Information on Cholera
Introduction
Cholera is a bacterial disease of severe dehydrating diarrhea caused by the consumption of contaminated water, milk, or food, usually due to impure water supplies and unsanitary disposal of excrement. The most common source is raw or undercooked shellfish. Person-to-person transmission is rare.
The essential medical treatment is the rapid replacement of lost body fluids and salts (electrolytes) using oral rehydration solution. Cholera is treatable with antibiotics.
Mild cases of cholera far outnumber severe cases. Severe cases begin with the explosive onset of frequent watery stools, and vomiting may also occur. These initial symptoms usually occur 1 to 3 days after exposure to the cholera bacteria (although symptoms can appear any time from a few hours to 5 days after exposure).
If untreated, an infected individual with severe symptoms becomes dehydrated with abnormally low blood pressure, subnormal temperature, muscle cramps, decreased urine output, shock, and coma.
Risk to travelers
This disease is a public health concern in developing countries all around the world, especially in Africa, south Asia and Latin America. Cases among travelers from developed countries are rare.
The direct contamination of food with infected excrement plays a significant role in the transmission of the infection. Raw or inadequately cooked fish and seafood drawn from sewage-polluted waters are particularly important sources of infection. This is because the cholera-causing organism is ingested, grows in the small bowel of a susceptible individual, and is contained in the fecal material of an infected person. Persons who have mild cases or have no symptoms of the disease, and especially those who have poor personal hygiene habits, help spread the infection (while preparing or serving food, for example).
Prevention
In areas with poor sanitation and hygiene, you should assume that canned or bottled carbonated drinks, beer, wine, and beverages made with boiled water are the only safe drinks. In some places the possibility exists that commercial water bottles may have been filled with tap water and recapped; therefore, carbonated bottled water is the safest option (although be aware that some brands may be high in sodium).
Always avoid ice cubes, and remember that alcohol will not make mixed drinks made with plain tap water safe. Always drink safe water. Avoid raw foods. Eat foods that are fully cooked and served hot. Avoid any raw foods, especially seafood.
Don't swim or fish in polluted waters, and don't eat fish that may have been caught in such waters.
Always wash your hands eating, or use a hand sanitizer such as Isagel or Purell.
Cholera is treatable with antibiotics; if diarrhea disease develops, prompt treatment is indicated.
Vaccination
Dukoral is an effective vaccine against Enterotoxic E Coli as well as Cholera – it does not offer protection against Bengal type of cholera, a strain present in south Asia. Protection after two oral administrations lasts for about two years. Dukoral will prevent most severe forms of diarrhea and can be life saving.
Although no country currently reports that it requires the vaccine for entry, local authorities may sometimes deviate from reported requirements and require evidence of cholera vaccination as a condition for entry. Some may even attempt to administer the vaccine to travelers arriving without evidence of immunization. A “Not Medically Indicated “ notation or stamp on your vaccine certificate may be helpful in this situation.
You should never let yourself be injected with cholera vaccine (or any other vaccine) in unsanitary settings in developing countries. You should make every possible protestation (calling the embassy, speaking to supervisors, etc.) to avoid receiving the vaccine.
Vaccine Prices
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