Cholera is an infectious disease caused by the bacteria Vibrio cholerae. People typically acquire cholera from contaminated water.

Most people with cholera have few or no symptoms, but some will experience severe diarrhea and dehydration.

In severe cases, immediate treatment is necessary because death can occur within hours. This can happen even if you were healthy before you contracted cholera.

Modern sewage and water treatment have effectively eliminated cholera in most countries. It’s still a problem in parts of Asia, Latin America, Africa, and the Middle East.

According to the World Health Organization (WHO), there are between 1.3 and 4 million cases of cholera worldwide each year, leading to between 21,000 and 143,000 deaths.

Countries affected by war, poverty, and natural disasters are at the greatest risk of a cholera outbreak. That’s because these conditions tend to force people to live in crowded areas without proper sanitation.

Most people with cholera have no symptoms at all or mild to moderate ones. According to the Centers for Disease Control and Prevention (CDC), only around 10 percent of people with cholera have severe symptoms.

Symptoms of cholera may include:

The dehydration associated with cholera is often severe and can cause signs and symptoms such as:

Dehydration may cause the loss of minerals in your blood, which can result in an electrolyte imbalance.

The first symptom of an electrolyte imbalance is severe muscle cramps. An electrolyte imbalance can eventually lead to shock.

In children

Children with cholera usually have the same symptoms as adults. Children may also experience:

When symptoms appear

The majority of people exposed to cholera bacteria never become ill. In most cases, you may never know you’ve been exposed.

According to the WHO, people who are symptomatic typically develop symptoms 12 hours to 5 days after ingesting cholera bacteria.

Once you’ve contracted cholera, you’ll continue to shed the bacteria in your stools for 1 to 10 days, regardless of whether you have symptoms.

Cholera is caused by the bacteria V. cholerae. The disease’s deadly effects are the result of cholera toxin (CTX), a strong toxin that’s produced in the small intestine by V. cholerae.

V. cholerae interferes with the normal flow of sodium and chloride, and it binds to the intestinal walls. When V. cholerae attaches to the walls of the small intestine, the body begins to secrete large amounts of water, leading to diarrhea and the rapid loss of fluids and salts.

Sources of cholera infection include:

  • drinking contaminated water or eating food made with it, which are the primary sources of infection
  • eating raw or undercooked seafood, such as shellfish
  • eating raw fruits and vegetables

Cholera is not usually transmitted from person to person through casual contact.

Anyone can potentially contract cholera, but a few factors may increase your risk. These risk factors also increase the likelihood that you’ll have a severe case:

  • Unclean conditions. Cholera is present in places with poor sanitation and contaminated water.
  • Sick household members. Close contact with people who have cholera can increase your risk.
  • Low levels of stomach acid. Cholera bacteria cannot live in highly acidic environments.
  • Type O blood. People with type O blood are more likely to experience severe illness. According to a 2016 study, this may be because CTX has a stronger response in people with type O blood than in people with other blood types.
  • Eating raw shellfish. If you eat shellfish that come from waters contaminated with cholera bacteria, there’s a greater chance of you contracting cholera.

That said, if you observe proper food safety practices or take preventive measures, the risk of infection is minor, even in places where cholera is endemic.

Cholera vaccines are available.

However, most people in developed countries have a slim chance of contracting cholera. A doctor is unlikely to suggest the vaccine unless you live in or travel to a place where transmission is high.

If you’ve already had the vaccine and are going to be in a country that’s experiencing an active cholera outbreak, you may need a booster. Check with a doctor for advice on receiving the booster vaccine.

The WHO has endorsed three oral vaccines via its vaccines prequalification program:

  • Dukoral
  • Euvichol-Plus/Euvichol
  • ShanChol

They typically require two doses, although 2- to 5-year-olds also receive a third dose of Dukoral. None of these vaccines are available in the United States.

The Food and Drug Administration (FDA) has approved one oral vaccine for use in the United States called Vaxchora.

Vaxchora is a single-dose vaccine for people 2 to 64 years old. In May 2021, amid the COVID-19 pandemic, the manufacturer temporarily stopped production and distribution due to reduced demand and travel. As of November 2021, production and distribution were still on hold, and supplies may be limited.

If you have symptoms of cholera, contact a doctor. They can confirm whether you have cholera by identifying the bacteria in a stool sample.

Common methods for treating cholera include:

These treatments add to the liquid in the body and rehydrate it. They also help reduce the length of time you have diarrhea.

Cholera can be fatal.

In severe situations, such as the 2010 outbreak in Haiti, death can occur in as little as 2 hours after the onset of symptoms. Even under typical circumstances, if cholera is left untreated, people can die of severe dehydration 6 to 12 hours after their symptoms start.

Shock can also set in after a few hours or days.

Severe dehydration and shock are the most serious complications of cholera. However, other problems may occur, such as:

If you’re traveling to an area where cholera is widespread, your chances of contracting it will still be low if you:

  • wash your hands often
  • use bottled or boiled water to brush your teeth or prepare food
  • treat your water with a chlorine product or bleach, if you cannot boil it
  • avoid dairy
  • avoid raw shellfish and most other raw foods
  • only eat raw fruits and vegetables you can peel yourself

If you still develop severe diarrhea after visiting an area with a high rate of cholera, see a doctor.