Cholera

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KEY POINTS

• Cholera is an infection caused by a type of bacteria that can enter your body when you drink dirty water or eat food contaminated or polluted with the bacteria.
• Diarrhea often gets better in a few days with oral hydration treatment. For serious cases, you may need to stay in the hospital to get IV fluids and medicines.
• To keep from getting cholera when you travel, use only bottled water or purified water and use good hand washing.

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What is cholera?

Cholera is an infection caused by a type of bacteria called Vibrio cholerae. The bacteria can enter your body when you drink dirty water or eat food contaminated or polluted with the bacteria. It can make adults and children get sick quickly and can be fatal.

You may get it when you travel. It is not common in the US.

What is the cause?

The bacteria can live in salty (brackish) rivers and water near a coastline. The bacteria can also live in the animal or human intestine in someone who is infected. Bowel movements can spread the bacteria to soil or water.

You may get infected if:

• You swallow polluted water that has the bacteria in it
• You eat raw or undercooked shellfish that has the bacteria in it from polluted water
• You eat food that is not cooked or served hot, or you eat fruit that does not have an outer peel
• You live in or visit an area that has poor water and sewer treatment

What are the symptoms?

Symptoms can start within a few hours or up to five days after you get infected. You may not have symptoms if you have a mild infection. In some cases, you may have serious symptoms within hours of infection such as:

• Very watery diarrhea
• Belly cramps
• Feeling very thirsty
• Dry skin and mouth
• Decreased urine
• Leg cramps
• Nausea and vomiting
• Feeling very tired

How is it diagnosed?

Your healthcare provider will ask about your symptoms and medical history and examine you. Your provider needs to know your recent travel history. Tests may include:

• Test of a sample of your bowel movements
• Blood tests

How is it treated?

Drink enough liquids to keep your urine clear to light yellow in color.

If you have severe diarrhea, your body can lose too much fluid and you can get dehydrated. Dehydration can be very dangerous, especially for children and older adults. You may also be losing minerals that your body needs to keep working normally. Your healthcare provider may recommend an oral rehydration solution (ORS), which is a drink that replaces fluids and minerals. You can buy an ORS at drug and grocery stores. Follow package directions for mixing powders or taking frozen products. Drink small amounts over several hours if you have vomiting along with diarrhea.

If you don’t have an ORS, you can drink clear broth or water mixed with fruit juice. These are easy for your body to absorb. Avoid concentrated fruit juices, dark sodas, milk, and milk products. They are not as easily absorbed and usually have too much sugar

For serious cases, your healthcare provider will prescribe an antibiotic and IV fluids. You may need to stay in the hospital to get enough fluids.

How can I take care of myself?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Rest your stomach and bowel but make sure that you drink enough liquids to keep your urine clear to light yellow in color. You can do this by not eating anything and by drinking clear liquids only. Clear liquids include water, weak tea, fruit juice mixed half and half with water, Jell-O, or clear soft drinks without caffeine (like lemon-lime soda). Stir soda until the bubbles are gone (the bubbles can make vomiting worse).
• Avoid liquids that are acidic, like orange juice, or caffeinated, like coffee, and milk.
• You may eat soft, plain foods. Good choices are soda crackers, toast, plain noodles, or rice, cooked cereal, applesauce, and bananas. Eat small amounts slowly and avoid foods that are hard to digest or may irritate your stomach, such as foods with acid (like tomatoes or oranges), spicy or fatty food, meats, and raw vegetables. You may be able to go back to your normal diet in a few days.

Ask your provider:

• How and when you will get your test results
• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent cholera?

To keep from getting cholera when you are visiting an affected area:

• Use only bottled water for drinking, washing, brushing teeth, preparing food, or making ice.
• If you are camping or won’t be where you can get bottled water, bring a way to purify water, such as a filter or purifier, chlorine or iodine tablets, or a pot and stove for boiling water. If you need to buy a water filter or purifier, buy one that can filter out organisms as small as the ones that cause giardiasis, cholera, and amoebic diarrhea.
• Wash your hands with soap and water for at least 20 seconds, and clean any dishes or utensils before you prepare, cook, serve, or eat food using bottled or treated water. If you cannot wash your hands, use an alcohol-based hand cleaner that has at least 60% alcohol.
• Eat only cooked food that is served hot, or eat fruit that can be peeled.
• Wash your hands for at least 20 seconds after you go to the bathroom. Teach children to wash their hands carefully with soap and water after using the toilet and before having a snack or meal.
• If you take care of young children, wash your hands often and dispose of diapers carefully so that bacteria can't spread to other surfaces or people.
• Cholera vaccines are not available in the US.