Below you will find answers to commonly asked questions about cholera.
- What is cholera?
- Where is cholera found?
- How does a person get cholera?
- What are the symptoms of cholera?
- How long after infection do the symptoms appear?
- Who is most likely to get cholera?
- What should I do if I or someone I know gets sick?
- How is cholera diagnosed?
- What is the treatment for cholera?
- Should I be worried about getting cholera from others?
- How can I avoid getting sick with cholera?
- Is a vaccine available to prevent cholera?
- What is the risk for cholera in the United States?
- Where can a traveler get information about cholera?
- What is the U.S. government doing to combat cholera?
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. 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.
- 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.
- The global picture of cholera changes periodically, so travelers should seek updated information on countries of interest. CDC has a Travelers’ Health Website with information on cholera and other diseases of concern to travelers.
- 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.