Information for Public Health & Medical Professionals

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CDC expert Dr. Karen Wong discusses the risk for cholera in travelers, how it can be prevented, and use of the new vaccine.

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Cholera Vaccine for Travelers

Learn about cholera diagnosis, treatment, and prevention, with a special focus on vaccination. Receive continuing education (CE) credit after completing the course.

Listed below are answers to common questions for public health and medical professionals addressing cholera diagnosis, testing, treatment, patient care, and prevention in outbreak and other settings. You will also find relevant publications and patient education materials.

What is cholera?

Cholera is an acute diarrheal illness caused by intestinal infection with the Vibrio cholerae bacteria. An estimated 2.9 million cases of cholera and 95,000 cholera-related deaths occur each year around the world. The infection is often mild or without symptoms but can be severe. Approximately 10% of infected people 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.

When should I suspect cholera?

You should suspect cholera in any patient who lives in or may have recently traveled to a cholera-endemic area if they present with

  • severe, watery diarrhea
  • vomiting, and
  • severe dehydration.

The patient may complain of painful cramping in the legs due to electrolyte disturbances. Providers should be particularly suspicious of cholera in patients returning from cholera-endemic areas or with a recent history of raw seafood consumption from a cholera-endemic area, even if they have only mild diarrheal illness. The incubation period of cholera is between 2 hours and 5 days.

How do I diagnose cholera?

Cholera is diagnosed by culturing the organism from the stool. Notify your lab that you are considering cholera so they will culture on thiosulfate-citrate-bile salts-sucrose (TCBS) agar. However, if symptoms are severe, do not wait for a positive culture before starting aggressive treatment.

Visit the Cholera Diagnosis and Detection page and Laboratory Testing for Cholera page for more information.

How do I treat cholera?

Patients with severe cholera may have lost more than 10% of body weight by the time they seek medical care. Rapid administration of appropriate fluids can prevent death by correcting dehydration, shock, and acidosis. Antibiotic treatment is less important but will decrease the duration of illness.

Visit the Cholera Treatment page for more information.

What fluids should I give?

The appropriate fluid depends on the patient’s condition. Patients with mild to moderate dehydration can be given an oral rehydration solution (ORS) such as Rehydralyte™ or WHO Formula Oral Rehydration Solution. Only solutions that contain the proper balance of electrolytes should be given.

Patients with severe dehydration and those with intractable vomiting need intravenous therapy with Ringer’s lactate solution. Intravenous fluid should be given quickly to restore the circulation. If Ringer’s lactate is not available, normal saline or 5% glucose in normal saline can be used. Dextrose (plain 5% glucose) solution is not recommended. After circulation has been restored, the major route for fluids should be oral.

Visit the Cholera Rehydration Therapy page for more information.

How much fluid should I give?

Fluid therapy needs to be individualized, based on the degree of dehydration. Severely dehydrated adults may require several liters of fluid immediately. Ongoing fluid losses should be measured and replaced.

Visit the Cholera Rehydration Therapy page for more information.

What antibiotic should I use?

Age group First-line drug choice Alternate drug choices
Table showing what antibiotic to use based on age.
Children <1 year old Doxycycline 2–4 mg/kg by mouth (per os, p.o.) single dose Azithromycin 20 mg/kg (max 1 g) p.o. single dose, or Ciprofloxacin 20 mg/kg (max 1 g) p.o. single dose
Children 1 year old and adults, including pregnant women Doxycycline 300 mg p.o. single dose Azithromycin 1 g p.o. single dose, or ciprofloxacin 1 g p.o. single dose

Clinical management guidelines including antibiotic treatment are also posted on the Cholera Treatment page.

What else should I do?

You should immediately report to your county or state health department all suspected or confirmed cases of cholera. Patients should not swim or enter bodies of water (like lakes or rivers) while ill with diarrhea. Patients who are incontinent should avoid recreational water activities for a week after diarrhea resolves.