Cholera; Causes, Symptoms, Treatment, & Prevention

Cholera is a dangerous intestinal infection that can kill within hours if left untreated. It’s rare in developed countries like the US, Denmark, and Australia, but in less developed regions like Nigeria, Eritrea, Zimbabwe, etc, it remains a persistent threat. So how does this nasty bug infect, spread, and kill so efficiently? What are the tell-tale symptoms? And most importantly, how can you protect yourself from getting it? Read on, and we’ll give you the low-down on everything about Cholera, from causes to symptoms, treatment, and prevention.

What Is Cholera?

Cholera is a highly contagious bacterial disease. It causes severe diarrhea and dehydration, which can be life-threatening if left untreated.

This acute diarrheal illness is caused by the Vibrio cholerae bacterium. These microscopic organisms release a toxin that triggers the intestines to secrete enormous amounts of fluids and electrolytes. This leads to the hallmark watery diarrhea symptom. You can get infected by ingesting contaminated food or water.

Cholera outbreaks frequently occur in areas with poor sanitation, crowding, war or famine. It remains a major public health threat in parts of Africa, Southeast Asia and Haiti. Rapid treatment is crucial to prevent fatalities.

Is There a Vaccine For Cholera?

Yes, there are oral cholera vaccines available that provide protection against Cholera. The two internationally approved cholera vaccines are:

Dukoral

• An oral, inactivated whole-cell vaccine. It requires two doses given 1-6 weeks apart.
• Provides 60-85% protection against Cholera for 2-3 years after vaccination.

Shanchol/mORC-Vax

• An oral killed whole-cell vaccine given in a single dose.
• Offers around 65% protection for at least 3 years in endemic areas.

Both vaccines are safe, effective and WHO-prequalified for use in cholera-affected areas. They provide a complementary tool along with other prevention and control measures like improving water/sanitation infrastructure.

History and Origin of Cholera

Cholera has plagued humanity for centuries. Some of the earliest recorded outbreaks trace back to ancient India and Greece around the 5th century BC. This acute diarrheal disease caused by the Vibrio cholerae bacterium has killed millions worldwide.

The earliest recorded outbreak dates back to the Ganges delta in 1817. However, some evidence suggests it may have existed since ancient Greek times. It eventually reached as far as Great Britain and the Americas by the 1830s via trade routes. Six more devastating global pandemics followed over the next 150 years. In 1854, John Snow traced a deadly London outbreak to a contaminated water pump. This discovery linked Cholera to contaminated water. However, it took decades before the cause, Vibrio cholerae bacteria, was identified.

Major scientific breakthroughs in cholera treatment occur late in this period (especially between 1879 and 1883), including the first immunization by Pasteur, the development of the first cholera vaccine, and the identification of the bacterium Vibrio cholerae by Filippo Pacini and Robert Koch’s. After a long while, a seventh cholera epidemic emerged in 1961. The epidemic subsided in the 1970s, but it persisted on a smaller scale. Outbreaks persist across the developing world to this day. Epidemics occurred following wars, civil upheaval, or natural disasters, such as when water and food supplies were polluted with Vibrio cholerae, as well as due to overcrowding and poor sanitation.

Despite medical advances, Cholera remains a global threat today, particularly in areas with poor sanitation, crowding, war and lack of clean water access. An estimated 3-5 million cases and over 100,000 deaths occur annually from this preventable disease.

Causes and Risk Factors for Cholera

Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none to mild to severe. These are the major causes of Cholera:

Poor Sanitation & Contaminated Water

The primary cause is ingesting food or water contaminated with the cholera bacteria. Poor sanitation and lack of clean drinking water enable the spread of fecal matter. Areas with inadequate sewage treatment and improper disposal of waste are at high risk.

Poverty & Overcrowding

Poverty-stricken areas lacking basic infrastructure like toilets and clean water supply are breeding grounds for cholera outbreaks. Overcrowded living conditions facilitate rapid transmission from person to person.

Natural Disasters

Flooding can contaminate water sources by overflowing sewage systems. Earthquakes often damage sanitation facilities, creating conditions ripe for Cholera to flourish in impacted regions.

Global Travel & Migration

As people traverse across borders, Cholera can spread to new areas. Outbreaks in refugee camps are common due to inadequate sanitary conditions.

Eating Undercooked Seafood

Raw or undercooked shellfish from cholera-infected waters can transmit the bacteria when consumed. Cooking seafood thoroughly kills the cholera pathogen.

Poor Personal Hygiene

Not washing hands regularly, especially before eating or after using the restroom, increases the risk of ingesting cholera bacteria and infecting others.

Immunocompromised Individuals

Those with weakened immune systems are more susceptible to contracting cholera and experiencing severe, life-threatening symptoms if infected.

