Cholera [edit]

Description

Cholera is an acute intestinal infection caused by toxigenic Vibrio cholerae O-group 1 or O-group 139. The infection is often mild and self-limited or subclinical. Patients with severe cases respond dramatically to simple fluid- and electrolyte-replacement therapy. Infection is acquired primarily by ingesting contaminated water or food; person-to-person transmission is rare.

Occurrence

Since 1961, V. cholerae has spread from Indonesia through most of Asia into Eastern Europe and Africa, and from North Africa to the Iberian Peninsula. In 1991, an extensive epidemic began in Peru and spread to neighboring countries in the Western Hemisphere. In 2001, nearly 185,000 cases from 58 countries were reported to the WHO.

Risk for Travelers

Persons who follow usual tourist itineraries and who observe food safety recommendations while in countries reporting cholera have virtually no risk. Risk increases for those who drink untreated water or eat poorly cooked or raw seafood in endemic areas.

Prevention

Vaccine

The risk of cholera to U.S. travelers is so low that vaccination is of questionable benefit. The manufacture and sale of the only licensed cholera vaccine in the United States (by Wyeth Ayerst) have been discontinued. The vaccine is not recommended for travelers because of the brief and incomplete immunity it offers.

Two recently developed vaccines for cholera are licens ed and available in other countries (Dukoral from Biotec AB and Mutacol from Berna). Both vaccines appear to provide a somewhat better immunity and have fewer side effects than the previously available vaccine. However, neither of these two vaccines is recommended for most travelers nor are they available in the United States. Currently, no country or territory requires vaccination as a condition for entry. Local authorities, however, may continue to require documentation of vaccination against cholera.

In such cases, a single dose of either oral vaccine is sufficient to satisfy local requirements, or a medical waiver may be given.

Other

Travelers to cholera-affected areas should be advised to avoid eating high-risk foods, especially fish and shellfish. Food that is cooked and served hot, fruits and vegetables peeled by the traveler personally, and beverages and ice that are made from boiled or chlorinated water or that are carbonated are usually safe.


Content from CDC, written by— Stephen Luby, Eric Mintz
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