FAQ on Cholera


by Dr. Y.L.M.

I read about the outbreak of cholera in Haiti. I haven’t heard of anyone getting cholera in Malaysia recently. What is cholera?

Cholera is an infection of our intestine with a bacteria called Vibrio cholerae. If you look at the bacteria under a microscope, it looks like a comma, and just one confirmed case is enough for public health authorities to declare an epidemic.



WHO estimates the incidence of cholera around the world to be around 3 to 5 million cases a year, so unfortunately it is still very common.

Cholera causes 100,000 deaths a year. Cholera initially was confined to the Ganges delta in India. But in the 19th century, it spread throughout the world. From then on, there have been 7 devastating pandemics that have killed millions of people around the world.

It is safe to say that cholera is everywhere today. Apparently, global warming is making conditions more favourable for cholera to thrive.



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How does one get cholera? Is it avoidable?

Vibrio cholerae is usually found in water or food which is contaminated by the faeces of a person infected with cholera. If our water is inadequately treated or if there is poor sanitation, cholera can spread very rapidly.

Haiti was victim to the recent earthquake that devastated buildings, drainage, and sanitation plants. Cholera was bound to spread in such conditions.

Vibrio cholerae is also found in slow-flowing rivers, especially with a lot of backwater and coastal waters. As for food, raw shellfish is a source of cholera, so make sure you know what you are getting into when eating raw oysters! Cholera cannot be spread from person to person.


How would I know if I have cholera?

Once infected with the bacteria, it can take anything from hours to days for the first symptoms of cholera to appear. Basically, most people have symptoms that appear within 2 to 3 days.

About 75% of the people infected with the bacteria do not show any symptoms. Unfortunately, the bacteria is present in these people's faeces and goes around contaminating the environment, spreading the disease to everyone else.

This happens for 7 to 14 days after the person is infected, and only after 14 days will the person's stools be uncontaminated.

As for the 25% of patients who develop symptoms, 4 out of 5 of them have mild to moderate symptoms such as watery diarrhoea. But one out of 5 people infected with cholera have a very severe, virulent disease. The diarrhoea is very profuse.

There is vomiting and leg cramps due to electrolyte loss. Severe dehydration sets in because of the extreme loss of fluids, leading to shock.

If untreated, these patients will rapidly die in a few hours.


How is cholera treated?

Cholera is treated by replacing the fluids and electrolytes that you have lost (through diarrhoea or vomiting). If your disease is mild to moderate, you can do this by drinking oral rehydration salts mixed with water. You have to keep on drinking this in large amounts.

If your diarrhoea and vomiting is severe, you will need to replace your fluids intravenously.

Antibiotics can shorten the course of your disease, but rehydration is the most important part of cholera treatment. Fewer than 1% of patients die if they have received adequate rehydration.


If I were to visit a country where sanitisation of water sources is known to be less than satisfactory, what must I do?

You should drink only bottled mineral water. Do not drink directly from cups. Use a straw if you must. When in a hotel room with a kettle, make sure you boil all your water before consuming it.

Do not put ice cubes in your drinks. You do not know where they came from. Do not drink from any water coolers. Keep washing your hands with soap and water. Even when brushing your teeth, do not use tap water.

Use bottled or boiled water instead. Do not eat raw or uncooked foods. Do not eat fresh salads that have been washed with 'unknown' water. Be careful of eating fruits that have been washed. Wash your own fruits and vegetables with bottled water.


I have heard of a cholera vaccine. Can I take a shot before I visit an endemic country?

Cholera vaccines are not shots. They are taken orally. They can help, but weeks can lapse before you receive immunity. Moreover, the disease protection conferred by these vaccines is only a little over 50%. It is therefore prudent to take all those measures outlined above as well as take the vaccines before going to a cholera endemic country.



More info on CHOLERA here.






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