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close this bookCholera: Basic Facts for Travellers (WHO, 1998, 2 p.)
View the document(introduction...)
View the documentWhat is cholera?
View the documentWhat should I do if I think I may have cholera?
View the documentWhere are the outbreaks of cholera?
View the documentDo vaccinations work against cholera?
View the documentWhat can I do to avoid cholera?


© WHO/OMS, 1998

What is cholera?

Cholera is an acute diarrhoeal disease caused by the bacterium Vibrio cholerae. A person can become infected by drinking water or eating food contaminated by the bacterium. Common sources of infection are raw or poorly cooked seafood, raw fruit and vegetables, and other foods that have been contaminated during preparation or storage.

Most episodes of cholera are mild. Persons who have been infected may have no symptoms or only mild diarrhoea. Others, however, develop very severe watery diarrhoea and vomiting. The loss of large amounts of fluids can rapidly lead to severe dehydration causing death - sometimes within three to four hours - if the patient is not adequately treated.

What should I do if I think I may have cholera?

If you have diarrhoea, especially severe diarrhoea, in an area where there is cholera, seek treatment immediately from a physician or other trained health care provider. Begin drinking water and other non-sweetened fluids, such as soup, on the way to getting medical treatment.

The most important treatment of cholera is called rehydration and consists of prompt replacement of the water and salts lost through severe diarrhoea and vomiting. Early rehydration can save the lives of nearly all patients with cholera. Most patients can be rehydrated quickly and simply with a solution of oral rehydration slats (ORS). Packets of these salts are available from most city pharmacies and you should carry a supply with you when you travel. Follow the instructions on the packet when making up the solution. The solution is drunk in large quantities, sufficient to replace what has been lost from diarrhoea and vomiting.

Patients who become severely dehydrated may need to receive fluid intravenously. An effective antibiotic can also help to shorten the illness in patients with severe cholera. Antidiarrhoeal medicines, such as loperamide, are not recommended, and should never be given.

Where are the outbreaks of cholera?

Today, cholera is present in many countries. New outbreaks can occur sporadically in any part of the world where water supplies, sanitation, food safety and hygiene practices are inadequate. The inhabitants of overpopulated communities with poor sanitation and unsafe drinking water supplies are most frequently affected. For information on whether there is cholera in the area where you will be travelling, contact your health care provider or local office of public health.

Do vaccinations work against cholera?

The traditional injectable cholera vaccine conveys incomplete, unreliable protection of short duration and its use, therefore, is not recommended. However, two oral cholera vaccines that provide high level protection for several months against cholera caused by Vibrio cholerae 01 have recently become available in a few countries for use by travellers. For more information contact your health care provider or local office of public health. No country requires proof of cholera vaccination as a condition for entry and the International Certificate of Vaccination no longer provides a specific space for recording of cholera vaccination.

What can I do to avoid cholera?

By taking a few basic precautions when travelling, cholera as well as most other food and water-borne diseases can easily be prevented. The main rule is: Always be aware of the quality of what you eat and drink when you are travelling.

· Drink only water that has been boiled or disinfected with chlorine, iodine or other suitable products. Products for disinfecting water are generally available in pharmacies. Beverages such as hot tea or coffee, wine, beer, carbonated water or soft drinks, and bottled or packaged fruit juices are also usually safe to drink

· Avoid ice, unless you are sure that it is made from safe water.

· Eat food that has been thoroughly cooked and is still hot when served. Cooked food that has been held at room temperature for several hours and served without being reheated can be an important source of infection.

· Avoid raw seafood and other raw foods, except fruits and vegetables that you have peeled or shelled yourself. Remember: Cook it, peel it, or leave it.

· Boil unpasteurized milk before drinking it.

· Ice cream from unreliable sources is frequently contaminated and can cause illness. If in doubt, avoid it.

· Be sure that meals bought from street vendors are thoroughly cooked in your presence and do not contain any uncooked foods.

If you are travelling with family members or others, ensure that they also take these precautions. Infants under six months who are breast-fed, and receive no other foods or drinks, have a low risk of infection.