Historically many different claimed remedies have existed in folklore. Many of the older remedies were based on the miasma theory. Some believed that abdominal chilling made one more susceptible and flannel and cholera belts were routine in army kits. In the 1854-1855 outbreak in Naples homeopathic camphor was used according to Hahnemann. T. J. Ritter's "Mother's Remedies" book lists tomato syrup as a home remedy from northern America. Elecampane was recommended in the United Kingdom according to William Thomas Fernie. The first effective human vaccine was developed in 1885, and the first effective antibiotic was developed in 1948.

Cholera cases are much less frequent in developed countries where governments have helped to establish water sanitation practices and effective medical treatments. The United States, for example, used to have a severe cholera problem similar to those in some developing countries. There were three large cholera outbreaks in the 1800s, which can be attributed to Vibrio cholerae's spread through interior waterways like the Erie Canal and routes along the Eastern Seaboard. The island of Manhattan in New York City touched the Atlantic Ocean, where cholera collected just off the coast. At this time, New York City did not have as effective a sanitation system as it does today, so cholera was able to spread.

Cholera morbus is a historical term that was used to refer to gastroenteritis rather than specifically cholera.

One of the major contributions to fighting cholera was made by the physician and pioneer medical scientist John Snow (1813-1858), who in 1854 found a link between cholera and contaminated drinking water. Dr. Snow proposed a microbial origin for epidemic cholera in 1849. In his major "state of the art" review of 1855, he proposed a substantially complete and correct model for the cause of the disease. In two pioneering epidemiological field studies, he was able to demonstrate human sewage contamination was the most probable disease vector in two major epidemics in London in 1854. His model was not immediately accepted, but it was seen to be the more plausible, as medical microbiology developed over the next 30 years or so. For his work on cholera, John Snow is often regarded as the "Father of Epidemiology".

The bacterium was isolated in 1854 by Italian anatomist Filippo Pacini, but its exact nature and his results were not widely known. In the same year, the Catalan Joaquim Balcells i Pascual discovered the bacterium and in 1856 probably António Augusto da Costa Simões and José Ferreira de Macedo Pinto, two Portuguese men, did the same.

Cities in developed nations made massive investment in clean water supply and well-separated sewage treatment infrastructures between the mid-1850s and the 1900s. This eliminated the threat of cholera epidemics from the major developed cities in the world. In 1883, Robert Koch identified V. cholerae with a microscope as the bacillus causing the disease.

Hemendra Nath Chatterjee, a Bengali scientist, who first formulated and demonstrated the effectiveness of oral rehydration salt (ORS) for diarrhea. In his 1953 paper, published in The Lancet, he states that promethazine can stop vomiting during cholera and then oral rehydration is possible. The formulation of the fluid replacement solution was 4 g of sodium chloride, 25 g of glucose and 1000 ml of water.

Indian medical scientist Sambhu Nath De discovered the cholera toxin, the animal model of cholera, and successfully demonstrate the method of transmission of cholera pathogen Vibrio cholerae.

Robert Allan Phillips, working at the US Naval Medical Research Unit Two in Southeast Asia, evaluated the pathophysiology of the disease using modern laboratory chemistry techniques and developed a protocol for rehydration. His research led the Lasker Foundation to award him its prize in 1967.

More recently, in 2002, Alam, et al., studied stool samples from patients at the International Centre for Diarrhoeal Disease in Dhaka, Bangladesh. From the various experiments they conducted, the researchers found a correlation between the passage of V. cholerae through the human digestive system and an increased infectivity state. Furthermore, the researchers found the bacterium creates a hyperinfected state where genes that control biosynthesis of amino acids, iron uptake systems, and formation of periplasmic nitrate reductase complexes were induced just before defecation. These induced characteristics allow the cholera vibrios to survive in the "rice water" stools, an environment of limited oxygen and iron, of patients with a cholera infection.

Global Strategy

In 2017, the WHO launched the "Ending Cholera: a global roadmap to 2030" strategy which aims to reduce cholera deaths by 90% by 2030. The strategy was developed by the Global Task Force on Cholera Control (GTFCC) which develops country-specific plans and monitors progress. The approach to achieve this goal combines surveillance, water sanitation, treatment and oral vaccines. Specifically, the control strategy focusses on three approaches: i) early detection and response to outbreaks to contain outbreaks, ii) stopping cholera transmission through improved sanitation and vaccines in hotspots, and iii) a global framework for cholera control through the GTFCC.

