BUPA GLOBAL

Cholera

This factsheet is for people who have cholera, or who are visiting or are living in a country where there is a risk of cholera infection.

Cholera is an infection of the small bowel which can cause diarrhoea and vomiting. It's mostly found in areas that don't have safe drinking water, and where food hygiene and sewage disposal aren't very good. It can be life-threatening if the symptoms are severe.

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Published by Bupa's Health Information Team, July 2010.

About cholera

About cholera

About cholera


The main areas of the world in which cholera is found include Africa, Asia, the Middle East, Peru and some parts of Central America. Find out current information on risk of cholera in a specific country here (link: http://www.nathnac.org/ds/map_world.aspx)

Cholera is also common in circumstances where people can't get access to clean water or sanitation is poor - for example, after a natural disaster or in a war zone.

Cholera is caused by infection with a bacterium called Vibrio cholerae. There are more than 100 forms (serotypes) of V. cholerae, but there are only two types that affect humans:

  • V. cholerae O1, of which there are two subtypes (Classical and El Tor)
  • V. cholerae O139

Causes of cholera


The symptoms of cholera are caused by the V. cholerae bacteria producing a poison (toxin) in your small bowel. A large number of the V. cholerae bacteria are required to produce enough toxin to cause the symptoms.

Cholera is usually spread through water contaminated with infected faeces. If you drink contaminated water you may develop symptoms. You can also get cholera from contaminated food, particularly poorly cooked seafood. It's rare to catch cholera directly from another person.

Symptoms and diagnosis

Symptoms and diagnosis

Symptoms of cholera


Cholera mainly affects your small bowel, causing watery diarrhoea and vomiting. If you have cholera, you may:

  • have watery faeces with a mild, fishy smell and bits of mucus - this is sometimes called 'rice water' faeces because it looks like water in which rice has been washed
  • feel sick and vomit
  • have abdominal (tummy) cramps
  • be dehydrated
  • have a fever, but this is rare and usually only occurs in children
There is normally a delay of between a few hours and five days from when you become infected with cholera and when you start to get symptoms. This is known as the incubation period. Most people get symptoms after two to five days.

The symptoms of cholera can vary from mild to severe. About three-quarters of people who are infected don't realise they have it, as they don't become ill. Less commonly, cholera can cause severe diarrhoea. This can lead to extreme dehydration and can potentially be life-threatening.

Although not necessarily a result of cholera, if you have these symptoms and they are severe, you should seek urgent medical advice.

Diagnosis of cholera


If you think you have cholera and see a doctor, he or she will ask about your symptoms and examine you. If you have recently travelled, you should let your doctor know which countries or regions you have visited (including any stopovers). He or she may ask you for a sample of your faeces (also known as a stool sample), which will be sent to a laboratory and tested to see if you are infected with the cholera bacteria.

Treatment

Treatment

Self-help


The main treatment for cholera is to replace the fluids that you have lost through diarrhoea. Your body will then usually fight off the infection by itself. You should drink enough fluids to replace those you have lost. It's also advisable that you take an oral rehydration therapy to replace lost salt and minerals. You can buy these from a pharmacist. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

You can also make homemade solutions using sugar and salt, but you should contact your doctor or pharmacist for advice first.

Medicines


If your symptoms are severe, your doctor may prescribe you antibiotics to take, such as doxycycline and tetracycline. These antibiotics can help control your diarrhoea and stop you losing any more fluids.

Hospital treatment


If you are very dehydrated you may need hospital treatment. You may have a drip inserted into a vein in your hand or arm to give you fluids.

The availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention

Prevention

Prevention of cholera


There are a number of precautions you can take to help reduce your risk of getting cholera if you are travelling to an affected area.

  • Only drink bottled water (make sure the seal is intact) or tap water that has been boiled. You can drink water that has been treated with chlorine or iodine, but don't have ice as the V. cholerae bacteria can survive the freezing process.
  • Eat freshly prepared foods that have been cooked thoroughly and are still hot. Don't eat raw vegetables such as green salads as they may have been washed in contaminated water. As a general rule, only eat raw vegetables and fruit that you can peel.
  • Wash your hands after going to the toilet and always before preparing and eating food, or drinking water.

Vaccine


Cholera vaccines are currently available in some countries. Most people who travel don't need to have the vaccine as taking preventive measures will usually provide enough protection against cholera. However, you may be offered a vaccine if you plan to stay in an area of known cholera outbreaks long-term - especially if there is limited access to good medical care.

The vaccines are given orally (you take them by mouth), and may come in a sachet that you dissolve in water. You may need two or three doses, depending on your age.

The doses must be separated by a period of between one and six weeks. You must have completed the course at least a week before you plan to travel to an area with cholera.

Cholera vaccines don't give you life-long immunity and you will need to have a booster to keep you protected. Adults and children over six need the booster two years after the initial dose and children aged two to six need it six months after.

Sources

Sources

Further information

World Health Organization: www.who.int
Sources

  • Cholera. Health Protection Agency. www.hpa.org.uk, published 12 December 2008
  • Cholera information sheet for travellers. National Travel Health Network and Centre. www.nathnac.org, published May 2004
  • Green book, chapter 14: cholera. Department of Health. www.dh.gov.uk, published 19 April 2010
  • Cholera factsheet. World Health Organization. www.who.int, published November 2008
  • Cholera. emedicine. www.emedicine.medscape.com, published 26 February 2010
  • Eddleston M, Davidson R, Wilkinson R, et al. Oxford handbook of tropical medicine. 2nd ed. Oxford: Oxford University Press, 2006:134-37
  • Cholera: general information. Centre for Disease Control and Prevention. www.cdc.gov, published 17 July 2009
  • Joint Formulary Committee, British National Formulary. 59th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2010
  • Focus on vaccinations and immunisations. British Medical Association. www.bma.org.uk, published April 2004

This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. Photos and videos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

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