Signs and Symptoms of Cholera

These are some of the symptoms of Cholera:

Severe, Watery Diarrhea

The hallmark symptom of Cholera is profuse, watery diarrhea. Stools can rapidly become so voluminous that they literally flood from the body. This extreme diarrhea leads to rapid dehydration.

Vomiting

Vomiting is another common symptom that compounds dehydration. It often starts with dry heaves caused by intestinal fluid loss.

Muscle Cramps

As the body loses massive amounts of fluids and electrolytes like sodium, potassium and chloride, painful muscle cramps can occur. These may first be felt in the arms and legs.

Rapid Heart Rate

Dehydration makes the heart work harder to pump diminishing fluids through the body, leading to a rapid or irregular heartbeat.

Loss of Skin Elasticity

With severe dehydration, the body’s cells are depleted of fluids and electrolytes. This causes the skin to become inelastic — if pinched, it may remain tented.

Dry Mouth

A dry, parched mouth is another common indicator of dehydration from Cholera. The excessive diarrhea and vomiting quickly deplete the body’s fluids.

Fatigue & Irritability

Cholera’s intense diarrhea can rapidly drain a person’s energy reserves. Fatigue, lethargy and irritability often accompany the other symptoms.

Low Urine Output

In trying to conserve fluids, the kidneys drastically reduce urine output during cholera infection. Little or no urination is a red flag.

Sunken Eyes

Loss of fluids and electrolytes causes the eyes to appear sunken in their sockets, giving a hollow, gaunt appearance.

What Problems Can Cholera Cause?

Cholera can lead to:

Severe Dehydration

Cholera’s hallmark symptom is watery diarrhea so severe that it can quickly lead to dangerous fluid loss and dehydration. Without proper rehydration, this can be fatal within hours, especially for young kids and the elderly.

Shock

Severe dehydration from Cholera can send the body into hypovolemic shock, a life-threatening drop in blood volume and pressure. Organs start failing without enough circulating blood flow.

Electrolyte Imbalance

The extreme purging of fluids causes a dangerous depletion of electrolytes like sodium, potassium and chloride, which the body needs to function properly. This electrolyte imbalance compounds other cholera complications.

Acute Kidney Injury

Severe dehydration and electrolyte disturbances put immense strain on the kidneys. Acute kidney injury can develop, where the kidneys abruptly lose their ability to filter waste from blood.

Severe Acidosis

A dangerous buildup of acid in the bloodstream (acidosis) is another major risk. It happens when the kidneys can’t expel enough acid waste due to Cholera’s effects.

Seizures & Coma

When Cholera gets extremely severe, the electrolyte imbalance and toxic acidosis can impact brain function. This can potentially trigger seizures, brain damage, and even coma.

Severe Muscle Cramps

The intense loss of sodium, potassium and other electrolytes through diarrhea can cause agonizing, uncontrollable muscle cramping throughout the body.

Death

If untreated, the combination of severe dehydration, electrolyte depletion, acidosis and organ failure caused by Cholera frequently leads to death, often within just a few hours in vulnerable groups.

How is Cholera Transmitted?

Cholera is a highly contagious disease that spreads through contaminated water and food. Here are the main ways it gets transmitted:

Contaminated Water Sources

• Drinking water contaminated by cholera-causing bacteria
• Using untreated water for cooking or washing food
• Swimming or bathing in contaminated water sources

Eating Contaminated Food

• Raw or undercooked fish, shellfish, fruits, and veggies irrigated with contaminated water
• Food handled by someone with Cholera who didn’t wash hands properly

Poor Sanitation and Hygiene

• Lack of proper toilets and sewage disposal leads to contamination
• Not washing hands thoroughly with soap after using the bathroom

Household Contacts

Close household contact with someone infected can easily transmit Cholera through sharing food, water, or poor hygiene.

Healthcare Settings

Cholera can spread in hospitals or clinics with inadequate water/sanitation systems and improper disinfection.

Traveling to Endemic Areas

Visiting regions with ongoing cholera outbreaks increases transmission risk without proper precautions.

Natural Disasters & Conflicts

These situations can damage water/sanitation infrastructure, creating conditions for rapid cholera spread.

Diagnosis of Cholera

Diagnosing Cholera involves testing the patient’s stool or vomit for the cholera bacterium. A lab technician looks at a sample under a microscope to identify the curved, comma-shaped bacteria.

A rapid dipstick test can also detect the toxic protein produced by the cholera bacteria in a stool sample. This provides results faster than culturing bacteria which can take days.

In areas without lab capabilities, a doctor might diagnose Cholera based on the patient’s severe diarrheal symptoms and recent travel to an area with an outbreak. But confirming with tests is ideal.

Treatment of Cholera

The most important treatment for Cholera is rehydration therapy to replace fluids lost through diarrhea and vomiting.

