CENTERS FOR DISEASE CONTROL AND PREVENTION Date Last Rev'd: March 9, 1995

FOOD AND WATER BORNE BACTERIAL DISEASES

CHOLERA
CDC has detailed information to help people understand foodborne diseases. This information is referenced on the Disease Information Directory.

Cholera is an acute intestinal infection. Cholera occurs in many of the developing countries of Africa, and Asia, where sanitary conditions are less than optimal. Most recently, cholera outbreaks have occurred in parts of Latin America.

Most infected persons have no symptoms or only mild diarrhea. However, persons with severe disease can die within a few hours after onset due to loss of fluid and salts through profuse diarrhea and, to a lesser extent, through vomiting.

Only a few cases of cholera have occurred in the United States since 1973. Even with foreign travel, the risk of infection to the U. S. traveler is very low, especially for those who are follow the usual tourist itineraries and stay in standard accommodations. Worldwide cholera activity is characterized by occasional epidemics in developing countries.

The organism that causes the illness is named Vibrio cholerae type O:1. During epidemics, it is spread by ingestion of food or water contaminated directly or indirectly by feces or vomitus from infected persons. Diagnosis is made by culturing the bacteria from the stool of a patient and confirming that the organism produces toxin.

The best protection is to avoid consuming food or water that may be contaminated with feces or vomitus from infected persons. The organism can grow well in some foods, such as rice, but it will not grow or survive in very acidic foods, including carbonated beverages, and is killed by heat.

A cholera vaccine is available, but normally is not recommended. Only 50% of those who take the vaccine develop immunity to cholera, and this immunity lasts only a few months.

Treatment for cholera involves rehydration with oral rehydration solution or, in the most severe cases, with intravenous solutions until the patient is able to ingest fluids. Treatment with antibiotics (usually tetracycline or doxycycline) will decrease the duration of illness and the excretion of live cholera bacteria, and will decrease the volume of fluid lost, but is not necessary for successful treatment.

CHOLERA VACCINE INFORMATION
A cholera vaccine is available, but normally is not recommended. Only 50% of those who take the vaccine develop immunity to cholera, and this immunity lasts only a few months. No country currently requires the cholera vaccine for entry if arriving from cholera-infected countries. Consult the International Travelers Hotline for specific recommendations.

The complete vaccination schedule includes 2 doses of vaccine spaced 1 to 4 or more weeks apart. Dosages are age specific.

For infants 0-6 months of age; the vaccine is not recommended.

Data indicate that simultaneous administration of cholera and yellow fever vaccines produces less-than-normal antibody responses to both vaccines. A three week minimum interval between cholera and yellow fever vaccines is recommended. In cases where both vaccines are required and time constraints exist, then administer simultaneously or as far apart as possible.

Reactions to the vaccine are: 1-2 days of pain, erythema, and induration at the site of injection; fever, malaise, and headache. Serious reactions are rare, but if experienced, re-vaccination is not advisable.

No specific information on the safety of cholera vaccine in pregnancy is available, therefore vaccination should be avoided.

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