Travellers

Travel Health Information Sheets

Updated December 2010

Cholera

Hospital Mirabalais - Artibonite province

What is cholera?

Cholera is a serious illness caused by several different types of bacteria. It is spread by drinking or eating contaminated water and food.

Symptoms:

Cholera’s main symptom is sudden, profuse, watery diarrhoea. As this diarrhoea can be severe, dehydration can occur very rapidly. Babies, children and older people are especially vulnerable.

Without medical treatment, severe cholera can be fatal. However, with prompt replacement of fluids, cholera can almost always be cured.

Where is cholera found?

In the past, cholera outbreaks occurred in Europe, with major epidemics in Britain in the nineteenth century. 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.

What’s 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 or 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:

  •  Wash your hands after using the toilet and before cooking or eating.

  •  Disinfect drinking water by boiling, using water purification tablets or water filtration devices:

- Water should be brought to a roiling boil;

- You can buy chemical water purification tablets from travel clinics and specialist outdoor shops. Water filters of smaller than 1 micron can also be purchased.

- Avoid ice. Bottled, carbonated drinks, with intact seals and hot drinks made with boiled water are usual safe.

  • Use bottled water or boiled, cooled tap water for brushing your teeth. Don’t use water from natural sources such as rivers or streams, uncovered wells or untreated tap water.   

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

- Don’t eat salads or uncooked fruit and vegetables, unless they have been washed and peeled carefully.

- Avoid buffets, food from street traders, unpasteurised dairy products and raw or undercooked meat, fish or shellfish.

Can cholera be treated?

Yes. Fluids lost through diarrhoea need to be replaced quickly 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 fluids directly into your veins. Antibiotics are also usually given. If you get prompt treatment, you should improve rapidly and completely recover.

                                                 Photo courtesy of WHO/Paul Garwood 2008

Cholera Vaccine:

                                                                                                                             There is a cholera vaccine, but it is generally only recommended for:

  • 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.

In the UK, this vaccine is only given as protection against cholera, it is not given to prevent travellers’ diarrhoea. For more information on travellers’ diarrhoea see NaTHNaC’s separate advice sheet.

Where can I get advice about the vaccine?

Your doctor, practice nurse or travel clinic can advise you about this vaccine. Remember - even if you are advised to have the vaccine, it is not 100% effective. Good food and water hygiene are essential.

Links

NaTHNaC: Food and water hygiene

NaTHNaC: Traveller’s Diarrhoea

NHS Choices

World Health Organization