The WHO and the GTFCC do not consider global cholera eradication a viable goal. Even though humans are the only host of cholera, the bacterium can persist in the environment without a human host. While global eradication is not possible, elimination of human to human transmission may be possible; and local elimination is possible, most recently during the 2010s Haiti cholera outbreak which aims to achieve certification of elimination by 2022.

The GTFCC targets 47 countries, 13 of which have established vaccination campaigns.

Society and culture

Health policy

In many developing countries, cholera still reaches its victims through contaminated water sources, and countries without proper sanitation techniques have greater incidence of the disease. Governments can play a role in this. In 2008, for example, the Zimbabwean cholera outbreak was due partly to the government's role, according to a report from the James Baker Institute. The Haitian government's inability to provide safe drinking water after the 2010 earthquake led to an increase in cholera cases as well.

Similarly, South Africa's cholera outbreak was exacerbated by the government's policy of privatizing water programs. The wealthy elite of the country were able to afford safe water while others had to use water from cholera-infected rivers.

According to Rita R. Colwell of the James Baker Institute, if cholera does begin to spread, government preparedness is crucial. A government's ability to contain the disease before it extends to other areas can prevent a high death toll and the development of an epidemic or even pandemic. Effective disease surveillance can ensure that cholera outbreaks are recognized as soon as possible and dealt with appropriately. Oftentimes, this will allow public health programs to determine and control the cause of the cases, whether it is unsanitary water or seafood that have accumulated a lot of Vibrio cholerae specimens. Having an effective surveillance program contributes to a government's ability to prevent cholera from spreading. In the year 2000 in the state of Kerala in India, the Kottayam district was determined to be "Cholera-affected"; this pronouncement led to task forces that concentrated on educating citizens with 13,670 information sessions about human health. These task forces promoted the boiling of water to obtain safe water, and provided chlorine and oral rehydration salts. Ultimately, this helped to control the spread of the disease to other areas and minimize deaths. On the other hand, researchers have shown that most of the citizens infected during the 1991 cholera outbreak in Bangladesh lived in rural areas, and were not recognized by the government's surveillance program. This inhibited physicians' abilities to detect cholera cases early.

According to Colwell, the quality and inclusiveness of a country's health care system affects the control of cholera, as it did in the Zimbabwean cholera outbreak. While sanitation practices are important, when governments respond quickly and have readily available vaccines, the country will have a lower cholera death toll. Affordability of vaccines can be a problem; if the governments do not provide vaccinations, only the wealthy may be able to afford them and there will be a greater toll on the country's poor. The speed with which government leaders respond to cholera outbreaks is important.

Besides contributing to an effective or declining public health care system and water sanitation treatments, government can have indirect effects on cholera control and the effectiveness of a response to cholera. A country's government can impact its ability to prevent disease and control its spread. A speedy government response backed by a fully functioning health care system and financial resources can prevent cholera's spread. This limits cholera's ability to cause death, or at the very least a decline in education, as children are kept out of school to minimize the risk of infection.

Notable cases

Tchaikovsky's death has traditionally been attributed to cholera, most probably contracted through drinking contaminated water several days earlier. Tchaikovsky's mother died of cholera, and his father became sick with cholera at this time but made a full recovery. Some scholars, however, including English musicologist and Tchaikovsky authority David Brown and biographer Anthony Holden, have theorized that his death was a suicide.

2010s Haiti cholera outbreak. Ten months after the 2010 earthquake, an outbreak swept over Haiti, traced to a United Nations base of peacekeepers from Nepal. This marks the worst cholera outbreak in recent history, as well as the best documented cholera outbreak in modern public health.

Adam Mickiewicz, Polish poet and novelist, is thought to have died of cholera in Istanbul in 1855.

Sadi Carnot, physicist, a pioneer of thermodynamics (d. 1832)

James K. Polk, eleventh president of the United States (d. 1849)

Carl von Clausewitz, Prussian soldier and German military theorist (d. 1831)

Elliot Bovill, Chief Justice of the Straits Settlements (1893)

Nikola Tesla, Serbian-American inventor, engineer and futurist known for his contributions to the design of the modern alternating current (AC) electricity supply system, contracted cholera in 1873 at the age of 17. He was bedridden for nine months, and near death multiple times, but survived and fully recovered.

