Epidemics of cholera have swept across the world for at least two hundred years, at times causing thousands of deaths. Today, epidemics are limited to locations without adequate safe water and sanitation systems. Sporadic (non-epidemic) cholera cases occur but are relatively rare.
A major cholera outbreak began in Zimbabwe in 2008 due to a breakdown in sewage and safe water systems. Over 15,000 people have been infected, and the death toll is expected to reach up to 1,000. In other parts of Africa, cholera has afflicted refugee and displaced persons camps.
In the Western Hemisphere, the last major epidemic occurred in the 1990s. In Brazil, for example, in 1993 over 60,000 cases were reported. More recently, only a handful of cases have been reported. The last cholera epidemic in the US was in 1910.
How is It Transmitted?
One cannot avoid saying it: it is spread by fecal-oral contamination. That’s why safe water and adequate sanitation systems prevent epidemics. Cholera is caused by consuming food or water contaminated by vibrio cholerae, a bacteria.
Is It Fatal?
Mostly not. Eighty percent of people recover uneventfully, if they have access to adequate fluid replacement. Ten to 20% get dehydration, and up to half may die. Severe dehydration causes poor blood circulation and kidney failure. A severely dehydrated person may have delirium and look shriveled, with sunken eyes, and leathery tongue.
Treatment
Rehydration is the goal. Fluid intake must replace fluid lost. Salts lost in diarrhea fluid must also be replaced. (Here, “salts” does not mean just table salt, sodium chloride; it means other electrolytes as well.)
Health workers use Oral Rehydration Salts, granules in packets that can be mixed with safe water and taken by mouth. Severely dehydrated people need intravenous fluids.
Traveler Information
Travelers to regions where cholera is present may get sporadic cholera if they do not “boil it, cook it, peel it, or forget it” (advice from the US Centers for Disease Control, CDC). Some foods are high risk: fish and shellfish. But food that is cooked and served hot, fruit peeled by the traveler, and carbonated beverages are usually safe, according to the CDC. Be sure ice is made from safe water, and avoid salads and cold cuts.
Vaccine
The CDC does not generally recommend vaccine for travelers, and it is not licensed in the US. No country requires vaccination for entry, but local authorities may. An oral vaccine is available from SBL Vaccin AB, Stockholm.
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