- The cholera bacteria is passed through feces (poop). It is spread by eating or drinking food or water contaminated by the feces (poop) of an infected person. This occurs more often in underdeveloped countries lacking proper water supplies and sewage disposal. It is not likely that cholera is spread directly from one person to another.
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A person can get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person that contaminates water and/or food. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water.
- Risk Factors
Cholera is a bacterial disease usually spread through contaminated water. Cholera causes severe diarrhea and dehydration. Left untreated, cholera can be fatal in a matter of hours, even in previously healthy people.Modern sewage and water treatment have virtually eliminated cholera in industrialized countries. The last major outbreak in the United States occurred in 1911. But cholera is still present in Africa, Southeast Asia and Haiti. The risk of cholera epidemic is highest when poverty, wa...
Most people exposed to the cholera bacterium (Vibrio cholerae) don't become ill and never know they've been infected. Yet because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water. Most symptomatic cases of cholera cause mild or moderate diarrhea that's often hard to distinguish from diarrhea caused by other problems.Only about 1 in 10 infected people develops more-serious signs and symptoms of cholera, usually within a few...
A bacterium called Vibrio cholerae causes cholera infection. However, the deadly effects of the disease are the result of a potent toxin called CTX that the bacterium produce in the small intestine. CTX binds to the intestinal walls, where it interferes with the normal flow of sodium and chloride. This causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes).Contaminated water supplies are the main source of cholera infectio...
Everyone is susceptible to cholera, with the exception of infants who derive immunity from nursing mothers who have previously had cholera. Still, certain factors can make you more vulnerable to the disease or more likely to experience severe signs and symptoms. Risk factors for cholera include: 1. Poor sanitary conditions. Cholera is more likely to flourish in situations where a sanitary environment — including a safe water supply — is difficult to maintain. Such conditions are common to ref...
Cholera can quickly become fatal. In the most severe cases, the rapid loss of large amounts of fluids and electrolytes can lead to death within two to three hours. In less extreme situations, people who don't receive treatment may die of dehydration and shock hours to days after cholera symptoms first appear.Although shock and severe dehydration are the most devastating complications of cholera, other problems can occur, such as: 1. Low blood sugar (hypoglycemia). Dangerously low levels of bl...
Cholera is rare in the United States with the few cases related to travel outside the U.S. or to contaminated and improperly cooked seafood from the Gulf Coast waters.If you're traveling to cholera-endemic areas, your risk of contracting the disease is extremely low if you follow these precautions: 1. Wash hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water are...
Transmission. Cholera bacteria have been found in shellfish and plankton. Transmission is usually through the fecal-oral route of contaminated food or water caused by poor sanitation. Most cholera cases in developed countries are a result of transmission by food, while in the developing world it is more often water.
Cholera is a bacterial disease that causes diarrhea (loose stool/poop) and is caused by the bacteria calledVibrio cholerae. Although only a few cases are recognized in the United States each year, many cases are identified each year in portions of Africa, South and Central America, and Southeast Asia.
While cholera is a rare disease in the U.S., people who may be at risk are those traveling to foreign countries where outbreaks are occurring and those who consume raw or undercooked seafood from warm coastal waters that may be exposed to sewage contamination. In both instances, the risk is small. Individuals living in places with inadequate water treatment, poor sanitation, and inadequate hygiene (cleanliness) are at a greater risk for cholera.
People infected with cholera may experience mild to severe watery diarrhea (loose stool/poop), vomiting, and dehydration (loss of water in the body causing weakness or dizziness). The symptoms may appear from a few hours to five days after eating or drinking contaminated food or water.
Cholera is diagnosed when the cholera bacteria, Vibrio cholerae, is found in a stool sample or rectal swab.
Cholera can be treated simply and successfully by immediate replacement of the fluid and salts lost through diarrhea (loose stool/poop). Patients can be treated with an oral rehydration solution, a prepackaged mixture of sugar and salts mixed with water in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, less than 1% of cholera patients die. Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as receiving rehydration. Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical attention promptly.