In popular culture

Unlike tuberculosis ("consumption") which in literature and the arts was often romanticized as a disease of denizens of the demimonde or those with an artistic temperament, cholera is a disease which almost entirely affects the lower-classes living in filth and poverty. This, and the unpleasant course of the disease - which includes voluminous "rice-water" diarrhea, the hemorrhaging of liquids from the mouth, and violent muscle contractions which continue even after death - has discouraged the disease from being romanticized, or even the actual factual presentation of the disease in popular culture.

Country examples

In Zambia, widespread cholera outbreaks have occurred since 1977, most commonly in the capital city of Lusaka. In 2017, an outbreak of cholera was declared in Zambia after laboratory confirmation of Vibrio cholerae O1, biotype El Tor, serotype Ogawa, from stool samples from two patients with acute watery diarrhea. There was a rapid increase in the number of cases from several hundred cases in early December 2017 to approximately 2,000 by early January 2018. With intensification of the rains, new cases increased on a daily basis reaching a peak on the first week of January 2018 with over 700 cases reported.

In collaboration with partners, the Zambia Ministry of Health (MoH) launched a multifaceted public health response that included increased chlorination of the Lusaka municipal water supply, provision of emergency water supplies, water quality monitoring and testing, enhanced surveillance, epidemiologic investigations, a cholera vaccination campaign, aggressive case management and health care worker training, and laboratory testing of clinical samples.

The Zambian Ministry of Health implemented a reactive one-dose Oral Cholera Vaccine (OCV) campaign in April 2016 in three Lusaka compounds, followed by a pre-emptive second-round in December.

In the city of Kolkata, India in the state of West Bengal in the Ganges delta has been described as the "homeland of cholera", with regular outbreaks and pronounced seasonality. In India, where the disease is endemic, cholera outbreaks occur every year between dry seasons and rainy seasons. India is also characterized by high population density, unsafe drinking water, open drains, and poor sanitation which provide an optimal niche for survival, sustenance and transmission of Vibrio cholerae.

Democratic Republic of Congo

In Goma in the Democratic Republic of Congo, cholera has left an enduring mark on human and medical history. Cholera pandemics in the 19th and 20th centuries led to the growth of epidemiology as a science and in recent years it has continued to press advances in the concepts of disease ecology, basic membrane biology, and transmembrane signaling and in the use of scientific information and treatment design.

References

Further reading

Arnold, David (1986). "Cholera and Colonialism in British India". Past & Present. 113 (113): 118-151. doi:10.1093/past/113.1.118. JSTOR 650982. PMID 11617906.

Azizi, MH; Azizi, F (January 2010). "History of Cholera Outbreaks in Iran during the 19th and 20th Centuries". Middle East Journal of Digestive Diseases. 2 (1): 51-55. PMC . PMID 25197514.

Bilson, Geoffrey. A Darkened House: Cholera in Nineteenth-Century Canada (U of Toronto Press, 1980).

Cooper, Donald B. (1986). "The New 'Black Death': Cholera in Brazil, 1855-1856". Social Science History. 10 (4): 467-488. doi:10.2307/1171027. JSTOR 1171027. PMID 11618140.

Echenberg, Myron (2011). Africa in the Time of Cholera: A History of Pandemics from 1817 to the Present. ISBN 978-0-521-18820-3.

Evans, Richard J. (1988). "Epidemics and Revolutions: Cholera in Nineteenth-Century Europe". Past & Present. 120 (120): 123-146. doi:10.1093/past/120.1.123. JSTOR 650924. PMID 11617908.

Evans, Richard J. (2005). Death in Hamburg: Society and Politics in the Cholera Years. ISBN 978-0-14-303636-4.

Gilbert, Pamela K. Cholera and Nation: Doctoring the Social Body in Victorian England" (SUNY Press, 2008).

Hamlin, Christopher (2009). Cholera: The Biography. Oxford University Press.

Huber, Valeska (November 2020). "Pandemics and the politics of difference: rewriting the history of internationalism through nineteenth-century cholera". Journal of Global History. 15 (3): 394-407. doi:10.1017/S1740022820000236. S2CID 228940685.

Huber, Valeska (June 2006). "THE UNIFICATION OF THE GLOBE BY DISEASE? THE INTERNATIONAL SANITARY CONFERENCES ON CHOLERA, 1851-1894". The Historical Journal. 49 (2): 453-476. doi:10.1017/S0018246X06005280. S2CID 162994263.

