Cholera is an acute gastro-intestinal infection caused by Vibrio cholerae bacteria. It is primarily associated with contaminated water, food, especially raw or undercooked fish and shellfish. The bacteria are found worldwide and are typically 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.
Risk: Travellers going to, or living and working in, places with inadequate sanitary conditions such as refugee camps are at greater risk. Persons with compromised immune systems, including those who have had surgery for duodenal or gastric ulcers or are on antacid therapy, and users of cannabis – smoking marijuana reduces acid secretion of the stomach – are more susceptible to cholera infection.
Symptoms: Most cases are asymptomatic (persons do not exhibit symptoms). Some have gastro-enteritis – 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.
Prevention: The best protection is to avoid potentially contaminated water and food. Drink purified water and eat well cooked foods only. Use the mantra Boil it, Cook it, Peel it, or Forget it! Also wash your hands frequently and thoroughly, and practice good body hygiene.
Note that the World Health Organization announced in 1991 that Cholera vaccination certificates are no longer required by any country or territory.
Vaccination: 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.
An inactivated oral vaccine is available in Canada and countries where Cholera may be endemic. It is not available in the USA. The vaccine does not provide 100% protection against Cholera and rapidly wanes over time so take food and water precautions, and practice good hand hygiene.
The vaccine is also licensed in Canada for protection against Enterotoxigenic E. coli (ETEC) bacteria. However, ETEC causes less than 50% Traveller’s Diarrhea cases and the vaccine does not work against other pathogens causing Traveller’s Diarrhea. Talk to your healthcare provider regarding your best prevention options.
Vaccination is recommended if travelling to the following countries: