CHOLERA is spread when people eat food or drink water that has been contaminated with faeces (excreted waste) containing Vibrio cholerae. Risk factors for epidemics of cholera include unsanitary and crowded living conditions, war, famine (scarcity of food), and natural disaster.

For example, following a natural disaster such as a hurricane or flood, supplies of drinking water can become contaminated. The disease is most frequently spread in areas with poor sanitation and water treatment facilities.

During outbreaks of the disease, cholera may spread by contact with the faeces of an infected person; Vibrio cholerae can live in faeces for up to two weeks. It also spreads when people use contaminated water for cleaning or waste disposal. Eating raw or undercooked shellfish can be another source of the illness because the bacteria can survive in slow-moving rivers and coastal waters.

The few cases in the United States are typically caused by contaminated seafood from the Gulf of Mexico or seafood brought home by people who have travelled to other countries.

Signs and symptoms

The major symptom of cholera is diarrhea, which can be severe and cause up to a quart of fluid loss per hour from the body. Diarrhea caused by cholera is painless, with stools that are fishy smelling and watery, often with flecks of mucus in them (these are sometimes called “rice water” stools, because they look like rice floating in water).

Diagnosis
Because the symptoms of cholera are often identical to those of other illnesses that cause diarrhea, knowing that a person has travelled to a country where cholera is endemic is important in helping a doctor make the diagnosis. Blood and stool samples can be taken to look for signs of the bacteria.

Treatment
Treatment of cholera can be very simple and effective, especially if it is given soon after symptoms appear. Rehydration, or replenishing the body with fluids, is the most important part of treatment. This can be accomplished most effectively by drinking a mixture of sugar, salts, and clean water, known as an oral rehydration solution. The World Health Organization has an oral rehydration solution that is distributed worldwide through the efforts of the United Nations. Such solutions replenish the fluid and salts lost by the body due to diarrhoea and vomiting.

More serious cases of cholera may require intravenous (in-tra-VEE-nus) fluids, or fluids injected directly into a vein. Antibiotics, which are given in severe cases, can shorten the time that the symptoms last and help prevent spread of the disease to others.

Complications
Complications from cholera are usually the result of severe dehydration. Seizures, abnormal heart rhythms, shock, damage to the kidneys, coma, and death can occur. Children, especially infants, are more likely to develop complications than adults because they are more prone to developing severe dehydration and body mineral imbalances.

Steps people can take to prevent cholera when travelling or after a natural disaster include:
-drinking only bottled water, water that has been boiled or treated with chlorine or iodine, or bottled, carbonated beverages

*eating only food that has been thoroughly cooked and is still hot
*not eating raw fruit or vegetables unless they have been peeled
*avoiding food and drinks sold by street vendors
*avoiding raw or undercooked seafood

Vaccines
Vaccines for cholera exist, but their effectiveness is short lived.