Cholera is an acute, contagious gastrointestinal infection, which is characterized by sudden severe diarrhea. As a result, the body can lose a lot of moisture. In some cases, this dehydration can lead to very severe situations and even death. But early treatment can prevent it.


Cholera is caused by eating food or drinking water that is contaminated with the cholera bacterium (Vibrio cholerae). The bacterium produces a toxin (enterotoxin), which stimulates the intestinal wall to produce large amounts of moisture. Malnourished people are much more susceptible to having this disease. One can also be infected via contact with feces or vomit from a patient. Under poor sanitary conditions, these bacteria can survive well and spread. This can especially occur after disasters and in wartime, when large quantities of people live together in camps with inadequate sanitary facilities.


After infection, it takes one to five days before the first symptoms occur. It starts with vomiting, diarrhea and abdominal pain. The stools come in large quantities (sometimes up to forty times per day) and is watery. The moisture loss is huge and a life-threatening situation may occur. During epidemics, there are also lots of milder cases. Depending on the nutritional status at the time of the onset of the disease, the mortality rate can be as much as seventy-five percent.


The diagnosis of cholera is made on the basis of physical examination and identification of the bacterium concerned. A stool sample or a smear of the rectum is sent to a laboratory where a culture is developed. The diagnosis is confirmed when the cholera bacterium has been identified by microscopic examination of the stool sample.


The treatment includes administration of oral rehydration fluid to stop dehydration and optionally antibiotics. If the patient cannot take the fluid, an infusion is required. Since 2004, a vaccine is available against cholera. This vaccine prevents about eighty-five percent of cholera infections. Given the small chance of getting cholera, for travellers there is basically no indication to take this vaccine prior to the trip. Exceptions are people going to work in a refugee camp and likely may not have boiled or bottled water available.


Cholera can have a very serious course and lead to death within hours. However, with rapid and appropriate treatment, the risk of death is low, about one percent. The severity of the disease is highly dependent on the health and nutritional status. However, the disease usually has a mild course.