What is
cholera?
Cholera is an acute, diarrheal illness caused by infection of the intestine with
the bacteria Vibrio cholerae. The infection is often mild or without symptoms,
but sometimes it can be severe. Approximately one in 20 infected persons has severe
disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these
persons, rapid loss of body fluids leads to dehydration and shock. Without treatment,
death can occur within hours.
How
does a person get cholera?
A person may get cholera by drinking water or eating food contaminated with the
cholera bacterium. In an epidemic, the source of the contamination is usually the feces of
an infected person. The disease can spread rapidly in areas with inadequate treatment of
sewage and drinking water.
The cholera bacteria may also live in the environment in brackish rivers and coastal
waters. Shellfish eaten raw have been a source of cholera, and a few persons in the United
States have contracted cholera after eating raw or undercooked shellfish from the Gulf of
Mexico. The disease is not likely to spread directly from one person to another;
therefore, casual contact with an infected person is not a risk for becoming ill.
What is the risk for
cholera in the United States?
In the United States, cholera was prevalent in the 1800s but has been virtually
eliminated by modern sewage and water treatment systems. However, as a result of improved
transportation, more persons from the United States travel to parts of Latin America,
Africa, or Asia where epidemic cholera is occurring. U.S. travelers to areas with epidemic
cholera may be exposed to the cholera bacterium. In addition, travelers may bring
contaminated seafood back to the United States; foodborne outbreaks have been caused by
contaminated seafood brought into this country by travelers.
What should travelers do
to avoid getting cholera?
The risk for cholera is very low for U.S. travelers visiting areas with epidemic
cholera. When simple precautions are observed, contracting the disease is unlikely.
All travelers to areas where cholera has occured should observe the following
recomendations:
- Drink only water that you have boiled or treated with chlorine
or iodine. Other safe beverages include tea and coffee made with boiled
water and carbonated, bottled beverages with no ice.
- Eat only foods that have been thoroughly cooked and are still
hot, or fruit that you have peeled yourself.
- Avoid undercooked or raw fish or shellfish, including ceviche.
- Make sure all vegetables are cooked and avoid salads.
- Avoid foods and beverages from street vendors.
- Do not bring perishable seafood back to the United States.
A simple rule of thumb is "Boil it, cook it, peel it, or forget it. "
Is a vaccine available to prevent
cholera?
A vaccine for cholera is available; however, it confers only brief and incomplete
immunity and is not recommended for travelers. There are no cholera vaccination
requirements for entry or exit in any Latin American country or the United States.
Can cholera be treated?
Cholera can be simply and successfully treated by immediate replacement of the
fluid and salts lost through diarrhea. Patients can be treated with oral rehydration
solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in
large amounts. This solution is used throughout the world to treat diarrhea. Severe cases
also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of
cholera patients die.
Antibiotics shorten the course and diminish the severity of the illness, but they are not
as important as rehydration. Persons who develop severe diarrhea and vomiting in countries
where cholera occurs should seek medical attention promptly.
How long will the current epidemic
last?
Predicting how long the epidemic in Latin America will last is difficult. The
cholera epidemic in Africa has lasted more than 20 years. In areas with inadequate
sanitation, a cholera epidemic cannot be stopped immediately, and there are no signs that
the epidemic in the Americas will end soon. Latin American countries that have not yet
reported cases are still at risk for cholera in the coming months and years. Major
improvements in sewage and water treatment systems are needed in many of these countries
to prevent future epidemic cholera.
What is the U.S. government doing to combat cholera?
U.S. and international public health authorities are working to enhance
surveillance for cholera, investigate cholera outbreaks, and design and implement
preventive measures. The Centers for Disease Control is investigating epidemic cholera
wherever it occurs and is training laboratory workers in proper techniques for
identification of V.cholerae. In addition, the Centers for Disease Control is providing
information on diagnosis, treatment, and prevention of cholera to public health officials
and is educating the public about effective preventive measures.
The U.S. Agency for International Development is sponsoring some of the international
government activities and is providing medical supplies to affected countries.
The Environmental Protection Agency is working with water and sewage treatment operators
in the United States to prevent contamination of water with the cholera bacteria.
The Food and Drug Administration is testing imported and domestic shellfish for V.
cholerae and monitoring the safety of U.S. shellfish beds through the shellfish sanitation
program.
With cooperation at the state and local, national, and international levels, assistance
will be provided to countries where cholera is present, and the risk to U.S. residents
will remain small.
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