Oral Rehydration Therapy

This affordable treatment replaces fluids and electrolytes lost through diarrhea. Pre-packaged sachets containing salts and glucose are mixed with water and sipped frequently.

IV Fluids

For severe cases, IV fluids are crucial to rehydrate the body quickly. Cholera’s rapid fluid loss can lead to shock and death if not treated immediately.

Antibiotics

While not always necessary for treatment, antibiotics can shorten the illness duration and reduce fluid requirements. Common options include doxycycline, azithromycin and ciprofloxacin.

Zinc Supplements

Zinc supplements reduce diarrhea duration and severity in children. They are recommended, along with ORT and antibiotics.

Supportive Care

Patients may need supplemental oxygen, IV nutrients, and monitoring for complications like kidney failure. Around-the-clock care is essential.

Isolation Precautions

To prevent spread, cholera patients should be isolated and their body fluids contained until diarrhea stops. Good sanitation and hygiene are critical.

Post-Recovery Monitoring

After recovering, patients should be monitored for potential long-term effects like malnutrition or post-infectious irritable bowel syndrome.

Public Health Measures

Community-wide cholera control involves improving water/sanitation infrastructure, proper waste disposal, health education, and vaccination campaigns.

Preventing Cholera: Hygiene and Vaccination

To prevent Cholera, follow these instructions:

Practice Good Hygiene

• Wash hands frequently with soap and clean water, especially before eating or preparing food. This eliminates cholera bacteria from your hands.
• Only drink safe water from a treated or chlorinated source. Boil it if unsure.

Get Vaccinated

• The cholera vaccine provides short-term protection against the disease. It’s recommended for high-risk areas.
• Two doses are needed for full immunization.

Cook Food Thoroughly

• Cholera bacteria are killed by heat. Ensure all foods are thoroughly cooked and still hot when eaten.

Peel it or Leave it

• Avoid raw fruits/vegetables you can’t peel. The bacteria can contaminate the outside.

Dispose Waste Properly

• Human waste spreads Cholera rapidly. Use proper sanitation facilities and good hygiene practices.

Avoid Unsanitary Areas

• Stay away from areas with poor sanitation or untreated water sources if possible.

How Common is Cholera in Nigeria?

Cholera remains a major public health concern in Nigeria. The country experiences frequent outbreaks, with cases reported across various states every year.

In a recent development, the Nigeria Centre for Disease Control and Prevention reported a significant cholera outbreak across the country in June 2024. The numbers were staggering 1,141 suspected cases, 65 confirmed infections, and a tragic loss of 30 lives. This outbreak wasn’t localized; it spanned a whopping 96 Local Government Areas across 30 states. Cholera, a highly contagious disease, can spread like wildfire if left unchecked. Urgent action is needed to contain this public health crisis.

With cases surging, health authorities urged citizens to remain vigilant. Practicing good hygiene, consuming safe water, and seeking immediate medical attention for symptoms like diarrhea were crucial steps. Only through a concerted effort could this deadly outbreak be brought under control.

Although, official data likely underestimates the true burden, as many cases go unreported due to limited access to healthcare and diagnostic facilities, especially in rural areas. However, Cholera is considered endemic in several Nigerian regions.

Emergency Hotline to Call About Cholera Outbreak in Lagos State, Nigeria

In case of any suspected case of Cholera, please kindly call the Disease Surveillance & Notification Officers [DSNOs] in your LGA or the Medical Officer of Health or Lagos State Ministry of Health should be notified by calling these GSM numbers: 08023169485, 08137412348. Use designated helplines to report cases and receive instructions. Call 767 or 112.

Additional Resources

World Health Organization (WHO): www.who.int

Nigeria Centre for Disease Control (NCDC): www.ncdc.gov.ng

How can I Protect Myself if I Plan to be in an Area with Cholera?

To protect yourself if you are in an area prevalent with Cholera, follow this instructions:

Stay Hydrated

Drink plenty of safe water and oral rehydration solutions to replace fluids lost from diarrhea. Dehydration is a major cholera risk, so stay hydrated.

Wash Hands Frequently

Wash your hands often with soap and safe water, especially before eating or preparing food. Good hand hygiene is crucial to prevent cholera transmission.

Eat Safe Foods

Only eat foods that are cooked hot and fresh. Avoid raw foods like fruits/veggies unless you peel them yourself. Avoid foods from street vendors.

Use Treated Water

Drink and use treated, boiled or chlorinated water for drinking, cooking, and brushing teeth. Avoid untreated water sources that could be contaminated.

Get Vaccinated

Get a cholera vaccine before travelling to high-risk areas. The vaccine provides short-term protection against Cholera.

Pack Sanitizer

Bring alcohol-based hand sanitizers (containing at least 60% alcohol) for times when soap and safe water aren’t available.

