Cholera

Cholera is transmitted by ingesting contaminated food or water. Cases of cholera are rare in the United States. Most infections happen while visiting countries where cholera is common. Countries include those within Asia, Africa, and Latin America. Infection is often associated with poor sanitation, untreated wastewater, overcrowding, and poverty.

Human feces can pollute nearby water sources in areas with major outbreaks and in countries where cholera is common. If not properly treated, tainted wastewater can lead to sickness when consumed as drinking water. Infection can also happen when eating raw or undercooked seafood, shellfish, and certain types of plankton.

The infection can have no symptoms, or it can range from mild to acute gastrointestinal (digestive system) illness. The incubation period can be a few hours to five days. The average is two to three days.

Symptoms include:

• Profuse painless watery diarrhea, described as ‘rice-water stool’ (due to the toxin stripping away the mucosal layer of the intestine)

• Nausea and vomiting

If left untreated:

• Rapid and severe dehydration – dry mucous membranes and loss of skin elasticity

• Electrolyte imbalances

• Muscle cramps, restlessness, and irritability

• Low blood pressure and rapid heart rate

• Collapse of the circulatory system, shock, and renal failure

• Coma and death

The high levels of watery diarrhea have high amounts of Vibrio cholerae bacteria. This can be a serious source of secondary transmission and contamination of water and food.

The risk of cholera in countries where it is common, even during epidemics, is very low when proper precautions are taken. The risk in the United States is even lower, with most cases coming from endemic countries.

General recommendations for avoiding cholera in endemic countries:

• Drink safe water such as bottled water with unbroken seals. Boil water from other sources for at least one minute.

• Avoid ingestion of tap water in countries where cholera is common. Tap water, ice, water served in mixers or drinks at eating establishments, and using tap water when brushing teeth can be contaminated. Do not swallow water when bathing or swimming.

• Avoid cross-contaminating drinking water and food with unsafe water sources. Sources can include tap water and water used in the bathroom or the laundry. Only eat foods that you have peeled yourself, or that have been boiled or cooked. Avoid salads and fresh produce that may have been rinsed or prepared with contaminated water.

• Avoid food and beverages from street vendors as unsafe water may have been used for their preparation (i.e., water used for rice).

• Only eat thoroughly cooked seafood and shellfish until they are steaming hot. Do not eat any raw seafood.

• Practice hand washing hygiene, wash with soap and safe water often:

  • Before you handle, prepare, or eat food

  • Before feeding your family, children, or others

  • After using the restroom or cleaning a diapered child

  • After taking care of anyone with diarrhea

Cholera is rare in Texas. Between 2015 and 2019, there were no cases of cholera in Texas.

There is no vaccine for Vibrio cholerae.

There is no investigation form for Vibrio cholerae. 

Report Vibrio infection, including cholera within one working day to 800-705-8868 or 800-252-8239.

U.S. Food and Drug Administration, Center for Food Safety and Applied Nutrition
Name of the organism; nature; diagnosis of human illness; associated foods; relative frequency of disease; course of disease and complications. 

• Bad Bug Book (PDF) 2012
• Vibrio cholerae Serogroup Non-O1

Cholera is an acute (sudden or severe; with limited duration) disease of the small intestine caused by the bacterium Vibrio cholerae.

Most people infected with V. cholerae do not become ill, but the bacterium is present in their stool for 7-14 days. About one in 20 infected people has severe disease. They will have large amounts of watery diarrhea, vomiting, and leg cramps. The loss of fluids in an infected person can quickly lead to severe dehydration. If not treated, death can occur within hours.

The most common cause of cholera happens by eating food or drinking water that is contaminated with the bacteria.

Although only a few cases occur in the U.S. each year, epidemic levels of cholera happen worldwide, particularly in parts of Africa. In 2001, there were over 180,000 cases reported in 58 countries. Cases seen today are part of a pandemic (a worldwide epidemic) that started over 40 years ago, affecting millions. Cholera reached the Americas in 1991, affecting at least a million people. In 2002, fewer than 30 cases were reported in the Americas.

In the U.S., cases are usually traced to people traveling to cholera-risk areas or to people who have eaten food brought over from cholera-risk areas. Shellfish eaten raw is a source of cholera. A few people in the U.S. have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico.

The greatest risk of cholera happens in overpopulated communities and refugee settings. This is because there can be poor sanitation and sewage treatment. There may also be unsafe drinking water.

There are currently no vaccines approved for use in the US, but they are available in other countries. Travelers are not recommended to take the vaccine as the risk of getting cholera is usually low. Also, the vaccine's protection is incomplete and only lasts a short time.

Getting treated as soon as possible is key. If you are in a place where cholera is common and you have diarrhea, especially severe diarrhea, you need to see a doctor or other medical professional right away. Begin drinking water and other unsweetened fluids while waiting for medical treatment.

Cholera is diagnosed by isolating the bacteria from an infected person's feces.

To treat cholera, the lost fluids and salts due to diarrhea should be replaced right away through oral rehydration. In severe cases, antibiotics like tetracycline or doxycycline and fluids given through IV may be needed.

Most travelers visiting an area where cholera occurs are at very low risk of acquiring infection. Travelers who may be at increased risk for getting cholera include health professionals working in areas where cholera is common. Others include aid workers in refugee camps and travelers to remote cholera areas without access to safe water supplies.

• Drink only water that you have boiled or treated with chlorine or iodine. Avoid popsicles and flavored ice that could contain contaminated water.

• Other safe drinks include tea or coffee made with boiled water and carbonated, bottled beverages with no ice.

• Avoid undercooked or raw fish and shellfish.

• Avoid raw salads and vegetables.

• Eat only food that's been well cooked and is still hot, or fruit that you've peeled yourself.

• Avoid food and drinks from street vendors. If not, be sure that meals bought from street vendors are well cooked in your presence and do not contain any uncooked foods.

• Avoid unpasteurized dairy products and ice cream.

• Practice good personal hygiene, including frequent handwashing.