Introduction
Only a few cases of cholera have occurred among non-travelers in the United States since 1973. Even with foreign travel, the risk of infection to the traveler is very low, especially for those who follow the usual tourist itineraries and stay in standard accommodations. Worldwide cholera activity is characterized by occasional epidemics in developing countries.
Occurence
The organism that causes the illness is named Vibrio cholerae type O:1 or O:139. During epidemics, it is spread by ingestion of food or water contaminated directly or indirectly by feces or vomit from infected persons. Diagnosis is made by culturing the bacteria from the stool of a patient and confirming that the organism produces toxin.
Symptoms
Most infected persons have no symptoms or only mild diarrhea. However, persons with severe disease can die within a few hours after onset due to loss of fluid and salts through profuse diarrhea and, to a lesser extent, through vomiting.
Precautions
The best protection is to avoid consuming food or water that may be contaminated with feces or vomit from infected persons. The organism can grow well in some foods, such as rice, but it will not grow or survive in very acidic foods, including carbonated beverages, and is killed by heat.When simple precautions are observed, contracting the disease is unlikely. All travelers to areas where cholera has occurred should observe the following recommendations:
- Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water and carbonated, bottled beverages with no ice.
- Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.
- Avoid undercooked or raw fish or shellfish, including ceviche.
- Make sure all vegetables are cooked avoid salads. Salads are always suspect, because the raw vegtables have almost certainly been exposed to untreated water in many cases. Especially problematic are fresh water vegetables.
- Avoid foods and beverages from street vendors.
- Do not carry perishable seafood for longer than twelve hours, and then only if chilled with ice or frozen.
- A simple rule of thumb is "Boil it, cook it, peel it, or forget it. "
Treatment
Treatment for cholera involves rehydration with oral rehydration solution or, in the most severe cases, with intravenous solutions until the patient is able to ingest fluids. Treatment with antibiotics (usually tetracycline or doxycycline) will decrease the duration of illness and the excretion of live cholera bacteria and will decrease the volume of fluid lost but is not necessary for successful treatment.
Description
Cholera is an acute intestinal infection. Cholera occurs in many of the developing countries of Africa and Asia, where sanitary conditions are less than optimal.
Medications
At the present time, the manufacture and sale of the only licensed cholera vaccine in the United States (Wyeth-Ayerst) has been discontinued. It has not been recommended for travelers because of the brief and incomplete immunity if offers. No cholera vaccination requirements exist for entry or exit in any country.Two recently developed vaccines for cholera are licensed and available in other countries (Dukoral®, Biotec AB and Mutacol®, Berna). Both vaccines appear to provide a somewhat better immunity and fewer side-effects than the previously available vaccine. However, neither of these two vaccines is recommended for travelers nor are they available in the United States. Further information on these vaccines can be obtained from the manufacturers at:Dukoral®Active Biotec AB (publ)Postal Address: P.O. Box 724, SE-220 07 Lund, SwedenOffice address: Scheelevagen 22Tel: +46 46 19 20 00,Fax +46 46 19 20 50E-Mail: info@activebiotech.comHome page: http://www.activebiotech.comMutacol®Berna, Switzerland DivisionP.O. BoxCH-3001 BerneDomicile:Rehhagstrasse 79eCH-3018 BerneTel. +41 31 981 22 11Fax +41 31 981 20 66E-mail: berna@berna.orgHome page: http://www.berna.org/
