Cholera is a bacterial infection caused by drinking contaminated water or eating food that has been in contact with contaminated water.

Not everyone who becomes infected will develop symptoms, but those who do will usually experience:

These symptoms generally develop within a few days of infection, although they can sometimes occur after only a few hours.

Without treatment, the combination of diarrhoea and vomiting can cause a person to quickly become dehydrated and go into shock (where there is a sudden massive drop in blood pressure). In the most severe cases, the condition can be fatal.

At-risk areas

Cholera can spread if food and water in particular becomes contaminated with the stools (faeces) of someone with the infection. This is why the condition is most common in regions of the world with poor sanitation, such as parts of:

  • sub-Saharan Africa
  • south and south-east Asia
  • the Middle East
  • central America and the Caribbean

Mass outbreaks of cholera can occur in times of a natural disaster or war, as a result of overcrowding in poor living conditions and a lack of access to clean water.

The World Health Organization estimates that there are between 3 and 5 million cases of cholera worldwide every year.

There have been no cases of cholera originating in England and Wales for over 100 years, although travellers do occasionally bring the infection back with them. This is rare, however, with only 12 reported cases in England and Wales during 2012.

Advice for travellers

If you are travelling to parts of the world known to be affected by cholera, following basic precautions should prevent you from contracting a cholera infection and other causes of traveller’s diarrhoea:

  • only drink water that has been recently boiled, or drink from a bottle that is properly sealed
  • avoid ice cream and don't have ice in your drinks
  • avoid uncooked fruits and vegetables unless you have washed them in safe water or peeled them yourself
  • avoid shellfish, seafood or salads

Read more about food and water safety abroad.

Cholera vaccination

Vaccination against cholera may sometimes be recommended if you are travelling to areas where the infection is widespread, particularly if you're an aid worker and likely to have limited access to medical services.

Speak to a nurse or doctor about whether you need a cholera vaccination well in advance of travelling if you are considering visiting an area affected by cholera.

The cholera vaccine is available as a drink, which is given in two or three separate doses that are taken between one and six weeks apart.

The vaccine is estimated to be about 85% effective in the months following vaccination, although the level of protection gradually reduces over time and booster doses will eventually be needed if you continue to be at risk.

Read more about cholera vaccination.

Treating cholera

Cholera needs prompt treatment with oral rehydration solution (ORS) to prevent dehydration and shock. ORS comes as a sachet containing a mixture of salts and glucose, which is designed to be dissolved in water. ORS is ideal for replacing the fluids and minerals that are lost when a person becomes dehydrated.

As well as treating dehydration and shock with ORS, antibiotics are sometimes used to treat the underlying infection.

ORS sachets are available from many pharmacists, camping shops and travel clinics. If you are travelling to regions of the world affected by cholera, take ORS sachets as a precaution.

Read more about accessing healthcare abroad.

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