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CholeraThis factsheet is for people who have cholera or are travelling to a country with a risk of cholera infection. Cholera is caused by infection with a bacterium called Vibrio cholerae. Cholera affects your bowel and causes watery diarrhoea. It is mainly found in areas where sanitary conditions and hygiene are poor. The main areas of the world in which cholera is present are Asia (particularly Bangladesh and Ganges Delta), the Middle East, Africa, Peru and some countries in Central America. Cholera is rarely reported in UK travellers - there have been less than 21 reports per year since 1990. Most cases affect local people who live in affected countries. What is cholera?Cholera is caused by Vibrio cholerae. There are two types that affect humans:
If someone eats or drinks liquid containing Vibrio cholerae then the bacteria get into the small bowel, where they produce a poison (toxin) which causes diarrhoea. Only a large dose of the bacteria can cause an infection. Cholera is therefore rare among foreign travellers and almost entirely confined to local people living in very poor sanitary conditions. How do you get cholera?You can get cholera by:
It is rare to catch cholera from another person. Sudden large outbreaks are usually due to an infected water supply. SymptomsThe time between catching cholera and getting the symptoms of diarrhoea - known as the incubation period - can be anything between a few hours and five days. Most people get symptoms after one to five days. If you have cholera you may have symptoms including:
Most people infected with cholera don't realise they have it, as they do not become ill. When illness does develop, 90 out of 100 people only get mild diarrhoea and vomiting, just like a tummy bug. Less commonly, cholera can cause severe diarrhoea. This can lead to severe dehydration which can be fatal. Therefore if you think you may have severe cholera, you should seek medical advice as soon as possible. DiagnosisYour doctor will examine you and ask you about your symptoms. He or she will also ask you a number of questions such as which countries or regions you have recently visited (including any stopovers). Your doctor may ask you for a stool sample. The sample will be sent to a laboratory for examination to find out if you are infected with cholera bacterium. TreatmentThe main treatment for cholera is to drink plenty of fluids to rehydrate. You should drink water and replace the salt and minerals you have lost with oral rehydration solution. You can make oral rehydration solution if you dissolve one-half teaspoon of salt, one-half teaspoon of baking soda and four tablespoons of sugar to a litre of (safe) water. Oral rehydration solution can be bought from pharmacies. You should take sachets of rehydration powders with you if you plan to travel to an area where cholera is common. If you are very dehydrated, you may need hospital treatment. Fluid can then be given to you through an intravenous drip where a needle is placed into one of your veins. Drug treatmentsSome people are given antibiotics to recover from cholera. Antibiotics will help to get diarrhoea under control and stop you losing any more fluids. Adults with cholera are usually given tetracycline. Erythromycin is used in children. PreventionThere are a number of precautions you can take to help prevent getting cholera.
VaccineA cholera vaccine (Dukoral) became available in the UK in 2004. The cholera vaccine is not used for most travellers as taking the preventive measures above should stop most people from getting cholera. It is usually only given to:
If you feel you are at higher risk and may need the cholera vaccine, you should discuss this with your doctor. Dukoral is an oral vaccine (can be taken by mouth) that comes in sachets that you dissolve in a drink. It can be used by adults and children over two. The vaccine course is:
You should not eat or drink anything an hour before or after taking the vaccine and the doses must be separated by an interval of one week. You must have completed the course at least a week before you plan to travel to an area with cholera. A booster vaccine is needed to maintain protection. This is after:
The vaccine does not provide complete protection as it does not protect against all strains of cholera. It is therefore still important to take the preventive measures with hygiene, food and drink as highlighted above. Further information
References
Reviewed by Dr James Quekett, Bsc.MB Ch.B MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre and Dr Paul Stoddart, MBChB DipObs DOccMed, senior regional physician, London BUPA Wellness. Published by BUPA's health information team, healthinfo@bupa.com, February 2006.
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