The FDA recently approved a single-dose live oral cholera vaccine called Vaxchora (lyophilized CVD 103-HgR) for adults 18 64 years old who are traveling to an area of active cholera transmission with toxigenic Vibrio cholerae O1 (the bacteria strain that most commonly causes cholera). The vaccine is not routinely recommended for most travelers from the United States, as most people do not visit areas of active cholera transmission. Two other oral inactivated (or non-live cholera vaccines), Dukoral® and ShanChol®, exist but these vaccines are not available in the U.S. No cholera vaccine is 100% protective and vaccination against cholera is not a substitute for standard prevention and control measures. The single most important preventive measure is to avoid consuming uncooked foods or water in foreign countries where cholera occurs unless they are known to be safe or have been properly treated (for example, sealed bottled, boiled, or chemically treated water). In addition, it is important to wash your hands often with soap and clean water or an alcohol based hand cleanser, particularly before you eat or prepare foods and after using the bathroom.
Key messages Cholera is transmitted through contaminated water or food. Prevention and preparedness of cholera require a coordinated multidisciplinary approach. Cholera can rapidly lead to severe dehydration and death if left untreated.
Cholera was transmitted by a sort of water fountain that children, and adults drank from and transmitted to others. ---- Cholera is a food- or water-borne infection transmitted by the fecal-oral ...
- Infectious Agent
- Clinical Presentation
Cholera is an acute bacterial intestinal infection caused by toxigenicVibrio cholerae O-group 1 or O-group 139. Many other serogroups of V. cholerae, with or without the cholera toxin gene (including the nontoxigenic strains of the O1 and O139 serogroups), can cause a choleralike illness. Only toxigenic strains of serogroups O1 and O139 have caused widespread epidemics and are reportable to the World Health Organization (WHO) as “cholera.”V. choleraeO1 is the source of an ongoing global pandemic, while the O139 serogroup remains localized to a few areas in Asia. V. choleraeO1 has 2 biotypes, classical and El Tor, and each biotype has 2 distinct serotypes, Inaba and Ogawa. The symptoms of infection are indistinguishable, although more people infected with the El Tor biotype remain asymptomatic or have only a mild illness. Globally, most cases of cholera are caused by O1 El Tor organisms. In recent years, an El Tor variant that has characteristics of both classical and El Tor biotypes...
Toxigenic V. cholerae O1 and O139 are free-living bacterial organisms found in fresh and brackish water, often in association with copepods or other zooplankton, shellfish, and aquatic plants. Cholera infections are most commonly acquired from drinking water in which V. choleraeis found naturally or into which it has been introduced from the feces of an infected person. Other common vehicles include fish and shellfish. Other foods, including produce, are less commonly implicated. Direct transmission from person to person, even to health care workers during epidemics, has been reported but is infrequent.
Cholera is endemic in approximately 50 countries, primarily in Africa and South and Southeast Asia, and can emerge in dramatic epidemics, although most cases go unreported. In October 2010, a large cholera epidemic began in Haiti and spread to the Dominican Republic and Cuba; it is now endemic at much lower levels in Haiti and the Dominican Republic, though small outbreaks still occur. Sporadic cases associated with travel to or from cholera-affected countries in Asia and Africa continue to occur. From 2010 through 2016, 107 cases of cholera were confirmed in the United States among people who had traveled internationally in the week before illness. Of these, approximately 75% were associated with travel to the Caribbean, and 10% were associated with travel to India or Pakistan; other travel destinations reported included countries in Southeast Asia and both East and West Africa. There is a risk of cholera infection for travelers to areas where cholera is endemic or where there is a...
