If untreated, rapid loss of body fluids can lead to severe dehydration, hypovolemic shock, and death within hours. Additional symptoms, including muscle cramps, are secondary to the resulting electrolyte imbalances. Signs and symptoms include tachycardia, loss of skin turgor, dry mucous membranes, hypotension, and thirst. Severe cholera is characterized by profuse watery diarrhea, described as “rice-water stools,” often accompanied by nausea and vomiting, that can rapidly lead to severe volume depletion. Infection is often mild or asymptomatic, but it can be severe. CLINICAL PRESENTATIONĬholera most commonly manifests as acute watery diarrhea in an afebrile person. Travelers who consistently observe safe food, water, sanitation, and handwashing recommendations while in countries affected by cholera have virtually no risk of acquiring cholera. People who have low gastric acidity or those with blood type O are at higher risk of severe cholera illness. Health care and response workers in cholera-affected areas, such as in an outbreak or after a disaster, may also be at increased risk of cholera. This risk is increased for those who drink untreated water, do not follow handwashing recommendations, do not use latrines or other sanitation systems, or eat raw or undercooked food, especially seafood. There is a risk of cholera infection for travelers to areas where cholera is endemic or where there is an active epidemic. Of these, approximately 75% were associated with travel to the Caribbean, and 10% were associated with travel to India or Pakistan other travel destinations reported included countries in Southeast Asia and both East and West Africa. Sporadic cases associated with travel to or from cholera-affected countries in Asia and Africa continue to occur.įrom 2010 through 2016, 107 cases of cholera were confirmed in the United States among people who had traveled internationally in the week before illness. In October 2010, a large cholera epidemic began in Haiti and spread to the Dominican Republic and Cuba it is now endemic at much lower levels in Haiti and the Dominican Republic, though small outbreaks still occur. EPIDEMIOLOGYĬholera is endemic in approximately 50 countries, primarily in Africa and South and Southeast Asia, and can emerge in dramatic epidemics, although most cases go unreported. Direct transmission from person to person, even to health care workers during epidemics, has been reported but is infrequent. Other foods, including produce, are less commonly implicated. Other common vehicles include fish and shellfish. cholerae is found naturally or into which it has been introduced from the feces of an infected person. Cholera infections are most commonly acquired from drinking water in which V. cholerae O1 and O139 are free-living bacterial organisms found in fresh and brackish water, often in association with copepods or other zooplankton, shellfish, and aquatic plants. This strain is responsible for the epidemic on Hispaniola and appears to cause a higher proportion of severe episodes of cholera with the potential for higher death rates. In recent years, an El Tor variant that has characteristics of both classical and El Tor biotypes and may be more virulent than older El Tor strains has emerged in Asia and spread to Africa and the Caribbean. Globally, most cases of cholera are caused by O1 El Tor organisms. The symptoms of infection are indistinguishable, although more people infected with the El Tor biotype remain asymptomatic or have only a mild illness. cholerae O1 has 2 biotypes, classical and El Tor, and each biotype has 2 distinct serotypes, Inaba and Ogawa. cholerae O1 is the source of an ongoing global pandemic, while the O139 serogroup remains localized to a few areas in Asia. Only toxigenic strains of serogroups O1 and O139 have caused widespread epidemics and are reportable to the World Health Organization (WHO) as “cholera.” V. cholerae, with or without the cholera toxin gene (including the nontoxigenic strains of the O1 and O139 serogroups), can cause a choleralike illness. INFECTIOUS AGENTĬholera is an acute bacterial intestinal infection caused by toxigenic Vibrio cholerae O-group 1 or O-group 139. The cholera vaccine may be in limited supply or unavailable. Please note: As of December 2020, the maker of the cholera vaccine will temporarily stop making and selling this vaccine.
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