By: Adam Ratner, M.D., M.P.H., FAAP
Cholera is an infection of the intestines caused by bacteria called Vibrio cholerae. The infection usually spreads through contaminated drinking water or food, such as raw or undercooked shellfish.
In the United States, cholera is rare. Most of the cholera cases that happen in the United States are due to travel. Each year, a handful of cholera cases are reported after travelers return from areas with active cholera transmission. Right now, these areas include parts of Africa, Asia and the Americas. A small number of people have been sickened after eating contaminated seafood from the Gulf coast.
The oral cholera vaccine is recommended for children and adults ages 2 through 64 years who are planning to travel to areas with a current or recent cholera outbreak. Here's what else families should know about cholera before they travel.
Cholera symptoms
Symptoms of cholera include vomiting and watery diarrhea that can range from mild to very severe. An infection does not always cause symptoms. In most cases, however, there is both vomiting and mild to moderate diarrhea. In about one in 10 infections, the watery diarrhea becomes severe and significant dehydration occurs, a condition called cholera gravis.
Early signs of dehydration include thirst, dry mouth, sunken eyes and decreased urination. In the most severe cases—especially when lost fluids are not replaced—very serious complications can develop, including seizures, shock and coma. If dehydration from cholera is not treated, it can be fatal.
Seek medical care if your child or you develop symptoms of watery diarrhea that occur within 5 days after travel.
How cholera is diagnosed & treated
Laboratory tests can detect the presence of V. cholerae bacteria in the child's poop.
Children with dehydration due to cholera need to be rehydrated right away. This can usually be done with solutions given by mouth that are available over the counter. For children who are moderately to severely ill, intravenous (IV) fluids are necessary.
Antibiotic medications, such as doxycycline, ciprofloxacin or azithromycin, can decrease the amount of bacteria in the poop and shorten the duration of the diarrhea. Antidiarrheal medicines should not be used for cholera.
How to prevent cholera
Vaccination, hand hygiene and food and water safety precautions can help keep children safe when visiting an area with active cholera transmission.
The bacteria can be killed by boiling, filtering or treating water with chemicals such as chlorine or iodine. Fish, shellfish, rice, grains and other foods that may have been contaminated by V. cholerae should be fully cooked or reheated to destroy the bacteria.
To keep food from spoiling, refrigerate leftover cooked seafood as soon as possible. Fruits and vegetables should be peeled before eating. They should not be purchased already peeled, as they may become contaminated after peeling.
Parents planning to bring children to an area with active cholera transmission should discuss cholera vaccination with their pediatrician.
More information
About Dr. Ratner  Adam Ratner, MD, MPH, FAAP, is a pediatric infectious diseases expert at New York University and Hassenfeld Children's Hospital, New York. He is a member of the American Academy of Pediatrics Committee on Infectious Diseases.
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