Cholera

Vibrio choleraeis found in the faeces (poo) of infected people. You become infected by ingesting the bacteria through your mouth. This can be by:

• drinking contaminated water
• eating food washed with contaminated water or prepared with soiled hands
• eating fish or shellfish caught in contaminated water.

Person-to-person spread of cholera is less common, but can still happen when there is contact with microscopic amounts of faeces or vomit from an ill person.

This may occur directly by close personal contact, or indirectly by touching contaminated surfaces such as taps, toilet flush buttons, toys and nappies.

Most people with Vibrio cholerae infection do not develop symptoms or have only mild illness. A small proportion of people will develop severe symptoms.

Symptoms typically start between 2 hours to 5 days (usually 2 to 3 days) after you have ingested the bacteria.

Symptoms can include:

• characteristic ‘rice water’ faeces (profuse, watery diarrhoea)
• nausea and vomiting
• signs of dehydration, such as weakness, lethargy and muscle cramps.

There are many causes of gastroenteritis, and laboratory testing of a faecal specimen is necessary to confirm that symptoms are due to cholera.

Cholera can be life threatening and death can occur, especially in young children, without appropriate treatment.

If you have or suspect you have cholera you should:

• Drink plenty of fluids such as water or oral rehydration drinks to avoid dehydration. Dehydration is especially dangerous for babies and the elderly.
• Avoid anti-vomiting or anti-diarrhoeal medications unless these are prescribed or recommended by a doctor.

Antibiotics may be given to shorten the length of illness and lessen the severity of symptoms.

Intravenous fluid replacement may be necessary for people who are severely dehydrated or those who cannot keep fluids down.

If you experience severe or prolonged symptoms you should visit a doctor.

While you have the infection

• Do not go to work or school for at least 24 hours after symptoms have finished.
• Avoid preparing or handling food and drinks for other people in your household until at least 24 hours after your symptoms have finished. If you must handle or prepare food, thoroughly wash your hands beforehand to reduce the risk of spreading the infection to others.
• Wash and dry your hands thoroughly after going to the toilet.
• Immediately remove and wash any clothes or bedding contaminated with vomit or diarrhoea using detergent and hot water.
• After an episode of diarrhoea or vomiting, clean contaminated surfaces (for example, benches, floors and toilets) immediately using detergent and hot water. Then disinfect surfaces using a bleach-based product diluted according to the manufacturer’s instructions.
• Clean carpet or soft furnishings contaminated with diarrhoea or vomit immediately using detergent and hot water and then steam clean.
• If you work in or attend a high-risk setting (such as health care, residential or child care facilities) or if you handle food as part of your job, you will be contacted by your local public health unit to discuss extra precautions and testing that will be required before you can return to work.

When travelling

When travelling to developing countries, especially in Asia, the Pacific islands, Africa, the Middle East and Central and South America, you should avoid:

• salads and fresh fruit juices
• raw or cold seafood, including shellfish
• raw or runny eggs
• cold meat
• unpasteurised milk and dairy products (including ice-cream)
• ice in drinks and flavoured ice blocks.

Fruit that you peel yourself is usually safe. Remember – ‘cook it, boil it, peel it, or leave it’.

Use bottled water or disinfect water (by boiling, chemical treatment or purifiers) for drinking and brushing teeth.

Read more about healthy international travel.

Is there a vaccine for cholera?

A cholera vaccine is available for travellers to high risk areas overseas and can provide some protection, but is not recommended routinely. See your doctor or travel medicine specialist at least 2 months prior to departure to see if any vaccinations or medications are recommended.