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Bacterial & Viral Infections


If you follow the news, you may have heard a reporter talk about an “outbreak of cholera” somewhere in the world. It may sound a little scary. But is cholera something you need to worry about?

What Is Cholera?

Cholera is an infection of the intestines. People get it from drinking water or eating food that’s contaminated with a type of bacteria called Vibrio cholerae.

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Cholera can cause watery diarrhea and vomiting, making people who have it get dehydrated quickly. When dehydration is severe, it can cause serious health problems if it’s not treated. It can even cause seizures and kidney failure. People who don’t get the proper medical treatment may even die.

The good news is, cholera is easy to treat if it’s caught early. People who have mild to moderate cases usually get better within a week. Even people with severe cases of cholera recover fully in a week or so if they get medical care.

Cholera is mostly found in the tropics — in particular Asia, Africa, Latin America, India, and the Middle East. It’s rare in the United States, but people can still get it. People who travel from countries where the infection is more common can bring cholera into the U.S. Some people in the U.S. have become sick from eating raw and undercooked shellfish from the Gulf of Mexico.

How Do People Get It?

It’s yucky to think about, but people get cholera from eating or drinking food or water that’s been contaminated with the feces (poop) of someone who has cholera. This is one reason why cholera is rare in countries with good sanitation systems. Things like flush toilets, sewer systems, and water treatment facilities keep poop out of the water and food supply.

But for people living in places without good sanitation, cholera is more of a risk. Cholera epidemics can also sometimes happen after a disaster (like an earthquake or flood) if people are living in tent cities or other places without running water or proper sanitation systems.

Cholera is not contagious, so you can’t catch it from direct contact with another person.

What Are the Signs and Symptoms?

When someone is infected with the cholera bacteria, symptoms can appear in a few hours or as late as 5 days later. Some people with cholera have no signs or symptoms, but some cases are severe and can be life-threatening.

Common symptoms of cholera and the dehydration it causes include:

  • watery, pale-colored diarrhea, often in large amounts
  • nausea and vomiting
  • cramps, particularly in the abdomen and legs
  • irritability, lack of energy, or unusual sleepiness
  • glassy or sunken eyes
  • dry mouth and extreme thirst
  • dry, shriveled skin
  • low urine (pee) output and a lack of tears
  • irregular heartbeat (arrhythmia) and low blood pressure

When Should I Call a Doctor?

If you develop symptoms of cholera, especially after visiting an area where the disease is common, call your doctor or get medical help right away. Severe dehydration can happen very quickly, so it’s essential to start replacing lost fluids right away.

If you have a severe case of diarrhea or vomiting, call a doctor immediately, even if you’re pretty sure it’s not cholera. Dehydration is a serious medical condition regardless of the cause, and it needs to be treated quickly before it can do damage to internal organs.

What Do Doctors Do?

To confirm a diagnosis of cholera, doctors may take a stool sample or vomit sample or rectal swab (a swab of the inside of the butt) to examine for signs of the bacteria.

Cholera needs immediate treatment because severe dehydration can happen within hours. Fortunately, treatment is simple and very effective. Very few people who get treatment die.

The goal of cholera treatment is to replace all the fluids and electrolytes (salts) lost through diarrhea and vomiting. For mild dehydration, a doctor may recommend drinking an over-the-counter rehydration solution. People with more severe cases of cholera may need to stay in the hospital and get intravenous (IV) fluids.

Sometimes doctors prescribe antibiotics to treat cholera. The antibiotics are not as important as rehydrating, but they can help shorten the length of time a person is sick. They also might make cholera-related diarrhea less severe. Sometimes doctors also prescribe zinc supplements.

Anti-diarrheal medicines can actually make the symptoms of cholera worse, so people who think they may have cholera should avoid taking them.

How Can I Prevent Cholera?

Some countries have cholera vaccines that can help protect people against cholera for a short while. Because cholera isn’t a problem in the United States, the vaccine is not offered here.

If you’re going to an area that has cholera, you can greatly reduce your risk of getting the disease by following a few simple precautions when you get there:

  • Boil or disinfect any water that you’ll use for drinking, washing or preparing food, making ice, making coffee or tea, or brushing your teeth. Choose bottled water or other drinks that come in sealed cans or bottles. Be sure to wipe the outside of the can or bottle before you drink from it, though. Avoid tap water, fountain drinks, and drinks with ice cubes.
  • Fully cook all food, especially seafood. Avoid food from street vendors. Instead, eat packaged foods and meals that are freshly cooked and served hot. Avoid sushi and any other raw or partly cooked seafood.
  • Avoid raw vegetables, including salads, and fruits that have already been peeled or cannot be peeled like grapes and berries. Bananas, avocados and oranges make better choices.
  • Dairy foods are often contaminated, so be careful with things like ice cream, milk, and cheese. Eat only pasteurized dairy and be sure dairy foods are refrigerated and kept cold.
  • Wash your hands well and often with soap and clean water, especially after you use the bathroom or before you prepare food. If no soap and water are available, use a hand cleaner that’s at least 60% alcohol.

If you’re planning to visit the tropics, especially an area that doesn’t have good sanitation, it’s a good idea to know the signs of cholera and what to do. Taking precautions with your food and water is the best way to avoid the disease.

Reviewed by: Rebecca L. Gill, MD
Date reviewed: January 2015