Digestive Health

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Cholera is a bacterial disease that affects the intestinal tract. The bacterium is called Vibrio cholera. Although cholera is a very rare disease today, six worldwide outbreaks were documented between 1817 and 1911 that resulted in hundreds of thousands of deaths. Currently, only a few cases are reported in the United States each year.

While cholera is a rare disease, those who may be at risk include people traveling to foreign countries where outbreaks are occurring and people who consume raw or undercooked seafood from warm coastal waters subject to sewage contamination. In both instances, the risk is quite small.

The cholera bacteria is passed in the stools (feces). It is spread by eating or drinking food or water contaminated by the fecal waste of an infected person. This occurs more often in underdeveloped countries lacking adequate water supplies and proper sewage disposal.


A person with cholera may have mild to severe diarrhea, vomiting and dehydration (loss of water from the body). Fever is usually absent. Some people develop profuse watery diarrhea, nausea, vomiting, and leg cramps, and if they do not receive treatment quickly enough they can die from dehydration, shock, or kidney failure.

The symptoms appear from a few hours to five days after exposure to the germ.


The diagnosis of cholera is made by finding the bacteria in a stool sample that is sent to a laboratory.


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.

Prevention / Risk Factors

There are several steps that you can take to reduce your chance of being exposed to cholera:

  • Always wash your hands thoroughly with soap and water after going to the bathroom, after changing diapers, before preparing meals, and before eating.
  • Be certain that bodily wastes are properly discarded, and make sure to properly wash or dispose of soiled diapers.
  • Avoid drinking untreated water.
  • Avoid eating raw or undercooked fish and shellfish.

If you are traveling to Africa, South and Central America, and the Middle and Far East, sanitation and hygiene vary considerably, and the risk for cholera may be higher. Avoid traveling to areas with known outbreaks of cholera.

In addition to the steps listed in the question above, travelers should practice the following recommendations:

  • “Boil it, cook it, peel it, wash it, or forget it.” Eat foods that have been thoroughly cooked and are still hot and steaming. Avoid raw vegetables and fruits that cannot be peeled or washed. Vegetables like lettuce are easily contaminated and are very hard to thoroughly wash.
  • Avoid foods and beverages from street vendors.
  • Drink only bottled water and carbonated beverages, keeping in mind that bottled carbonated water is safer than uncarbonated water.
  • Ask for drinks without ice unless the ice is made from bottled or boiled water.
  • Avoid popsicles and flavored ices that may have been made with contaminated water.

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