Cholera is a bacterial infection caused by a microbe that multiplies in water. People who become seriously ill with cholera can become dehydrated very quickly due to diarrhea and explosive vomiting. Not all people who get cholera get the disease, but those who do run the risk of dying if not treated quickly.
Cholera is extremely rare in the United States and other developed countries, where public sanitation is well developed and personal hygiene is widely practiced. For example, between 2001 and 2011, only 111 cases of cholera were reported in the United States, according to the Centers for Disease Control and Prevention (CDC). However, cholera outbreaks still occur in parts of the world where sanitation and personal hygiene are rudimentary.
If you plan to visit such an area, you must understand how the disease is transmitted and take care to keep yourself safe.
For example, there is a cholera vaccine for adults. But keep in mind that most people who travel to countries where cholera still exists do not travel to areas where outbreaks are occurring.
Symptoms of severe cholera include massive amounts of explosive watery diarrhea, sometimes called rice water feces (because it resembles the water used to wash rice), vomiting, and leg cramps. Rapid fluid loss (up to 20 liters per day) can quickly lead to severe dehydration.
Signs of dehydration include skin turgor (that is, an area of skin that pinches and slowly returns to its normal position), sunken eyes, heart palpitations, low blood pressure, and weight loss.
Shock can occur when fluid loss causes the circulatory system to collapse because not as much blood is flowing through it as usual. Cholera does not usually cause a fever.
The microbe that causes cholera is a gram-negative bacterium called Vibrio cholerae . A person usually becomes infected with these bacteria by drinking water contaminated with the feces of another infected person. Bacteria can also be transmitted through food washed or prepared with contaminated water. It is sometimes transmitted through raw or undercooked shellfish. Person-to-person transmission is unlikely.
V. cholerae wreaks havoc on the digestive system by producing a toxin that disrupts the control and balance of fluid retention in the cells of the intestinal lining. Again, this does not usually cause a fever; the bacteria remain in the intestines.
Because diarrhea caused by cholera has a very distinctive appearance, this is usually enough to make a diagnosis. Other factors that help confirm the diagnosis include vomiting, rapid dehydration, a recent trip to an area with outbreaks of cholera, or a recent ingestion of shellfish. However, there are laboratory tests to diagnose cholera, including stool culture.
Death from cholera results from dehydration, so the most important aspect of treating the disease is to replace the loss of fluid in the body. This is surprisingly easy to do with oral rehydration solutions, which are made up of large volumes of water filled with a mixture of sugar and salts. They are commercially available, but are difficult to find in developing countries due to their cost. TRO's homemade recipes that use common household ingredients and materials can be very effective. People with diarrhea are often placed in "cholera beds" that allow stool to drain directly into the bucket. In this way, doctors can see how much fluid is being lost and therefore how much needs to be replaced.
However, people at risk for shock may need intravenous fluids to speed their replacement. These critically ill patients may also be prescribed antibiotics to help kill the V. cholerae bacteria as quickly as possible, in order to reduce both the need for fluids and the amount of time the bacteria is present in the stool.
Antidiarrheal medications are not recommended for the treatment of cholera because they prevent bacteria from being eliminated from the body.
Although most cholera infections are not serious, people infected with V. cholerae continue to spread the bacteria to the environment, which can infect other people with severe cholera disease. For this reason, the CDC recommends that anyone living or traveling in an area where cholera is found drink boiled or chlorinated or iodine-treated water or bottled beverages. Food must be well cooked and people must peel its fruit. Also, it is wise to be careful around ice, raw food, ice cream, and any food and drink sold by street vendors. Frequent and thorough hand washing is also vital to preventing cholera.
There are several cholera vaccines available, but only one, Vaxchora (CVS 103-HgR lyophilized), is available in the United States. It works by preventing severe diarrhea caused by the most common type of cholera, and the CDC recommends it for adults traveling to areas with active cholera transmission.
However, keep in mind that cholera vaccines do not provide complete protection, so even if you have been vaccinated, basic safety precautions are important.
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People living in developed countries need not worry about cholera, but in some parts of the world it can be a very real threat . Countries with cholera outbreaks include Haiti and the Dominican Republic, as well as parts of Africa and Asia. The World Health Organization (WHO) reports that there are between 1.3 and 4 million cases of cholera each year and that 21,000 to 143,000 people die of cholera.
In an effort to rid the world of cholera completely, the Global Task Force on Cholera, which brings together more than 50 universities, non-governmental organizations and United Nations agencies, together with WHO, focuses on three strategies:
- Contain cholera outbreaks as soon as possible
- Focus on the transmission of cholera in the areas most severely affected by the disease
- Provide support to the countries most affected by cholera with human, technical and financial resources.
Given how devastating cholera can be during outbreaks, this work is worth the effort and is an important step toward overall health and wellness.