Frequently Asked Questions
In January 1991, epidemic cholera appeared in South
America and quickly spread to several countries. A few cases have
occurred in the United States among persons who traveled to South
America or ate contaminated food brought back by travelers.
Cholera has been very rare in industrialized nations for the last
100 years; however, the disease is still common today in other
parts of the world, including the Indian subcontinent and sub-Saharan
Although cholera can be life-threatening, it is easily prevented
and treated. In the United States, because of advanced water and
sanitation systems, cholera is not a major threat; however, everyone,
especially travelers, should be aware of how the disease is transmitted
and what can be done to prevent it.
Cholera is an acute, diarrheal illness caused by infection of
the intestine with the bacterium Vibrio cholerae. The
infection is often mild or without symptoms, but sometimes it
can be severe. Approximately one in 20 infected persons has severe
disease characterized by profuse watery diarrhea, vomiting, and
leg cramps. In these persons, rapid loss of body fluids leads
to dehydration and shock. Without treatment, death can occur within
does a person get cholera?
A person may 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. The
disease can spread rapidly in areas with inadequate treatment
of sewage and drinking water.
The cholera bacterium may also live in the environment in brackish
rivers and coastal waters. Shellfish eaten raw have been a source
of cholera, and a few persons in the United States have contracted
cholera after eating raw or undercooked shellfish from the Gulf
of Mexico. The disease is not likely to spread directly from one
person to another; therefore, casual contact with an infected
person is not a risk for becoming ill.
is the risk for cholera in the United States?
In the United States, cholera was prevalent in the 1800s but has
been virtually eliminated by modern sewage and water treatment
systems. However, as a result of improved transportation, more
persons from the United States travel to parts of Latin America,
Africa, or Asia where epidemic cholera is occurring. U.S. travelers
to areas with epidemic cholera may be exposed to the cholera bacterium.
In addition, travelers may bring contaminated seafood back to
the United States; foodborne outbreaks have been caused by contaminated
seafood brought into this country by travelers.
should travelers do to avoid getting cholera?
The risk for cholera is very low for U.S. travelers visiting areas
with epidemic cholera. When simple precautions are observed, contracting
the disease is unlikely.
All travelers to areas where cholera has occurred should observe
the following recommendations:
- Drink only water that you have boiled or treated with chlorine
or iodine. Other safe beverages include tea and coffee made
water and carbonated, bottled beverages with no ice.
- Eat only foods that have been thoroughly cooked and are still
hot, or fruit that you have peeled yourself.
- Avoid undercooked or raw fish or shellfish, including ceviche.
- Make sure all vegetables are
cooked - avoid salads.
- Avoid foods and beverages from street vendors.
- Do not bring perishable seafood back to the United States.
A simple rule of thumb is "Boil it, cook it, peel it, or
forget it. "
a vaccine available to prevent cholera?
At the present time, the manufacture and sale of the only licensed
cholera vaccine in the United States (Wyeth-Ayerst) has been discontinued.
It has not been recommended for travelers because of the brief
and incomplete immunity if offers. No cholera vaccination requirements
exist for entry or exit in any country.
Two recently developed vaccines for cholera are licensed and
available in other countries (Dukoral�, Biotec AB and Mutacol�,
Berna). Both vaccines appear to provide a somewhat better immunity
and fewer side-effects than the previously available vaccine.
However, neither of these two vaccines is recommended for travelers
nor are they available in the United States. Further information
on these vaccines can be obtained from the manufacturers at:
Note: CDC is not responsible for
the content of Web pages found at these links. Links to
nonfederal organizations are provided solely as a service
to our users. These links do not indicate an endorsement
of these organizations by CDC or the federal government.
Use of trade names is for identification
only and does not imply endorsement by the U.S. Department
of Health and Human Services.
Active Biotec AB (publ)
Postal Address: P.O. Box 724, SE-220 07 Lund, Sweden
Office address: Scheelevagen 22
Tel: +46 46 19 20 00
Fax +46 46 19 20 50
E-Mail: [email protected]
Home page: http://www.activebiotech.com
Berna, Switzerland Division
P.O. Box CH-3001 Berne
Domicile: Rehhagstrasse 79e
Tel. +41 31 981 22 11
Fax +41 31 981 20 66
E-mail: [email protected]
Home page: http://www.berna.org
cholera be treated?
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.
long will the current epidemic last?
Predicting how long the epidemic in Latin America will last is
difficult. The cholera epidemic in Africa has lasted more than
20 years. In areas with inadequate sanitation, a cholera epidemic
cannot be stopped immediately, and there are no signs that the
epidemic in the Americas will end soon. Latin American countries
that have not yet reported cases are still at risk for cholera
in the coming months and years. Major improvements in sewage and
water treatment systems are needed in many of these countries
to prevent future epidemic cholera.
is the U.S. government doing to combat cholera?
U.S. and international public health authorities are working to
enhance surveillance for cholera, investigate cholera outbreaks,
and design and implement preventive measures. The Centers for
Disease Control is investigating epidemic cholera wherever it
occurs and is training laboratory workers in proper techniques
for identification of V.cholerae. In addition, the Centers for
Disease Control is providing information on diagnosis, treatment,
and prevention of cholera to public health officials and is educating
the public about effective preventive measures.
The U.S. Agency for International Development is sponsoring some
of the international government activities and is providing medical
supplies to affected countries.
The Environmental Protection Agency is working with water and
sewage treatment operators in the United States to prevent contamination
of water with the cholera bacterium.
The Food and Drug Administration is testing imported and domestic
shellfish for V. cholerae and monitoring the safety of U.S. shellfish
beds through the shellfish sanitation program.
With cooperation at the state and local, national, and international
levels, assistance will be provided to countries where cholera
is present, and the risk to U.S. residents will remain small.
can a traveler get information about cholera?
The global picture of cholera changes periodically, so travelers
should seek updated information on countries of interest. The
Centers for Disease Control maintains a travelers' information
telephone line on which callers can receive recent information
on cholera and other diseases of concern to travelers. Data for
this service are obtained from the World Health Organization.
The number is 877-FYI-TRIP (394-8747) or check out http://www.cdc.gov/travel