Cholera is an acute infection caused by the bacterium Vibrio cholerae that results in diarrhea and severe dehydration. Left untreated, cholera can be fatal in a matter of hours to even healthy individuals. An estimated 3 to 5 million cases and more than 100,000 deaths occur each year around the world.

Most often spread by ingesting contaminated food or water, cholera occurs in places with poor sanitation or overcrowding; impoverished countries; refugee camps; and areas devastated by war, natural disaster or famine. Water may be contaminated by the feces of an infected person or by untreated sewage. Food may be contaminated by water containing the bacteria or by being handled by a person with cholera. The disease is not likely to spread directly from person to person, so casual contact with an infected person is not a risk. A type of cholera is associated with infected shellfish, especially raw oysters.

In the United States, incidence due to contaminated food is low, but there has been a cholera pandemic in Asia, Africa and Latin America for the last four decades. Sierra Leone is experiencing its worst outbreak in 15 years, with more than 19,000 cases and 274 deaths as of Sept. 19. Outbreaks have been ongoing in Haiti and the Dominican Republic for two years, with more than 140,000 cases in Port-au-Prince alone, though the number of cases decreased recently. This year saw the first outbreak in Cuba in more than a century, with 236 confirmed cases and three deaths as of July 31.

Symptoms of cholera include abdominal cramps, dry mucous membranes, dry skin, excessive thirst, glassy or sunken eyes, lack of tears, lethargy, low urine output, nausea, rapid dehydration, rapid heart rate, unusual sleepiness or tiredness, leg cramps and watery diarrhea that starts suddenly and has a fishy odor. Children have the same symptoms as adults but may also experience fever and convulsions. In infants, the soft spot (fontanel) on the top of the baby’s head will appear sunken.

Inform your physician if you are returning from a country where cholera occurs. Cholera infection is often asymptomatic or results in mild gastroenteritis. Severe cholera is characterized by acute, profuse watery diarrhea described as “rice-water stools” and often vomiting. Dehydration from cholera can be rapid, leading to shock and death within hours.

Cholera is confirmed through a stool specimen or rectal swab. The best treatment is oral rehydration with fluids containing salts; intravenous fluids are used when necessary. Antibiotics shorten the course of the disease and diminish the severity but are not as important as rehydration. The World Health Organization developed oral rehydration salts (powder that can be reconstituted with bottled water) that are cheaper and easier to administer than typical IV fluid. Up to 80 percent of cases can be successfully treated with ORS.

Most U.S. travelers are not at high risk of getting cholera. However, travelers to an area with a known outbreak should take steps to avoid getting sick. The Centers for Disease Control believe the two oral cholera vaccines currently available abroad offer incomplete protection for a relatively short time, so they are not available in the United States. For information about these vaccines, contact your health care provider or local public health office. No country requires immunization against cholera as a condition of entry.

The best way to avoid getting sick is to follow water and food safety precautions. Use bottled or canned water or carbonated beverages with unbroken seals. Use safe water to brush your teeth, wash, prepare food and make ice. Clean food preparation areas and utensils with soap and safe water and let dry completely before reuse. Piped water sources, ice and drinks sold in cups or bags may not be safe; boil or treat all water for drinking or making ice.

Wash your hands often with soap and safe water, especially before eating, preparing food and feeding children; and after using the bathroom, changing diapers or taking care of someone who has diarrhea. In lieu of soap, use hand sanitizer containing at least 60 percent alcohol. Wash yourself, your children, diapers and clothes at least 100 feet away from drinking water sources.

Do not defecate in any body of water. Use toilets, latrines or chemical toilets. Clean toilets and surfaces with a solution of one part household bleach to nine parts water.

WATER SAFETY

• Boil unbottled water for at least one minute.

• Or treat with purification tablets.

• Or treat with household bleach (eight drops/gallon of water; two drops/liter) and let stand 30 minutes.

• Store treated water in clean, covered containers.

FOOD SAFETY

• Boil it, cook it, peel it or leave it.

• Peel fruits and vegetables.

• Handle and store raw and cooked food separately.

• Eat cooked food hot.

• Cook shellfish thoroughly.

• Avoid raw foods except fruits and vegetables you have peeled.