Cholera: Causes, Symptoms, Prevention, Vaccine, & Treatment

What is Cholera?

Cholera is an acute intestinal infection caused by the toxigenic bacteria Vibrio cholerae serogroup O1 or O139. Individuals generally get this infection from contaminated water. The majority of the patients with cholera are mild and exhibit little or no symptoms, while others develop severe diarrhea and dehydration.

Immediate medical care is crucial in severe cases, as death can occur within a few hours, and this may occur even in previously healthy individuals before getting cholera.

In the majority of nations, modern sewage and water treatment have effectively eradicated cholera. But it continues to be an issue in various portions of the Middle East, Latin America, Asia, and Africa.

Every year, 1.3 to 4 million cases of cholera are reported globally, resulting in 21,000 to 143,000 fatalities, according to the World Health Organization (WHO) (1).

Countries afflicted by poverty, natural catastrophes, or war are most vulnerable to outbreaks of cholera. The reason behind this is that these circumstances often compel individuals to live in overcrowded locations without adequate sanitation.

What are The Signs and Symptoms of Cholera?

The majority of persons suffering from cholera exhibit no symptoms or just mild to moderate symptoms. According to the Centers for Disease Control and Prevention (CDC), around 10% of those infected with cholera have severe symptoms (2).

Its symptoms can begin from a few hours to five days after infection. About 1 out of 20 infected people has severe watery diarrhea along with vomiting, which may lead to dehydration. Even though infected people with minimal or no symptoms can still contribute to the spread of the infection.

The symptoms of cholera may include the following:


Diarrhea in cholera comes on suddenly and can quickly cause severe fluid loss (maybe as much as 1 liter an hour). Cholera-related diarrhea often has a pale, milky appearance that looks like water in which rice has been rinsed.

Nausea and vomiting

Vomiting occurs mainly in the early stages of cholera and may last for hours.


Dehydration can develop within a few hours after the appearance of cholera symptoms and may range from mild to severe. A 10% or more body weight loss specifies severe dehydration.

The Signs and symptoms of dehydration related to cholera may manifest themselves in the following ways:

  • Fatigue
  • Extreme thirst  
  • Moodiness
  • Irritability
  • Dry mouth
  • Dry and Shriveled skin (that’s slow to bounce back when pinched into a fold)
  • Sunken eyes
  • Little or no urinating
  • Low blood pressure
  • Irregular heartbeat

Dehydration can result in rapid loss of minerals in your blood that sustain the balance of fluids in your body. This is known as an electrolyte imbalance.

Electrolyte imbalance

An electrolyte imbalance may cause serious signs and symptoms like:

Muscular Cramps

Severe muscular cramps are the first sign of an electrolyte imbalance and result from the rapid loss of salts like sodium, potassium, and chloride.


An electrolyte imbalance may ultimately lead to shock and is one of the most serious complications of dehydration.

It occurs when your low blood volume results in a decline in blood pressure and a decline in the amount of oxygen in your body. If it is not treated, severe hypovolemic shock can lead to death in minutes.

Symptoms of Cholera In Children

Generally, kids with cholera exhibit the same symptoms as those present in adults. Additionally, children may have:

  • Fever
  • Severe drowsiness
  • Convulsions
  • Coma

What are the Causes of Cholera?

Cholera is caused by the toxigenic bacteria vibrio cholerae serogroup O1 or O139. Its lethal consequences are caused by a toxin (CTX) produced by the bacteria in the small intestine. The toxin stimulates the body to secrete huge amounts of water, resulting in diarrhea and rapid fluid and salt loss (electrolytes).

While not all persons exposed to cholera germs get sick, they can pass the bacteria in their feces, which may contaminate food and water sources.

The primary cause of cholera infection is contaminated water sources. This bacterium is found in the following places:

1) Water from the surface or a well

Public wells that have been contaminated are a common cause of large-scale cholera epidemics. Individuals who live in overcrowded settings without access to basic sanitation are particularly vulnerable.

2) Grains

Keeping contaminated cooked grains like millet and rice at normal temperatures for many hours increases the risk of cholera bacteria growth in places where the disease is prevalent.

3) Raw Fruits and vegetables

Raw, unpeeled vegetables and fruits are a common cause of cholera infection. Uncomposted manure fertilizers or irrigation water having raw sewage may taint crop produce in impoverished nations.

