Cholera is a serious and sometimes life-threatening infection that mainly affects people in developing countries, where clean water and other sanitation measures are hard to come by. If you live in the United States, the chances of someone in your family getting cholera are slim.

But if you're planning to travel to a foreign country, especially one in the tropics, it's a good idea to know about cholera, and how to prevent it. Taking precautions with your food and water is the best way to avoid the illness.

About Cholera

Cholera is an intestinal infection caused the bacterium Vibrio cholerae. This bacterium produces a potent toxin that binds to the walls of the intestines. The body responds by secreting large amounts of water, causing watery diarrhea, vomiting, and subsequent dehydration as fluids and salts exit the body.

As a result, people with cholera can become dehydrated very quickly. Untreated severe dehydration can cause serious health problems like seizures and kidney failure. A person who doesn't get the proper medical treatment might even die.

The good news is, cholera is easy to treat if it's caught early. Kids who have mild to moderate cases usually get better within a week. Even people with severe cases of cholera recover fully in a week or so if they get medical care.

Cholera is mostly found in hot, tropical climates — in particular Asia, Africa, Latin America, India, and the Middle East. Although it's rare in the United States (the last outbreak was in 1911), cases can still occur. Travelers from countries where cholera is more common can bring it into the country, and some people in the U.S. have become sick from eating raw or undercooked shellfish from the Gulf of Mexico.

How It Spreads

People get cholera from eating or drinking food or water that's been contaminated with the feces (poop) of someone who has cholera.

This is one reason why cholera is rare in countries with good sanitation systems. Things like flush toilets, sewer systems, and water treatment facilities keep poop out of the water and food supply. Cholera epidemics also sometimes happen after a disaster (like an earthquake or flood) if people are living in tent cities or other places without running water or proper sanitation systems. Less commonly, the bacteria that cause cholera are found in brackish rivers and coastal waters.

Cholera is not contagious, so you can't catch it from direct contact with another person.

Signs & Symptoms

When someone is infected with the cholera bacterium, symptoms can appear in a few hours or as late as 5 days later. Many kids with cholera have no signs or symptoms, but some cases can be severe and life threatening.

Common symptoms of cholera and the dehydration it causes include:

• watery, pale-colored diarrhea, often in large amounts
• nausea and vomiting
• cramps, particularly in the abdomen and legs
• irritability, lack of energy, or unusual sleepiness
• glassy or sunken eyes
• dry mouth and extreme thirst
• dry, shriveled skin
• low urine output and a lack of tears
• arrhythmia (irregular heartbeat) and low blood pressure

If your child develops symptoms like these, especially after visiting an area where cholera is likely or common, call your doctor or get medical help right away. Severe dehydration can happen very quickly, so it's essential to start replacing lost fluids right away to avoid damage to internal organs.

Diagnosis

To confirm a diagnosis of cholera, doctors may take a stool or vomit sample or a rectal swab to examine for signs of the bacteria. Rapid, dipstick-style tests are now available, which help health care providers in remote areas identify the disease more quickly and control outbreaks more effectively. All confirmed cases of cholera must be reported to local health officials.

Treatment

Since severe dehydration and death can occur within hours, cholera needs to be treated immediately. Most kids recover with no long-term problems as long as they receive prompt treatment.

The goal of treatment is to replace all the fluids and salts lost through diarrhea and vomiting. For mild dehydration, a doctor may recommend giving your child an over-the-counter rehydration solution. Kids with more severe cases of cholera may need to stay in the hospital and get intravenous (IV) fluids.

Sometimes doctors prescribe antibiotics to treat cholera. The antibiotics are not as important as rehydration, but can help shorten the length of time someone is sick. They also might make cholera-related diarrhea less severe. Sometimes doctors also prescribe zinc supplements.

Anti-diarrheal medicines can actually make the symptoms of cholera worse, so if your child has cholera (or you think your child has it), do not offer them.

Prevention

Some countries have cholera vaccines that can help protect people against cholera for a short while. Because cholera isn't a problem in the United States, the vaccine is not offered here.

If you're going to an area that has cholera, you can greatly reduce your family's chances of getting sick by following a few simple precautions while you're there:

• Boil or disinfect any water that you'll use for drinking, washing or preparing food, making ice, making coffee or tea, or brushing your teeth. Choose bottled water or other drinks that come in sealed cans or bottles. Be sure to wipe the outside of the can or bottle before you drink from it, though. Avoid tap water, fountain drinks, and drinks with ice cubes.
• Fully cook all food, especially seafood. Avoid food from street vendors. Instead, eat packaged foods and meals that are freshly cooked and served hot. Avoid sushi and any other raw or partly cooked seafood.
• Avoid raw vegetables, including salads, and fruits that have already been peeled or cannot be peeled (like grapes and berries). Bananas, avocados, and oranges are better choices.
• Dairy foods are often contaminated, so be careful with things like ice cream, milk, and cheese. Eat only pasteurized dairy and be sure dairy foods are refrigerated and kept cold.
• Wash your hands frequently with soap and clean water, especially after you use the bathroom or before you prepare food. If no soap and water are available, use a hand cleaner that's at least 60% alcohol.

Reviewed by: Elana Pearl Ben-Joseph, MD
Date reviewed: October 2012