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I forgot to add that all the markers on the world map are countries that are cholera hotspots either now or at some point in history.

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Vibrio cholerae is a rod shaped Gram-negative, facultative anaerobe bacterium. Of the 206 V. cholerae serogroups only two are responsible for cholera, 01 and 0139. 01 and 0139 have genes that code for the cholera toxin (CT) and toxin-coregulated pilus (TCP) of which a majority of the other 204 serogroups do not have.

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Domain: Bacteria

Phylum: Proteobacteria

Class: Gammaproteobacteria

Order: Vibionales

Family: Vibrionaceae

Genus: Vibrio

Species: cholerae

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Gram-negative (stains pink/red)

Rod/comma shaped

Single flagellum makes it highly motile

Aerobic or facultative anaerobe

Cholera toxin causes severe diarrhea and dehydration

Serogroups 01 & 0139. Most common outbreaks are associated with 01, including the classical and El Tor biotypes.

Salt-tolerant, can tolerate high salt concentrations and is found in aquatic environments

Lipopolysaccharide O antigen

Bacteriophage-mediated toxin production

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Spreading/transmission may occur when poor hygiene and/or sanitation is involved.

drinking contaminated water

consuming rice that has been watered with contaminated water

consuming produce that has been washed in contaminated water

eating raw or undercooked seafood (shellfish such as shrimp & crab)

direct contact with an infected individual's feces or vomit

Note that it is unlikely to spread cholera via casual contact with an infected person

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Early signs and symptoms of cholera include:

watery diarrhea that is often described as "rice-water stools"

vomiting

leg cramping

restlessness/irritability

Later and more severe symptoms include

rapid heart rate

loss of elasticity of the skin

dry mucous membranes

low blood pressure

If left untreated these symptoms can lead to severe dehydration which can lead to kidney failure, shock, coma, and even death.

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Long term effects include electrolyte imbalance due to dehydration, headaches, loss of appetite, nausea, and tiredness in adults.

More concerning is the long-term effects on infants and young children of whom suffer in term of stunted growth, particularly in height.

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Cholera prevention includes practicing proper hygiene and sanitation of food and water. Proper hand washing techniques before and after eating, using the restroom, and the caring/cleaning up after and infected individual is paramount in protecting oneself from contracting cholera. Safe water practices also include drinking only water that has been treated with chlorine or iodine, or drinking bottled water. This also applies to the washing and cooking of foods and cooking those foods to the right internal temperatures for the appropriate amount of time.

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Dukora, Euvichol, Shanchol, and Vaxchora are oral cholera vaccines (OVC).

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Shanchol and Euvichol OVC are currently available and are used in mass vaccination campaigns in highly endemic areas.

Both Dukora and Voxchora are used/recommended for travelers if they are planning to travel to countries where cholera is known to be present or where the water might be unsafe to drink/use. Voxchora is the only FDA vaccine approved for use in the US.

Cholera vaccines work because they contain a weakened or dead form of the bacteria thus triggering the production of antibodies and an immune response without causing the disease. The immune response happens in the intestine where cholerae normally attaches to the intestinal walls and colonizes the gut.

It should be noted that OCVs are not 100% effective and do not protect against all strains of V. cholerae.

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Treatment options include:

Rehydration therapy to replace fluids lost due to diarrhea and vomiting. Ex. Drinking oral rehydration solutions that contain salts and minerals, intravenous fluids, and electrolytes.

Antibiotics can be used for patients that are severely ill depending on the length of time that they have been sick. Antibiotics are to be used in conjunction with frequent/continuous rehydration.

Treatment for children under the age of 5 it is common to include Zinc supplementation regardless of the severity of dehydration because it reduces the duration and volume of diarrhea.

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While rapid diagnostic test kits are used in epidemic/hotspot settings they are not used in routine settings. The most common way to confirm a cholera diagnosis is through the culturing of a stool sample. 01 and 0139 serotyping is done on thiosulfate-citrate-bile salts-sucrose (TCBS) agar. TCBS is selective for isolation and identification which makes it the preferred method of culturing.

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Cholera cases* reported to WHO by year and continent, global CFR, 1989-2021.

* In 2017 and 2019, Yemen accounted for 84% and 93% of all cholera cases respectively (Weekly Epidemiological Report 2018, 2020).

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There have been seven recorded cholera pandemics since its discovery.

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Global situation of active epidemics of cholera and watery diarrhea as of February 1, 2023. Note: Countries in white are not reporting any ongoing cholera outbreaks as of Feb 1, 2023.

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1. CDC. (2024, May 12). About Cholera. CDC. https://www.cdc.gov/cholera/about/index.html

2. 1. CHOLERA Five Basic Prevention Steps. (n.d.). https://www.cdc.gov/cholera/media/pdfs/Cholera_5-Basic-Prevention-Steps_English.pdf

3. Cholera: Symptoms, Diagnosis and Treatment : Symptoms, Diagnosis and Treatment, edited by Evelyn L. Melbourne, Nova Science Publishers, Incorporated, 2011. ProQuest Ebook Central, https://ebookcentral.proquest.com/lib/tccd-ebooks/detail.action?docID=3018633.

4. Global Task Force on Cholera Control. (2025). About cholera – global task force on cholera control. Www.gtfcc.org. https://www.gtfcc.org/about-cholera/

5. Harris, J. B., LaRocque, R. C., Qadri, F., Ryan, E. T., & Calderwood, S. B. (2012). Cholera. The Lancet, 379(9835), 2466-76. Retrieved from https://tccd.idm.oclc.org/login?url=https://www.proquest.com/scholarly-journals/cholera/docview/1024689460/se-2

6. Kanungo, Suman et al. “Cholera.” The Lancet (British edition) 399.10333 (2022): 1429-. Web.

7. Manzoor Ahmad Mir. (2022). Human Pathogenic Microbes : Diseases and Concerns. Elsevier Science & Technology.

8. Pant, A., Das, B., & Bhadra, R. K. (2020). CTX phage of vibrio cholerae : Genomics and applications. Vaccine, Suppl.Supplement 1, 38, A7-A12. doi:https://doi.org/10.1016/j.vaccine.2019.06.034

9. Robinson, R. K., Batt, C. A., & Patel, P. D. (2000). Encyclopedia of food microbiology. Vol. 3. Academic.

10. Section 7: Case Management in Treatment Facilities | Cholera Outbreak Response Field Manual. (2022). Choleraoutbreak.org. https://www.choleraoutbreak.org/book-page/section-7-case-management-treatment-facilities.html

11. Shibboleth Authentication Request. (2025). Proquest.com. https://ebookcentral.proquest.com/lib/tccd-ebooks/reader.action?docID=3018633&ppg=1

12. WHO. (n.d.). WHO Global Cholera and AWD dashboard public. Who-Global-Cholera-And-Awd-Dashboard-1-Who.hub.arcgis.com. https://who-global-cholera-and-awd-dashboard-1-who.hub.arcgis.com/

13. World Health Organization. (2024, December 5). Cholera. Who.int; World Health Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/cholera