4) Seafood

Consuming raw as well as undercooked seafood, particularly shellfish, from certain locations might infect you with this bacterium. Recent cholera infections in the US have been linked to the seafood of the Gulf of Mexico.

This infection is generally not transmitted from person to person through casual contact.

Diagnosis of Cholera

A healthcare practitioner will require a sample of your feces to test for cholera. Frequently, you will defecate in a collecting cup or bag. A healthcare practitioner may sometimes insert a swab into your rectum (opening where stool comes out).

The sample is transported to a lab, where it is examined under a microscope by specialists to determine whether it contains the bacteria V. cholerae. Certain places where cholera is more prevalent have access to “dipstick” equipment that may quickly test a stool sample.

Isolation and identification of Vibrio cholerae serogroups O1 or O139 from stool specimens continue to be the gold standard for cholera laboratory diagnosis.

Cary Blair medium is well suited for transport, whereas selective thiosulfate–citrate–bile salts agar (TCBS) is well suited for isolation and identification. Serogrouping reagents for Vibrio cholerae isolates are available in all state health department labs across the United States. While commercially available quick test kits are beneficial in epidemic situations, they do not generate an isolate for antimicrobial susceptibility testing or subtyping and should not be utilized for regular diagnosis (3).

Prevention of Cholera

You may protect yourself and your family by drinking only boiling water, chemically treated water, or bottled water.

For the following uses, ensure that you use bottled, boiled, or chemically disinfected water:

  • Drinking
  • Making ice         
  • Preparing food and beverages
  • Washing hands and face
  • Cleaning your teeth,
  • You have to properly wash your dishes as well as the utensils that you use to consume or prepare meals
  • Washing vegetables and fruits

To disinfect water, either you boil it for one to three minutes or filter it and add a commercial chemical disinfectant. Also, you should avoid uncooked foods, like:

  • Fruits and vegetables that have not been peeled
  • Meat or shellfish that is raw or undercooked
  • Fish collected on tropical reefs that may be infected
  • Milk and milk products that have not been pasteurized

What is the Treatment of Cholera?

If you experience severe, watery diarrhea and vomiting especially after consuming raw shellfish or visiting a place where cholera is prevalent, then you must seek medical treatment immediately. Cholera is fairly curable, but immediate treatment is required to avoid dehydration.

Cholera requires instant treatment because this infectious disease can cause death within hours. Among the most often-used ways of cholera treatment are the following:


The goal is to reload lost body fluids and electrolytes by using oral rehydration salts (ORS). The ORS solution is available in powder form and can be made with boiled or bottled water.

Without rehydration, about half the people die from cholera. With treatment, the mortality rate drops to less than 1%.

Intravenous (IV) Fluids

Most people having cholera can be helped by oral rehydration alone, but people with severe dehydration might also need intravenous (IV) fluids.


The use of some antibiotics can decrease cholera-related diarrhea and also, shorten the duration of diarrhea in severely ill people.

Zinc Supplements

Zinc may decrease diarrhea and shorten the duration it lasts in children with cholera.

These therapies replenish the body’s fluid and rehydrate it. Additionally, they aid in reducing the duration of diarrhea.

Cholera Vaccine

Vaccines for cholera are available.

The majority of individuals in affluent nations have a remote risk of developing cholera. A doctor is unlikely to recommend the vaccination unless you reside in or visit an area with a high rate of transmission.

If you were previously vaccinated and will be traveling to a country with a current cholera epidemic, then you may need a booster dose. You must consult your physician for guidance on having the booster dose.

Currently, there are three cholera vaccines recommended by the World Health Organization (WHO). These are:

  • Dukoral
  • SanChol
  • Euvichol

All three normally need two doses to give full protection; however, children aged two to five years are also given a third dosage of Dukoral.

Dukoral vaccine is required to be taken with clean water and gives about 65 percent protection for 2 years. On the other hand, Shanchol and Euvichol don’t require to be taken with water, and they give about 65 percent protection for 5 years. All these three vaccines offer higher protection closer to the time they are taken.

In the United States, none of these vaccinations is accessible. The Food and Drug Administration (FDA) of the United States has permitted Vaxchora, an oral vaccine.

Vaxchora is a single-dose vaccine for children and adults aged 2 to 64 years. In May 2021, during the COVID-19 pandemic, the company temporarily suspended manufacturing and delivery owing to decreased demand and travel. Production and distribution were still on hold as of November 2021, and supplies may be restricted.

