Cholera

Ingestion of water or food contaminated with Vibrio cholerae bacteria. Often linked to poor sanitation and humanitarian crises.

Symptoms

Acute watery diarrhea (rice-water stools), vomiting, rapid dehydration. Can progress to shock and death within hours if untreated.

Treatment

Oral rehydration salts (ORS) for mild cases. IV fluids for severe dehydration. Antibiotics (doxycycline, azithromycin) can shorten duration.

Endemic regions

Sub-Saharan Africa, South/Southeast Asia, Haiti, areas affected by conflict or natural disasters.

Prevention & prophylaxis

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Vaxchora (oral, single dose — US)

Single oral dose ≥10 days before travel. FDA-approved for adults 2–64. ~90% effective at 10 days, waning over 3–6 months. Recommended for travelers to active cholera outbreak areas.

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Dukoral (oral, 2 doses — international)

2 oral doses given 1–6 weeks apart, completed ≥1 week before travel. Available outside the US. Provides moderate protection (~65%) for up to 2 years. Also provides some cross-protection against ETEC traveler's diarrhea.

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Water and food safety

Drink only bottled, boiled, or chemically treated water. Avoid ice. Eat only thoroughly cooked foods. Avoid raw seafood, particularly shellfish. Frequent handwashing. Cholera risk is highest in humanitarian crisis settings and areas without water treatment.