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Cholera
Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and
even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium
called Vibrio cholerae.
Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems
eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in
the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera
outbreaks in the U.S. However, cholera outbreaks are still a serious problem in other parts of the world.
At least 150,000 cases are reported to the World Health Organization each year.
The disease is most common in places with poor sanitation, crowding, war, and famine. Common
locations include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas,
knowing the following cholera facts can help protect you and your family.
Cholera Causes
Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by
feces from a person with the infection. Common sources include:
Raw or undercooked fish and seafood caught in waters polluted with sewage
When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines
that produces severe diarrhea.
It is not likely you will catch cholera just from casual contact with an infected person.
Cholera Symptoms
Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often,
symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe
watery diarrhea accompanied by vomiting, which can quickly lead to dehydration. Although many
infected people may have minimal or no symptoms, they can still contribute to spread of the infection.
Loss of skin elasticity (the ability to return to original position quickly if pinched)
Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids
Thirst
Muscle cramps
If not treated, dehydration can lead to shock and death in a matter of hours.
Although there is a vaccine against cholera, the CDC and World Health Organization don't normally
recommend it, because it may not protect up to half of the people who receive it and it lasts only a few
months. However, you can protect yourself and your family by using only water that has been boiled,
water that has been chemically disinfected, or bottled water. Be sure to use the bottled, boiled, or
chemically disinfected water for the following purposes:
Drinking
Making ice
Washing dishes and utensils that you use to eat or prepare food
To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use
a commercial chemical disinfectant. You should also avoid raw foods, including the following:
If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling
to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but
because dehydration can happen quickly, it's important to get cholera treatment right away.
Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment
will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are
not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half
and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.
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Cholera is an acute diarrhoeal illness caused by some strains of the bacterium Vibrio cholerae.
The cholera organism is known to be present in some rivers along the eastern Australian coast, but
cholera acquired in Australia is very rare. In Australia, because of our high standards of sanitation, water
and food quality, cholera outbreaks do not occur. Typically, cholera is seen only in travellers arriving
from countries where the disease is still common, such as Africa, Central Europe, Latin America and Asia.
Infection occurs when the bacteria are taken in by mouth, usually in food or water contaminated by
human faeces.
The cholera organism can survive for long periods in water and ice.
Symptoms include:
dehydration.
In severe untreated cases, death may occur within hours, but with simple treatment full recovery can be
expected.
Diagnosis
Diagnosis is suspected on clinical signs and confirmed by growing Vibrio cholerae from a faecal specimen.
Incubation period
Infectious period
Treatment
Anyone who has been in a high-risk region within the previous 5 days and develops severe vomiting and
diarrhoea should seek urgent medical assessment.
Although cholera can be life-threatening, it is easily treated by immediate rehydration, that is,
replacement of the fluid and salts lost through diarrhoea.
Patients with severe dehydration or who are unable to keep oral fluids down require hospitalisation and
intravenous fluid replacement.
Antibiotics shorten the duration of the illness and lessen the severity, but they are not as important as
rehydration.
Prevention
Exclude people with cholera from childcare, preschool, school and work until there has been no
diarrhoea for 24 hours. If working as a food handler in a food business, the exclusion period should be
until there has been no diarrhoea or vomiting for 48 hours.
Infants, children and adults with cholera infection should not swim until there has been no diarrhoea for
24 hours.
People who are less severely ill can be nursed at home. Faeces and vomit can be disposed of into the
toilet except in areas where there is not an adequate sewage disposal system.
All linen and articles used by the patient should be washed in hot soapy water and the room thoroughly
cleaned when the person has recovered.
Vaccines are available but are recommended only for travellers to high-risk countries. They may not
protect against all strains of cholera bacteria and protection is for several months only.
When travelling to high-risk countries, seek advice from a travel medical clinic or an experienced general
practitioner on how to protect yourself from cholera and other diarrhoeal illnesses. In particular, drink
only water that has been boiled or disinfected with iodine or chlorine tablets. Carbonated bottled drinks
are usually safe, if no ice is added.
Good food handling procedures should always be followed, including when travelling.
Contacts (for example, family members) of a case should be observed for 5 days from the date of the
last exposure to the infected person. A contact is any person who has been close enough to an infected
person to be at risk of having acquired the infection from that person.
Useful links
Hand hygiene
Collecting a faecal
1 – In South Australia the law requires doctors and laboratories to report some infections or diseases to
SA Health. These infections or diseases are commonly referred to as 'notifiable conditions'.
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