Cholera

Is an acute diarrhoeal illness caused by the gram-negative bacterium Vibrio cholerae. Following colonisation of the small bowel, the bacteria produces an enterotoxin that causes secretion of fluid and electrolytes and leads to painless, watery diarrhoea but can be fatal if left untreated.

Symptoms

Sudden onset of profuse, watery stools with occasional vomiting. Usually occurs between 2 and 5 days but may be only a few hours of ingesting the bacteria. In severe disease, dehydration, metabolic acidosis and circulatory collapse may follow rapidly. Untreated, over 50% of the most severe cases die within a few hours of onset. With prompt, correct treatment, mortality is less than 1%.

Transmission

Mainly water-borne through ingestion of faecally contaminated water or shellfish and other foods. Person-to-person spread may occur through the faecal–oral route.

Prevalence

Increased risk during natural disasters and war zone but reports of occurrence are mainly in countries with poor sanitation and poor hygiene. WHO reports history of prevalence particularly in Africa, Asia, Central and South America.

Vaccination

Oral, killed cholera vaccine (Dukoral®) is the only licensed cholera vaccine available in the UK. It is inactivated, does not contain live organisms and cannot cause the disease against which it protects.
Vaccine Name Course Per Dose
Cholera 2 Doses £30