Cholera is an acute bacterial infectious disease of the digestive system caused by Vibrio cholerae.
Key information:
What causes the disease? Gram-negative bacterium Vibrio cholerae (mainly serogroups O1 and O139).
How does infection occur? Infection occurs via the fecal-oral route, most often through:
drinking water contaminated with feces of a sick person or carrier,
eating food washed or prepared in such water,
consuming fish and seafood from contaminated waters,
rarely – direct contact with a sick person or carrier (dirty hands).
Who is the source of the pathogen? A sick person or an asymptomatic carrier. Bacteria can be excreted in feces for up to 10 days after infection, contaminating water and the environment.
Incubation period: From several hours to 5 days, most often 2–3 days.
Who is most at risk?
travelers going to regions with poor hygiene and poor water quality,
people staying for a long time in countries where cholera is endemic (parts of Africa, Asia, Latin America),
humanitarian and medical mission workers in refugee camps, disaster zones, and armed conflict zones,
children, the elderly, and the chronically ill – dehydration develops faster in them.
Cholera does not pose a significant threat in countries with high sanitary standards, such as Poland – sporadic cases are usually "imported" from travel.
2. Symptoms of cholera
In most infected people, the infection is asymptomatic or has mild symptoms. About 1 in 10 infected people develop full-blown disease.
Most common symptoms:
sudden, profuse, watery diarrhea without abdominal pain,
stools with a characteristic appearance – like "rice water",
vomiting, often without preceding nausea,
increasing thirst,
muscle cramps (result of electrolyte loss),
dry, less elastic skin, dry tongue and mucous membranes,
"sunken" face, weakness, hoarse voice.
Course of the disease:
The disease can develop very quickly – within 24 hours a patient can pass even dozens of liters of watery stools.
Without treatment, rapid dehydration, acidosis, electrolyte disturbances occur, followed by:
drop in blood pressure and hypovolemic shock,
acute kidney failure,
disturbances of consciousness, convulsions (e.g., hypoglycemic).
With proper, rapid rehydration, most patients recover; mortality drops to approx. 1%. Untreated severe cholera can lead to death in a short time.
When to urgently contact a doctor / go to the hospital?
Especially after returning from countries with lower sanitary standards, if the following occur:
very profuse, watery diarrhea and/or repeated vomiting,
symptoms of dehydration:
dry mouth, lack of saliva,
dark, scanty urine or lack thereof,
severe weakness, drowsiness, dizziness, fainting,
fever, severe abdominal pain, confusion, anxiety,
symptoms of shock: cold, clammy skin, rapid pulse, drop of blood pressure.
In such situations, urgent medical help is necessary, preferably in hospital conditions.
3. Where does cholera occur?
For travelers, the most important thing is that cholera occurs mainly in regions with poorer sanitary conditions, high population density, and difficult access to clean water.
Continents and areas of highest risk:
Africa
many countries of East and Central Africa, including Kenya, Tanzania, Democratic Republic of the Congo, Sudan, Somalia, Central African Republic;
cholera outbreaks often appear in regions affected by armed conflicts and natural disasters.
Asia
Indian Subcontinent: India, Bangladesh, Nepal, and neighboring countries – classically endemic areas,
part of Southeast Asian countries,
selected regions of the Middle East (e.g., Yemen).
Latin America and Caribbean
Haiti – long-standing, recurrent epidemic outbreaks,
Dominican Republic (especially regions bordering Haiti),
periodic cases in other countries of the region.
For whom is this information particularly important?
People planning exotic trips to African countries, South Asia, and parts of Latin America.
Travelers going to regions with low water and sanitation standards (villages, slums, camps, flood areas).
Volunteers, medical personnel, and aid organization workers.
In countries with high hygiene levels (including Poland), cholera cases are rare and usually related to travel to an endemic region.
4. How to protect yourself against cholera?
A. General prevention
In countries with increased cholera risk, the rule applies: "Boil it, cook it, peel it… or forget it" – boil it, cook it, peel it or forget it.
Most important rules:
Water
drink only bottled water with an intact cap or boiled water,
avoid ice cubes (most often made from unboiled water),
also use bottled or boiled water for brushing teeth.
Food
eat freshly cooked, well-fried dishes,
avoid raw seafood and fish,
wash fruits and vegetables in safe water, and preferably peel them,
limit eating food from street stalls, especially where you are unsure about hygiene.
Personal hygiene
wash hands often with soap and water, especially after using the toilet and before eating,
when there is no access to water – use alcohol-based hand sanitizers,
avoid putting hands in mouth, touching face.
Sanitary conditions
use toilets of the best possible standard,
in case of diarrhea, take care of hygiene carefully – so as not to transfer bacteria to others.
Adhering to these rules significantly reduces the risk of infection, but does not eliminate it – especially during longer stays in endemic regions. Therefore, vaccination is an important supplement to protection.
B. Vaccination against cholera
Vaccinations are a key element of protection for people traveling to high-risk areas.
Types of vaccines
Currently, oral cholera vaccines are used, containing:
or live, attenuated (weakened) strains (e.g., Vaxchora – availability depends on the country).
In Poland, the Dukoral vaccine is primarily registered and used.
For whom is vaccination recommended?
for people traveling to regions of endemic cholera occurrence,
for people planning a longer stay in places with low sanitary standards,
for participants of humanitarian missions, health care workers, military, volunteers in disaster and conflict areas,
it is particularly worth considering vaccination in people with chronic diseases, children, and the elderly, in whom dehydration can threaten life faster.
Protection appears about 1 week after the last dose,
vaccination should be completed at least 7 days before departure.
Booster doses
adults and children ≥ 6 years: 1 booster dose every 2 years,
children 2–6 years: 1 booster dose every 6 months if they continue to stay in a risk zone or plan another trip.
Duration of immunity
in adults and children ≥ 6 years – about 2 years,
in children 2–6 years – about 6 months, therefore they more often require a booster dose.
Rules for taking oral vaccine
the vaccine is taken on an empty stomach,
at least 1 hour before and 1 hour after vaccination, refrain from eating, drinking, and taking other medicines,
it is very important to complete the full cycle (all doses) to obtain full protection.
Additional notes
No vaccine gives 100% protection – therefore, even after vaccination, hygiene rules must be observed (water, food, hands).
Some preparations, like Dukoral, thanks to the presence of toxin B subunit, can also provide partial protection against traveler's diarrhea caused by ETEC.
5. Summary
Cholera is a dangerous, but largely avoidable disease. We get infected most often through contaminated water and food in countries with poorer sanitary conditions. The disease can quickly lead to severe dehydration and life-threatening complications if proper rehydration treatment is not implemented quickly.
Why is it worth getting vaccinated?
vaccination significantly reduces the risk of getting cholera,
can also limit the risk of severe disease course,
is particularly important where access to rapid medical care is difficult.
Who should especially consider vaccination?
people traveling to Sub-Saharan Africa, parts of Asia, and Latin America,
people going to regions with low sanitary standards (camp, mission, field work),
children, elderly, and chronically ill people going to endemic areas.
When is the best time to get vaccinated?
optimally at least 2–3 weeks before departure,
so as to have time to take all doses and develop immunity (minimum 7 days from the last dose).
Thanks to the combination of vaccination and sensible hygiene rules, you can significantly reduce the risk of illness and enjoy your trip peacefully.