Cholera

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 hours.

Prevention

 * Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled 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. "

Vaccine
A recently developed oral vaccine for cholera is licensed and available in other countries (Dukoral from SBL Vaccines). The vaccine appears to provide somewhat better immunity and have fewer adverse effects than the previously available vaccine. However, CDC does not recommend cholera vaccines for most travelers, nor is the vaccine available in the United States. Further information about Dukoral can be obtained from the manufacturers:

Chances of Developing
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 Africa, Asia, or Latin America 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.

Public Health
Predicting how long a Cholera epidemic will last is difficult. The cholera epidemic in Africa has lasted more than 30 years. In areas with inadequate sanitation, a cholera epidemic cannot be stopped immediately, and, although far fewer cases have been reported from Latin America and Asia in recent years, there are no signs that the global Cholera pandemic will end soon. Major improvements in sewage and water treatment systems are needed in many countries to prevent future epidemic cholera.

Other Resources
The global picture of cholera changes periodically, so travelers should seek updated information on countries of interest. The Centers for Disease Control and Prevention 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 [/travel http://www.cdc.gov/travel.]