What Are The Complications of Cholera?

Cholera can rapidly become fatal. In severe situations, like the outbreak in Haiti in 2010, death can occur in as little as 2 hours after the onset of symptoms (5), due to the rapid loss of large amounts of fluids and electrolytes.

In less severe situations, people who don’t get treatment can die of severe dehydration 6 to 12 hours after cholera symptoms first appear (6). Shock can also occur after a few hours or days.

Although severe dehydration and shock are the worst complications of cholera, other problems can also occur, like:

 Hypoglycemia (Low Blood Sugar)

Dangerously low levels of blood sugar can occur when people become too sick to eat. Children are at the highest risk of this complication, and it can lead to seizures, unconsciousness, and even death.

Low Potassium Levels

People suffering from cholera lose large quantities of minerals, like potassium, in their feces. Very low potassium levels interfere with nerve functions & the heart; and can be life-threatening.

Kidney Failure

When the kidneys lose their filtering capability, excess amounts of fluids, some electrolytes, and wastes build up in the body; which is possibly a life-threatening condition. In people suffering from cholera, kidney failure often accompanies shock.

What are The Risk Factors for Cholera?

Anyone can get infected with cholera, except infants who get immunity from nursing mothers who have previously had cholera. But certain factors may increase your risk of infection or more likelihood that you’ll have severe signs and symptoms. These Risk factors for cholera are:

Poor Sanitary Conditions

Cholera is more likely to present in places with poor sanitation and contaminated water. Such conditions are common in refugee camps, areas afflicted by war, famine, or natural disasters, and impoverished countries

Household Exposure

You’re at increased risk of cholera if you are in close contact with people who have cholera.

Reduced or Nonexistent Stomach Acid

Cholera bacteria can’t live in a highly acidic environment, and ordinary stomach acid often serves as a defense against this infection. Thus, people having low levels of stomach acid, like children, older adults, and people taking H-2 blockers, proton pump inhibitors, or antacids, are at greater risk of cholera as they lack this protection.

Raw or Undercooked Shellfish

If you consume shellfish that come from waters known to harbor the bacteria greatly increases your risk of contracting cholera.

Type O Blood

People with type O blood (for reasons that aren’t entirely clear), are twice as likely to develop cholera compared with people with other blood types.

If you follow proper food safety practices or take preventive measures, then the risk of infection, even in places where cholera is endemic, is minor.

What is The Prognosis of Cholera?

Cholera has an excellent to poor prognosis. Rapid fluid and electrolyte replacement improves outcomes, however, individuals with other health concerns or those who don’t immediately get fluid therapy have a lower prognosis.

Globally, the chance of dying from cholera has decreased in recent years as a result of increased access to healthcare, better sanitation, and greater education. If people suffering from cholera are treated rapidly and properly, the mortality rate is less than 1%; but with untreated cholera, the mortality rate rises to 50–60%.

Before the introduction of efficient regimens for replenishing fluid and electrolyte deficits, severe cholera had a death rate of more than 50%. Pregnant women and children have a higher mortality rate. Where intravenous treatment is available, mortality rates are lowest. Europe and the Americas continue to have average case fatality rates of roughly 1%.

Since 1970, case fatality rates have decreased significantly in Africa; yet, Africa continues to have the highest recorded case fatality rates (about 4% in 1999) in comparison to the rest of the globe. South America has attained low case fatality rates, owing to the availability of proper treatment facilities and qualified workers.

Overall, the less severe the symptoms and the fewer time individuals have dehydration symptoms, the better the prognosis; in many individuals, if dehydration is rapidly reversed, the prognosis is often excellent.

If you have extreme diarrhea because of cholera or something else, call a doctor right away. If you don’t take enough water and electrolytes, you will become dehydrated. So, when you’re suffering from cholera take enough fluids and electrolytes to prevent dehydration. This issue may lead to fatal health consequences, including death.


1) Cholera

2) Cholera – Illness and Symptoms

3) Cholera – How to Diagnose

4) CBER-Regulated Products: Current Shortages

5) Update: Outbreak of Cholera — Haiti, 2010

6) Current views and challenges on clinical cholera

Disclaimer: This article is intended for informational purposes only. Any information associated with this article should not be considered as a substitute for prescriptions suggested by local healthcare professionals.

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