Seek Medical Care

If you develop severe diarrhea, vomiting, or dehydration, seek immediate medical care. Cholera can be fatal without proper treatment.

Frequently Asked Questions

These are some frequently asked questions and answers about:

How long does Cholera last?

Cholera symptoms usually appear 12 hours to 5 days after infection. Without treatment, it can last 7 days or longer. With proper rehydration, Cholera typically resolves within 3-7 days.

What happens if Cholera is untreated?

Left untreated, Cholera can quickly cause severe dehydration and electrolyte imbalances that can be fatal within hours, especially in children. Seek immediate medical care if Cholera is suspected.

Is there a cholera vaccine?

Yes, oral cholera vaccines are available and recommended for high-risk areas. They provide short-term protection against Cholera but don’t provide complete immunity.

Can you heal from Cholera?

With prompt rehydration treatment, most cholera patients recover completely with no lasting issues. However, Cholera can recur without improved sanitation and hygiene.

Who is most at risk for Cholera?

Those living in areas with poor sanitation and lack of clean drinking water face the highest cholera risk. Children are especially vulnerable due to greater fluid loss and dehydration dangers.

What is the best treatment for Cholera?

Oral rehydration solutions containing water, salts and sugars are crucial. Antibiotics can shorten illness duration. Severe cases require IV fluids and electrolyte replacement.

Is Cholera contagious?

Yes, Cholera spreads through contaminated food and water sources containing the vibrio cholerae bacteria from the feces of infected people. Good hygiene practices prevent transmission.

What food is good for cholera patients?

Eat bland, starchy foods like rice, bread, bananas and soups. Avoid dairy, fatty or spicy items that can further irritate the digestive system. Stay hydrated.

What tests are done to diagnose Cholera?

A stool sample is tested in a lab to identify the cholera bacteria. A quick dipstick test can also detect Cholera. But for full confirmation, the bacteria needs to be isolated and identified.

Which antibiotic is best for Cholera?

Oral rehydration salts are crucial to replace lost fluids. But antibiotics like azithromycin and doxycycline help shorten the illness and prevent severe dehydration.

Does boiling water stop Cholera?

Yes, boiling water kills cholera bacteria, making it safe to drink. Cholera spreads through contaminated water and food. So disinfecting water is key.

What is another name for Cholera?

Cholera was historically called Asiatic Cholera or epidemic cholera. But it’s simply called Cholera now.

Which part of the body gets affected by Cholera?

Cholera bacteria infect the intestines (small intestine), causing severe diarrhea and vomiting. This leads to rapid dehydration and electrolyte imbalances in the body.

What blood type is susceptible to Cholera?

People with O blood type have an increased risk of severe Cholera. Their lack of certain antibodies makes them more susceptible to the cholera toxin.

What are the five complications of Cholera?

• Severe dehydration and electrolyte imbalances from extreme diarrhea. This can lead to shock, coma, and death if untreated.
• Acute kidney failure due to lack of fluids.
• Severe malnutrition and muscle wasting from fluid/nutrient losses.
• Respiratory distress from severe electrolyte abnormalities.
• Long-term complications like Guillain-Barré syndrome.

What does cholera stool look like?

The hallmark “rice-water” diarrhea is voluminous, pale, milky, and flecked with mucus, looking like water after rinsing rice. It has little to no odor.

What is the first aid treatment for Cholera?

Immediately start oral rehydration therapy with pre-packaged ORS solution or a homemade mixture of 1 litre of water, 6 teaspoons of sugar, and 1/2 teaspoon of salt. Seek medical care rapidly.

What is the best fluid for cholera patients?

Oral rehydration solutions like Pedialyte or a homemade mixture of sugar, salt, and clean water are best for replacing fluids lost through diarrhea. Avoid milk products, caffeine, and alcohol, which can worsen symptoms.

Why is Cholera called the blue death?

The extreme dehydration from Cholera can cause the skin to take on a bluish tint, hence the name “blue death.” This is due to low oxygen levels in the blood from dehydration.

How is Cholera transmitted?

Cholera spreads through contaminated food or water sources containing the Vibrio cholerae bacteria. Poor sanitation, overcrowding, and lack of clean drinking water increase transmission risks.

Conclusion

Cholera is still around and can cause some pretty nasty symptoms if you get infected. Stay on top of water treatment and good hygiene, especially if traveling, and get medical help fast if you notice the telltale signs. Cholera thrives on poverty and poor sanitation, so supporting infrastructure improvements and access to clean water in vulnerable areas is key to giving it the boot. We’ve come a long way in managing cholera outbreaks, but it will keep sneaking back until everyone has access to clean H2O and proper sewage systems. In the meantime, sip safely and stay healthy.