Cholera is an acute gastrointestinal infection caused by Vibrio cholerae bacteria. It is primarily associated with contaminated water and food, including raw or undercooked fish and shellfish. The illness is transmitted from person to person via the fecal-oral route – an infected person who does not practice proper hand or body hygiene passes the infection to another person when handling food and water.
Vibrio cholerae bacteria are found worldwide. Travellers living and working in areas with cholera outbreaks, including refugee camps, are at increased risk – particularly those a weakened immune system, persons who have had surgery for duodenal or gastric ulcers or taking antacid therapy, and cannabis users (smoking marijuana reduces stomach acid secretion).
Most cases are asymptomatic – persons do not exhibit symptoms. Some have gastroenteritis – diarrhea, vomiting, stomach cramps. Severe symptoms include watery diarrhea, vomiting, nausea, stomach pain, dehydration, dry skin and mucous membranes. If untreated, the infection can lead to severe dehydration and death in undernourished persons or those with compromised immune systems. Treatment includes taking an oral rehydration solution to rebalance electrolytes and antibiotics.
The best protection is to avoid potentially contaminated food and water.
Note that the World Health Organization announced in 1991 that Cholera vaccination certificates are no longer required for entry by any country or territory.
Recommended for long-term travellers, healthcare and humanitarian workers, and immunosuppressed travellers going to endemic areas, as well as travellers with reduced stomach acid production.
A live attenuated oral vaccine is available in the USA. An inactivated oral vaccine is available in Canada and countries where Cholera may be endemic. This vaccine is also licensed in Canada for protection against Enterotoxigenic E. coli (ETEC) bacteria. However, ETEC causes less than 50% of Traveller’s Diarrhea cases and the vaccine does not work against other pathogens causing diarrhea. Talk to your healthcare provider regarding your best prevention options.
Vibrio cholerae images, life cycle, and distribution maps:
Information last updated: October 23, 2020