Travellers

Travel Health Information Sheets

Cholera

Hospital Mirabalais - Artibonite province

What is cholera?                                

Cholera is a potentially serious bacterial illness caused by drinking or eating contaminated water and food.

Symptoms:

Cholera often causes profuse sudden, profuse, watery diarrhoea, and severe, dehydration can occur very rapidly if it is not treated. Babies, children and older people are especially vulnerable. In the most severe cases, without treatment, severe cholera can be fatal. However, with prompt replacement of fluids, cholera can almost always be cured.

Where is cholera found?

Due to improvements in sanitation, public health and medical knowledge, cholera is now rare in Europe. Unfortunately, it is still common in less wealthy parts of the world, usually where water supplies, sanitation and hygiene are poor.

In regions without clean water and proper sewers, or in countries that have suffered natural disasters (like earthquakes or floods) or conflicts (such as a civil war) cholera spreads very quickly and can kill large numbers of people. The map below shows areas where cholera outbreaks have been reported.

Cholera Map courtesy of the World Health Organization.

View larger image (will open in new window)

What is my risk?

Your chance of catching cholera is very low. The overall risk of cholera for British travellers is estimated to be: 0.2 cases per 100,000 travellers. It is essentially a disease of poverty.

Your risk is increased by living in unhygienic conditions, travelling to remote areas where outbreaks have been reported or by working in a disaster area or refugee camp.

 How can I avoid cholera?

For most travellers good food and water hygiene is the best prevention.

Food & Water hygiene:

  • Avoid ice
  • Wash your hands after using the toilet, changing nappies and before cooking or eating.
  • Disinfect drinking water by boiling, using water purification tablets or water filtration devices
  • Water should be boiled for at least one minute.
  • Bottled, carbonated drinks with intact seals and hot drinks made with boiled water are usually safe.
  • You can buy chemial water purification tablets and water filters from travel clinics and specialist outdoor shops.
  • Use bottled water or boiled, cooled water for brushing your teeth. Never use water from natural sources liks rivers, streams or wells.

Try to eat recently prepared, thoroughly cooked, piping hot food:

  • Avoid salads or uncooked fruit and vegetables, unless you are sure they have been washed and peeled carefully.
  • Avoid buffets, street food, unpasteurised dairy products and raw or undercooked meat, fish or shellfish.
     

Can cholera be treated?

Yes, treatment usually consists of promptly replacing fluids lost through diarrhoea by drinking a balanced solution of sugar, salt and clean water (oral rehydration salts).

If you are severely dehydrated, you need a “drip” of sterile intravenous fluids. Antibiotics are also usually given. If you get prompt treatment, you should improve quickly  and make a full recovery.

                                                                     Photos courtesy of WHO/PAHO

Cholera Vaccine:

                                                                                                              There is a cholera vaccine, but it is not needed by most travellers and is usually only recommended for travellers at high risk:

  • Aid workers in disaster areas or refugee camps.

  • People travelling to remote areas with cholera outbreaks, with little or no access to clean water and medical care.

Although it has been suggested that it may help prevent diarrhoea, in the UK, this vaccine is only given as protection against cholera. For more information on travellers’ diarrhoea please see NaTHNaC’s separate advice sheet.

Where can I get advice about the vaccine?

Your GP, practice nurse or travel clinic can advise you. Remember, even if you have the vaccine, it is not 100% effective. Good food and water hygiene are still essential.

Links

NHS Choices: Cholera

Public Health England: Cholera

World Health Organization: Cholera

Reviewed August 2013