Jenson, Deborah; Szabo, Victoria (November 2011). "Cholera in Haiti and Other Caribbean Regions, 19th Century". Emerging Infectious Diseases. 17 (11): 2130-2135. doi:10.3201/eid1711.110958. PMC . PMID 22099117.

Kotar, S. L.; Gessler, J. E. (2014). Cholera: A Worldwide History. ISBN 978-0-7864-7242-0.

Kudlick, Catherine Jean (1996). Cholera in Post-Revolutionary Paris: A Cultural History. Berkeley: University of California Press.

Legros, Dominique (15 October 2018). "Global Cholera Epidemiology: Opportunities to Reduce the Burden of Cholera by 2030". The Journal of Infectious Diseases. 218 (suppl_3): S137-S140. doi:10.1093/infdis/jiy486. PMC . PMID 30184102.

Mukharji, Projit Bihari (2012). "The 'Cholera Cloud' in the Nineteenth-Century 'British World': History of an Object-Without-an-Essence". Bulletin of the History of Medicine. 86 (3): 303-332. doi:10.1353/bhm.2012.0050. JSTOR 26305866. PMID 23241908. S2CID 207267413. INIST:26721136 Project MUSE 492086.

Rosenberg, Charles E. (1987). The Cholera Years: The United States in 1832, 1849, and 1866. University of Chicago Press. ISBN 978-0-226-72677-9.

Roth, Mitchel (1997). "Cholera, Community, and Public Health in Gold Rush Sacramento and San Francisco". Pacific Historical Review. 66 (4): 527-551. doi:10.2307/3642236. JSTOR 3642236.

Snowden, Frank M. Naples in the Time of Cholera, 1884-1911 (Cambridge UP, 1995).

Vinten-Johansen, Peter, ed. Investigating Cholera in Broad Street: A History in Documents (Broadview Press, 2020). regarding 1850s in England.

Vinten-Johansen, Peter, et al. Cholera, chloroform, and the science of medicine: a life of John Snow (2003).

External links

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Cholera Other names Asiatic cholera, epidemic cholera[1] A person with severe dehydration due to cholera, causing sunken eyes and wrinkled hands and skin.

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Cholera - Diagnosis and treatment - Mayo Clinic

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Cholera is a treatable, yet potentially fatal bacterial disease that causes diarrhea and dehydration. Learn how to lower your risk.

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"A person can 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 that contaminates water and/or food. "

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Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. An estimated 1.3 to 4 million people around the world get cholera each year and 21,000 to 143,000 people die from it. People who get cholera often have mild symptoms or no symptoms, but cholera can be severe. Approximately 1 in 10 people who get sick with cholera will develop severe symptoms such as watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

The cholera bacterium is usually found in water or in foods that have been contaminated by feces (poop) from a person infected with cholera bacteria. Cholera is most likely to occur and spread in places with inadequate water treatment, poor sanitation, and inadequate hygiene.

Cholera bacteria can also live in the environment in brackish rivers and coastal waters. Shellfish eaten raw have been a source of infection. Rarely, people in the U.S. have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico.

A person can get cholera by drinking water or eating food contaminated with cholera bacteria. In an epidemic, the source of the contamination is usually the feces of an infected person that contaminates water or food. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The infection is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk factor for becoming ill.

Cholera infection is often mild or without symptoms, but can be severe. Approximately 1 in 10 people who get sick with cholera will develop severe symptoms such as watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

It usually takes 2-3 days for symptoms to appear after a person ingests cholera bacteria, but the time can range from a few hours to 5 days.

Persons living in places with unsafe drinking water, poor sanitation, and inadequate hygiene are at the highest risk for cholera.

If you think you or a member of your family might have cholera, seek medical attention immediately. Dehydration can be rapid so fluid replacement is essential. If you have oral rehydration solution (ORS), start taking it immediately; it can save a life. Continue to drink ORS at home and while traveling to get medical treatment. If an infant has watery diarrhea, continue breastfeeding.

To test for cholera, doctors must take a stool sample or a rectal swab and send it to a laboratory to look for the cholera bacteria.

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 (ORS), a prepackaged mixture of sugar and salts that is mixed with 1 liter of 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 appropriate 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.

The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk factor for becoming ill.

Be aware of whether cholera cases have recently occurred in an area you plan to visit. However, the risk for cholera is very low for people visiting areas with epidemic cholera when simple prevention steps are taken.

