Reviewed: December 14, Medically Reviewed. Modern sewage and water treatment technologies have essentially eliminated cholera in most industrialized countries. The condition still exists in Africa, Southeast Asia, and in parts of the Caribbean, particularly Haiti. As evidenced by the cholera outbreak in Haiti , in the immediate aftermath of the devastating earthquake there, the risk of a cholera outbreak is highest when poverty, war, or natural disasters leave people living in crowded conditions, without access to clean water and proper sanitation.
Cholera is caused by the bacteria Vibrio cholerae. Most people infected don't develop any symptoms, and among the majority of those who do, the symptoms are mild to moderate, notes the World Health Organization WHO.
Roughly 1 in 10 people sickened with cholera will develop severe symptoms. Vibrio cholerae takes between 12 hours and five days to incubate in the body before causing symptoms, according to the WHO.
Most of the time, symptoms appear within two to three days of exposure to the bacteria, the CDC says. Symptoms of cholera infection include:. Diarrhea caused by cholera typically starts suddenly and can quickly cause dangerous levels of dehydration.
Cholera-related diarrhea can be hard to differentiate from diarrhea caused by other illnesses, but with cholera, your diarrhea may have a pale, milky appearance. Nausea and vomiting are common in the early stages of cholera and can last for hours.
Severe diarrhea and vomiting caused by cholera can lead to dehydration , usually within hours of when symptoms first appear. In severe cases, dehydration from cholera can lead to a loss of body weight of 10 percent or more. If untreated, shock accompanied by an electrolyte imbalance can lead to death. Other complications can include low blood sugar and kidney failure.
See Complications, below. Cholera is caused by a bacterial infection. There are two serotypes, or strains, of Vibrio cholerae that cause outbreaks of cholera: O1 and O Of the two, O1 is more common. This in turn causes the cells that line your intestine to release increased amounts of water, which can lead to dehydration. Drinking contaminated water or consuming contaminated food is the most common way you can be exposed to the O1 or O bacteria. O1 and O bacteria are most common in places with poor water treatment, sanitation, and hygiene practices, according to the CDC.
In addition, although there are no other animals besides humans in which the bacteria can reproduce and spread, Vibrio cholerae frequently attach to the shells of crabs, shrimps, and other shellfish. As a result, raw and undercooked shellfish have been sources of cholera infections in the United States. Raw fruits and vegetables are also a common source of cholera in areas where the disease is found, because crops may be treated with contaminated water or manure fertilizers.
Similarly, in regions where cholera is common, grains such as rice that are contaminated after cooking and kept at room temperature for several hours can also contain cholera bacteria. Everyone is at risk for cholera though infants can get immunity from a nursing mother who has previously had the infection. In general, cholera is common in areas where a safe supply of drinking water is difficult to maintain, including refugee camps, impoverished countries, and areas impacted by famine, war, or natural disasters.
In addition, research indicates that people with type O blood are twice as likely to develop cholera compared with people with other blood types — though it's unclear why. Cholera also spreads easily.
A person infected with the bacteria can cause a one-million-fold increase in Vibrio cholerae numbers in the environment through a single diarrheal episode, according to the National Institute of Allergy and Infectious Diseases. In addition, because people with cholera shed bacteria in their stool for 7 to 14 days, they can infect anyone who comes in contact with their feces, or water contaminated by it.
In areas where the infection is common, cholera may be recognized by its symptoms, but the only way to confirm the diagnosis of cholera is to identify the O1 or O bacteria in a stool sample. If you develop severe diarrhea after visiting an area with a high rate of cholera, you should see a doctor.
If you have symptoms of cholera, you should contact your doctor. A doctor can confirm that you have cholera by identifying bacteria in a stool sample. These treatments add to the liquid in the body and rehydrate it. They also help reduce the length of time you have diarrhea. Cholera can be fatal. In severe cases, rapid loss of fluids and electrolytes can cause death in as little as 2 or 3 hours.
Even in typical cases, if cholera is left untreated, people can die of dehydration and shock in as little as 18 hours. Shock and severe diarrhea are the most serious complications of cholera.
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The deadly effects of the disease are the result of a toxin the bacteria produces in the small intestine. The toxin causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts electrolytes. Cholera bacteria might not cause illness in all people who are exposed to them, but they still pass the bacteria in their stool, which can contaminate food and water supplies.
Contaminated water supplies are the main source of cholera infection. The bacterium can be found in:. Everyone is susceptible to cholera, with the exception of infants who get immunity from nursing mothers who have previously had cholera.
Still, certain factors can make you more vulnerable to the disease or more likely to have severe signs and symptoms. 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 hours. In less extreme situations, people who don't receive treatment can die of dehydration and shock hours to days after cholera symptoms first appear.
Although shock and severe dehydration are the worst complications of cholera, other problems can occur, such as:. Cholera is rare in the United States with the few cases related to travel outside the U. If you're traveling to areas known to have cholera, your risk of contracting the disease is extremely low if you follow these precautions:. Drink only safe water, including bottled water or water you've boiled or disinfected yourself. Use bottled water even to brush your teeth.
Hot beverages are generally safe, as are canned or bottled drinks, but wipe the outside before you open them. Don't add ice to your drinks unless you made it yourself using safe water. For adults traveling from the United States to areas affected by cholera, a vaccine called Vaxchora is available in the United States.
It is a liquid dose taken by mouth at least 10 days before travel. A few other countries offer oral vaccines as well. Contact your doctor or local office of public health for more information about these vaccines.
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