What Is Cholera?
Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and death if it is severe and left untreated. But death is easily avoided with simple hydration treatments. Cholera is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.
Cholera Epidemic
Cholera , first found in India, was spread from bacteria in the Ganges delta. There have been seven cholera pandemics that spread the disease to various countries, including the United States. It was during the second cholera pandemic that it reached the United States. It was brought here after being found in Russia, then Eastern Europe, where it traveled via shipping routes. Cholera reached Quebec in 1832 and then moved quickly down the Eastern coast, where it caused thousands of deaths.
Today, only about 10 cases of the condition are reported each year in the United States and half of these are caught abroad. Rarely, contaminated seafood has caused cholera outbreaks in the United States. However, cholera outbreaks are still a serious problem in other parts of the world. The World Health Organization reports that there are 1.3 million to 4 million cases 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.
Cholera Causes
Vibrio cholerae is usually found in food or water contaminated by feces from a person with the infection. If you have the bacteria but no symptoms, you can still pass cholera through your poop (for up to 2 weeks) that contaminates the water.
Common sources of cholera bacteria include:
Public water supplies. It's most commonly found in polluted well water in areas without good sanitation.
Foods and drinks sold by street vendors. Cholera can be passed this way when food is undercooked or good food preparation and sanitation procedures aren't followed by the vendors.
Raw vegetables. These can spread cholera when grown using manure fertilizers or water that is contaminated. This is more common in developing countries.
Raw or undercooked fish and seafood. The most recent U.S. outbreak came from seafood caught in polluted waters in the Gulf of Mexico.
Grains. If a grain, like rice, is contaminated after being cooked and is then left out at room temperature, the bacteria can grow.
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 from casual contact with an infected person.
Cholera Symptoms
Some people who have the cholera bacteria have very mild symptoms or none at all. For others, symptoms of cholera can begin as soon as a few hours or as long as 5 days after infection. Often, symptoms are mild. But sometimes they are very serious.
- Diarrhea. About 1 in 20 people infected have severe, watery diarrhea . It often comes on quickly and may look milky and pale.
- Vomiting. Vomiting can happen soon after being infected and can quickly lead to dehydration.
Symptoms of dehydration include:
- Irregular heartbeat
- 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
- Low blood pressure
- Thirst
- Muscle cramps
- Fatigue
- Sunken eyes
- Not peeing a lot
- Irritability
If not treated, dehydration from severe cholera can lead to shock and death in a matter of hours.
Stages of Cholera
Cholera impacts the body in three stages, often moving from one to another quickly.
Stage one is known as the evacuation stage. It lasts for three to 12 hours, and you can have symptoms that include stomach cramps, vomiting, watery diarrhea, and thirst.
During stage two, known as collapse, you may pass out. Symptoms here include low body temperature, blood pressure that drops very low, and a weak pulse. Your eyes may be sunken, breathing shallow, and you may not be peeing much, if at all. Intense thirst is also common during this stage. Severe dehydration can cause death during stage two.
After stage two is recovery. Here, your symptoms may improve, with your blood pressure and temperature rising. You should begin to pee again. During this stage, though, you may get other infections including pneumonia.
Cholera Diagnosis
If your doctor thinks you have cholera, they will ask about symptoms and take a sample of your poop to test for the Vibrio cholerae bacteria. Getting a stool sample can confirm you have cholera and help reduce the chances of it spreading to other people.
Cholera Treatment
If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is found -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get begin 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. Don't take over-the-counter medication to stop diarrhea because it can make symptoms worse.
Cholera Prevention
Vaxchora is an oral cholera vaccine available in the United States. Both the CDC and the World Health Organization have specific guidelines for who should be given this vaccine. You may consider getting the vaccine if you are planning to travel somewhere that cholera is found.
If you are unsure if your water is safe to drink, 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 bottled, boiled, or disinfected water for the following purposes:
- Drinking
- Preparing food or drinks
- Making ice
- Brushing your teeth
- Washing your face and hands
- Washing dishes and utensils that you use to eat or prepare food
- Washing fruits and vegetables
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:
- Unpeeled fruits and vegetables
- Unpasteurized milk and milk products
- Raw or undercooked meat or shellfish
- Fish caught in tropical reefs, which may be contaminated
Cholera Complications
If cholera is very severe, you can die within hours of symptoms appearing. If it is less severe, you can still die from dehydration within days. Other complications of cholera include:
Hypoglycemia. If you can't eat because of the stomach pain and vomiting that comes with cholera, your blood sugar may drop too low. Low blood sugar can cause symptoms like seizures, passing out, and even death, if it is severe enough. Children with cholera are more likely to have low blood sugar than adults.
Low potassium. When you have diarrhea, you can lose important minerals, like potassium, in your stool. When potassium levels get too low, it can impact your heart and nerves.
Kidney failure. Damage to your kidneys can make them lose their ability to filter. This can cause fluid, waste, and electrolytes to build up in your body. This can be life-threatening and often happens along with shock if you have cholera.
Takeaways
Cholera is not common in the United States, and it's usually caught by people traveling to other countries. If you are in an area where the water is unsafe to drink, use bottled, boiled, or chemically treated water for drinking, washing, and cooking. You should also only eat cooked food, not raw foods, if you think the water may be unsafe. If you think you have cholera, see a doctor right away to begin treatment and avoid dehydration.
Cholera FAQs
Does cholera spread from person to person? Cholera is contagious, but doesn't spread through casual contact with someone, like coughing or sneezing. To get cholera, you have to drink water, or eat food prepared with water, that has been contaminated with the bacteria.
Why is cholera called the blue death? It was given this name in the 1800s because dehydration from cholera made peoples' blood thicken. As they began to lose oxygen, their skin would turn a blue/gray color.
How common is cholera? According to the World Health Organization, there are between 1.3 million and 4 million cases of cholera worldwide each year. Between 21,000 to 143,000 people die from cholera each year.