All visitors or residents in areas where cholera is occurring or has occurred should follow recommendations to prevent getting sick:

Drink only bottled, boiled, or chemically treated water and bottled or canned beverages. When using bottled drinks, make sure the seal has not been broken. Carbonated water may be safer than non-carbonated water. Avoid tap water, fountain drinks, and ice cubes.

To disinfect your own water, choose one of the following options:

Boil it for 1 minute, or

Filter it and add either ½ an iodine tablet or 2 drops of household bleach per liter/quart of water, or

Use commercial water chlorination tablets according to the manufacturer's instructions.

Wash your hands often with soap and clean water, especially before you eat or prepare food and after using the bathroom.
If no water and soap are available, use an alcohol-based hand sanitizer with at least 60% alcohol.

Use bottled, boiled, or chemically treated water to wash dishes, brush teeth, wash and prepare food, and make ice.

Eat foods that are packaged or that are freshly cooked and served hot.
Do not eat raw or undercooked meats and seafood, or raw or undercooked fruits and vegetables unless they are peeled.

Dispose of feces in a sanitary manner to prevent contamination of water and food sources.

A single-dose live oral cholera vaccine, called Vaxchora (lyophilized CVD 103-HgR), is approved by the U.S. Food and Drug Administration for people 2-64 years old who are traveling to an area of active cholera transmission. However, Vaxchora is currently unavailable. Three other oral cholera vaccines are approved by the World Health Organization (WHO) - Dukoral, ShanChol, and Euvichol-Plus/Euvichol. These vaccines are not available in the United States, but may be available at your travel destination or if you're living outside the United States. Check CDC's Travel Health Notices website to identify areas with active cholera transmission. Visit a doctor or travel clinic to talk about vaccination if you will be traveling to or living in one of these areas.

For more information, visit the Visit CDC's global immunization website to learn more about CDC's global work with cholera vaccines.

Cholera was prevalent In the United States in the 1800s but water-related spread has been eliminated by modern water and sewage treatment systems. Very rarely, people in the U.S. get sick with cholera after eating raw or undercooked shellfish from the Gulf of Mexico.

However, U.S. travelers to areas with epidemic cholera (for example, parts of Africa, Asia, and Latin America) can be exposed to cholera bacteria, and might develop illness after arriving home. Some travelers have brought contaminated seafood home from abroad, resulting in cholera.

U.S. and international public health authorities are working to enhance surveillance for cholera, investigate and respond to cholera outbreaks, and design and implement preventive measures across the globe. The Centers for Disease Control and Prevention (CDC) investigates epidemic cholera wherever it occurs at the invitation of the affected country and trains laboratory workers in proper techniques for identification of Vibrio cholerae. In addition, CDC provides information on diagnosis, treatment, and prevention of cholera to public health officials and educates the public about effective preventive measures.

The World Health Organization (WHO) and the Global Task Force on Cholera Control (GTFCC) along with partners and various stakeholders launched Ending Cholera - a Global Roadmap to 2030, which is an unprecedented initiative to fight and reduce cholera transmission globally. This comprehensive plan identifies priorities to reduce cholera deaths by 90% and stop transmission in up to 20 countries by 2030. The Centers for Disease Control and Prevention (CDC) supports the global strategy by participating in task force working groups for water, sanitation and hygiene (WASH), case management, epidemiology and surveillance, laboratory, and oral cholera vaccines.

The U.S. Agency for International Development sponsors some of the international U.S. government activities and provides medical supplies, and water, sanitation and hygiene supplies to affected countries.

The Food and Drug Administration tests imported and domestic shellfish for V. cholerae and monitors the safety of U.S. shellfish beds through the shellfish sanitation program.

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Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. An estimated 1.3 to 4 million people around the world get cholera each year and 21,000 to 143,000 people die from it.

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Cholera is "caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. "
https://www.webmd.com/a-to-z-guides/cholera-faq#1

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" It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. "

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Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in the U.S. However, cholera outbreaks are still a serious problem in other parts of the world. The World Health Organization reports that there are 1.3 million to 4 million cases each year.

The disease is most common in places with poor sanitation, crowding, war, and famine. Common locations include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas, knowing the following cholera facts can help protect you and your family.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include:

Municipal water supplies

Ice made from municipal water

Foods and drinks sold by street vendors

Vegetables grown with water containing human wastes

Raw or undercooked fish and seafood caught in waters polluted with sewage

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea.

