Bioterrorism

FAQs - "B" Agents

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Cholera

What is cholera?

Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. The infection is often mild or without symptoms, but sometimes it can be severe. Approximately 1 in 20 infected persons has severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these persons, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

How does a person get cholera?

A person may get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water.

The cholera bacterium may also live in the environment in brackish rivers and coastal waters. Shellfish eaten raw have been a source of cholera, and a few persons in the United States have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk factor for becoming ill.

What is the risk for cholera in the United States?

In the United States, cholera was prevalent in the 1800s but has been virtually eliminated by modern sewage and water treatment systems. However, as a result of improved transportation, more persons from the United States travel to parts of Latin America, Africa, or Asia where they are infected by cholera. In addition, domestic foodborne outbreaks in the United States have been caused by cholera-contaminated seafood brought back by travelers.

What should travelers do to avoid getting cholera?

The risk for cholera is very low for U.S. travelers visiting areas with epidemic cholera. When simple precautions are observed, contracting the disease is unlikely.

All travelers to areas where cholera has occurred should observe the following recommendations:

  • Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water and carbonated, bottled beverages with no ice.
  • Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.
  • Avoid undercooked or raw fish or shellfish, including ceviche.
  • Make sure all vegetables are cooked; avoid salads.
  • Avoid foods and beverages from street vendors.
  • Do not bring perishable seafood back to the United States.
  • A simple rule of thumb is "Boil it, cook it, peel it, or forget it."

Is a vaccine available to prevent cholera?

No cholera vaccines are available in the United States. Two oral vaccines are available outside of the United States however, they are not generally recommended for travelers because of the brief and incomplete immunity they offer.

Can cholera be treated?

Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients die.

Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as rehydration. Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical attention promptly.

What is the U.S. government doing to combat cholera?

U.S. and international public health authorities are working to enhance surveillance for cholera, investigate cholera outbreaks, and design and implement preventive measures. The Centers for Disease Control is investigating epidemic cholera wherever it occurs and is training laboratory workers in proper techniques for identification of V. cholerae. In addition, the Centers for Disease Control is providing information on diagnosis, treatment, and prevention of cholera to public health officials and is educating the public about effective preventive measures.

The U.S. Agency for International Development is sponsoring some of the international government activities and is providing medical supplies to affected countries.

The Environmental Protection Agency is working with water and sewage treatment operators in the United States to prevent contamination of water with the cholera bacterium.

The Food and Drug Administration is testing imported and domestic shellfish for V. cholerae and monitoring the safety of U.S. shellfish beds through the shellfish sanitation program.

With cooperation at the state and local, national, and international levels, assistance will be provided to countries where cholera is present, and the risk to U.S. residents will remain small.

Where can a traveler get information about cholera?

The global picture of cholera changes periodically, so travelers should seek updated information on countries of interest. The Centers for Disease Control maintains a travelers' information telephone line on which callers can receive recent information on cholera and other diseases of concern to travelers. Data for this service are obtained from the World Health Organization. The number is 877-FYI-TRIP (394-8747) or check out CDC.gov.


Find the PDF version of this FAQ in the Zebra Manual.