Cholera most commonly manifests as acute watery diarrhea in an afebrile person. Infection is often mild or asymptomatic, but it can be severe. Severe cholera is characterized by profuse watery diarrhea, described as “rice-water stools,” often accompanied by nausea and vomiting, that can rapidly lead to severe volume depletion. Signs and symptoms include tachycardia, loss of skin turgor, dry mucous membranes, hypotension, and thirst. Additional symptoms, including muscle cramps, are secondary to the resulting electrolyte imbalances. If untreated, rapid loss of body fluids can lead to severe dehydration, hypovolemic shock, and death within hours. With adequate and timely rehydration, the case-fatality ratio is <1%.
Cholera is confirmed through culture of a stool specimen or rectal swab. Cary-Blair medium can be used for transport, and selective media such as taurocholate-tellurite-gelatin agar and thiosulfate-citrate-bile salts agar may be used for isolation and identification. Reagents for serogrouping V. cholerae isolates are available in state health department laboratories. Culture-independent diagnostic tests (CIDT) do not yield an isolate for antimicrobial susceptibility testing and subtyping. Reflex culture to recover an isolate should be performed when a diagnosis of V. choleraeis derived from a CIDT, and the isolate should be forwarded to a public health laboratory for additional characterization. All isolates obtained in the United States should be sent to CDC via state health department laboratories for identification and virulence testing. Cholera is a nationally notifiable disease.
Rehydration is the cornerstone of cholera treatment. Oral rehydration solution and, when necessary, intravenous fluids and electrolytes, if administered in a timely manner and in adequate volumes, will reduce case-fatality ratios to <1%. Antibiotics reduce fluid requirements and duration of illness and are indicated in conjunction with aggressive hydration for severe cases and for those with moderate dehydration and ongoing fluid losses. Whenever possible, antimicrobial susceptibility testing should inform treatment choices. In most countries, doxycycline is recommended as the first-line antibiotic treatment for adults, and azithromycin is recommended for children and pregnant women. Multidrug-resistant isolates are emerging, particularly in South Asia, with resistance to quinolones, trimethoprim-sulfamethoxazole, and tetracycline. The strain from Hispaniola is also multidrug resistant; however, it is still sensitive to doxycycline and tetracycline. Zinc supplementation reduces the...
Food and Water
Safe food and water precautions and frequent handwashing are critical in preventing cholera (see Chapter 2, Food & Water Precautions). Chemoprophylaxis is not indicated.
No country or territory requires vaccination against cholera as a condition for entry. CVD 103-HgR, a single-dose oral cholera vaccine (Vaxchora, PaxVax), is licensed and available in the United States. The vaccine was previously marketed under the names Orochol and Mutacol in other countries. Vaxchora was approved in June 2016 for use in adults ≥18 years of age. The Advisory Committee on Immunization Practices (ACIP) recommends CVD 103-HgR vaccine for adult travelers (age 18–64 years) to an...Chen WH, Cohen MB, Kirkpatrick BD, Brady RC, Galloway D, Gurwith M, et al. Single-dose live oral cholera vaccine CVD 103-HgR protects against human experimental infection with Vibrio cholerae O1 El...Danzig L, editor. Vaxchora™ clinical data summary. Meeting of the Advisory Committee on Immunization Practices; 2016 Feb 24; Atlanta, GA.Freedman DO. Re-born in the USA: Another cholera vaccine for travelers. 2016. Travel Med Infect Dis. July–Aug; 14(4):295–6.Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB. Cholera. Lancet. 2012 Jun 30;379(9835):2466–76.
Cholera is highly contagious. Cholera can be transferred person to person by infected fecal matter entering a mouth or by water or food contaminated with Vibrio cholerae bacteria. The organisms can survive well in salty waters and can contaminate humans and other organisms that contact or swim in the water.
Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection.
- Mary Anne Dunkin
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Cholera is an infectious disease caused by a bacterium called Vibrio cholerae. The bacteria typically live in waters that are somewhat salty and warm, such as estuaries and waters along coastal...
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