It is not likely you will catch cholera just from casual contact with an infected person.

Cholera Symptoms

Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.

Signs and symptoms of dehydration include:

If not treated, dehydration can lead to shock and death in a matter of hours.

Continued

Cholera Treatment and Prevention

There is a vaccine for cholera. Both the CDC and the World Health Organization have specific guidelines for who should be given this vaccine.

You can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected, or bottled water. Be sure to use bottled, boiled, or chemically disinfected water for the following purposes

Drinking

Preparing food or drinks

Making ice

Brushing your teeth

Washing your face and hands

Washing dishes and utensils that you use to eat or prepare food

Washing fruits and vegetables

To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant. You should also avoid raw foods, including the following:

Unpeeled fruits and vegetables

Unpasteurized milk and milk products

Raw or undercooked meat or shellfish

Fish caught in tropical reefs, which may be contaminated

If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.

Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

Sources

SOURCES:

CDC: "Cholera: General Information;" "Cholera: Disease;" and "Cholera: Prevention and Control." "Recommendations of the Advisory Committee on Immunization Practices for Use of Cholera Vaccine."

University of Alabama at Birmingham Health System: "Cholera."

MedlinePlus.gov: "Cholera."

World Health Organization: "Cholera."

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Cholera: Causes, Symptoms, Treatment, and Prevention

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Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae. Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water.

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Cholera is caused by a bacterial infection called vibrio cholerae.

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Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and muscle cramps may also occur.

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Here's a good source for this.

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The United Nations recently admitted that it played a role in introducing cholera to Haiti after a deadly earthquake hit the nation in 2010.

In recent years, cholera has afflicted at least 770,000 Haitians and claimed over 9,200 lives. The Haitian epidemic alone resulted in an 85 percent increase in the number of cholera cases worldwide. The UN has not explicitly said it caused the cholera outbreak; however, the Secretary-General's office says peacekeepers who arrived in Haiti after the earthquake may have helped trigger the epidemic.

How Did It Spread?

Cholera spreads through drinking water or food contaminated by the bacterium Vibrio cholerae; large epidemics often stem from water supplies contaminated by fecal matter. The Haitian outbreak is believed to have started near a UN camp hosting peacekeepers from Nepal who were in Haiti for relief efforts.

Situated alongside the Meille River, the camp discharged its waste directly into the river. At the time, Nepal was suffering a cholera outbreak, and the peacekeepers are suspected to have transmitted the disease through their waste. The river was a primary source of water for thousands of people, and lacking sanitation options, the water may have been consumed without proper treatment.

Many experts believe this outbreak of cholera was the first incidence of the disease in Haiti in decades. As a result, the population lacked immunity and was particularly vulnerable to the illness.

Why Was It So Devastating?

Cholera is a messy disease. The symptoms include diarrhea, vomiting, and cramping. In severe cases, dehydration and shock can take hold within hours. If left untreated, 25 to 50 percent of cases can be fatal.

Urban centers lacking water and sanitation infrastructure are especially susceptible. The rapid diffusion of the disease is tied to squalid conditions and insufficient health and sanitary infrastructure in earthquake-ravaged Haiti.

In areas with poor sanitation and hygiene, explosive diarrhea and vomiting can accelerate the diffusion of disease because the waste-and the bacteria it carries-is harder to contain.

How Can It Be Prevented?

Cholera can be prevented through careful sanitation and hygiene. If possible, use bottled water with unbroken seals, and if bottled water is unavailable, boil the water for at least one minute or treat it with chlorine or household bleach. Any food, especially shellfish and seafood, should be thoroughly cooked; bacteria can attach themselves to the shells of crab, shrimp, and other shellfish.

Safe handwashing practices are crucial for cholera prevention. Handwashing after using the bathroom, and again before preparing food or eating, is critical for prevention.

Lastly, cholera can be thwarted by properly disposing of human waste. Latrines and other sanitation systems should be located away from homes, if possible, and any defecation should take place at least 98 feet (30 meters) from a body of water.

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How Cholera Spread So Quickly Through Haiti

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The United Nations recently admitted that it played a role in introducing cholera to Haiti after a deadly earthquake hit the nation in 2010. In recent years, cholera has afflicted at least 770,000 Haitians and claimed over 9,200 lives. The Haitian epidemic alone resulted in an 85 percent increase in the number of cholera cases worldwide.

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Cholera is caused by a bacterium.