How is cholera spread?

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Cholera is an infectious disease that affects the small intestine. If humans are in contact with the 'Vibrio cholera' bacterium, which usually occurs through ingesting contaminated water or food, it can infect the digestive system and lead to illness. Once present in the body, the cholera bacteria multiply in the intestinal tract and are passed out in the faeces of the infected person. Cholera is very rare in the UK and other developed countries due to highly effective systems of water purification for drinking and well-developed sewerage treatment, although prior to the wide-scale development of water treatment facilities, cholera was relatively common. In many less developed countries, such as parts of Africa and Asia, the disease is still widespread and outbreaks can occur often, particularly during periods of heavy rain.

Common Sources of Contamination and Transmission

The bacterium associated with the cholera disease can contaminate food or drinking water in two distinct ways; through contaminated faeces or by natural transmission. During a cholera epidemic, the disease is usually spread by the contaminated faeces of an infected person. When communities are living with inadequate sewage facilities or when separate clean drinking water is not available, the disease can spread rapidly. When a single river or water source is used for bathing, drinking and sewerage, the disease can very quickly infect whole communities. As a result, cholera outbreaks often occur in developing countries, refugee camps, after a natural disaster such as an earthquake or flood and during periods of war. Unfortunately, in these situations it is generally also very difficult to provide the necessary medical care once an outbreak does occur and mortality rates tend to be much higher than average.

Other Sources

The cholera bacterium can also live naturally in salt-water rivers and water bodies. It is this source of cholera that has led to some reports of infection after eating raw or undercooked shellfish, as the bacterium remains present in the shellfish and when ingested by a human, infects that person's digestive system allowing the disease to take hold. Cholera is also commonly spread by infected persons failing to wash their hands after using the toilet and then touching food or water that other people will consume. Once water is infected, the disease can be spread quite quickly if people continue to drink, bathe or wash food in the contaminated water. It is therefore very important to educate people as to how cholera can be spread in order to try to maintain outbreaks.

Symptoms and Risks

Cholera can be extremely dangerous due to the rapid loss of fluid from the body that occurs as a result of the infection. Anyone infected with cholera, especially the elderly or young children, can become dangerously dehydrated very quickly and, without treatment, death can occur within a matter of hours. On average it takes around two to three days for symptoms to manifest following contraction of the disease; the time between ingesting contaminated water or food and the appearance of cholera-related symptoms is known as the cholera incubation period. Symptoms can include vomiting, dehydration, diarrhoea and, in some cases, muscle cramps. In many cases the infection is relatively mild and there will be no symptoms at all; however in around one fifth of cases, the infected person displays an extreme reaction characterised by rapid fluid loss, shock, increased heart rate and, without treatment, eventually death.

Treatment

One of the most important treatments for cholera sufferers, especially in young children, is rehydration salts which can help to prevent the body becoming excessively dehydrated. In many cases, especially in otherwise healthy adults, the infection is mild and the person can recover without treatment. If, however, the individual experiences severe vomiting or diarrhoea leading to serious dehydration, the replacement of body fluids and vital sugars and salts is essential and oral rehydration salts are likely to be recommended. In the most severe cases, patients may have to be hospitalised and treated with an intravenous drip to replace lost fluids. An antibiotic can also be prescribed in some cases to lessen the duration of illness and reduce the severity of the infection however it is the risk of dehydration rather than the illness itself that is the biggest risk of the disease.

Should you ever find yourself in a resource-limited setting and have to treat someone with suspected cholera, a simple rehydration solution could save their life. You can make this very cheaply by taking one litre of boiled or purified drinking water and dissolving eight teaspoons of sugar and half a teaspoon of salt in the water. Drinking this solution frequently as soon as symptoms are displayed should help to prevent excessive dehydration, which could lead to coma and death if untreated. Try to encourage the patient to drink at least two cups of the rehydration solution after each stool and seek medical help if possible.

Prevention

There are a number of simple precautions that can help to reduce the likelihood of contracting cholera and these are especially important in areas of poor sanitation due to the increased probability of outbreaks. Regular hand washing with soap and water, especially after using the toilet and before preparing food, can help to minimise contamination. It is also recommended that untreated water is not used for drinking and, if you are in an area that does not have treated drinking water, you should take care to boil all water and leave to cool before drinking, cooking or brushing teeth. A vaccine does exist for cholera and this can sometimes be recommended for travellers visiting areas that are considered high cholera risk. This might be appropriate, especially for visits to rural areas or situations such as refugee camps where water and sanitation systems can be very rudimentary. The cholera vaccine is thought to be around 50% effective, although the effectiveness declines further from around two months after vaccination so it is not completely effective against infection.

On the whole, cholera is no longer a major threat in most developed countries due to the effective sanitation systems and widespread knowledge about basic hygiene. However, travellers visiting less developed countries, especially in rural areas, can be at risk of contracting the disease and it well worth being aware of the symptoms. By taking a few basic precautions to avoid drinking contaminated drinking water or eating contaminated food you should minimise the risk of contracting the disease. If you do get infected, remember that dehydration is the single biggest danger and be sure to drink plenty of fluids and rehydration solution to replace lost fluids and salts.

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