Should You be Worried About Getting Cholera?

Cholera is not a threat of the past.

Unlike the Spanish Flu and Bubonic Plague, it still lurks around. Between 2011 and 2020, there have been 565 reported outbreaks in India, resulting in 45,759 cases and 263 deaths. Globally too, the situation is grim — according to WHO, the seventh cholera pandemic has impacted the world since mid-2021. Here’s what you need to know about cholera symptoms, causes, treatment, and prevention strategies.

Cholera, caused by the bacterium Vibrio cholerae, induces acute intestinal infection. CTX, a toxin generated by the bacteria in the small intestine, results in excessive water secretion, leading to fluid loss and diarrhoea.

The disease spreads through the consumption of food or water contaminated by an infected person's faeces. Using unsanitised water for cooking, drinking, or washing increases the risk of infection.

In the Futuremakers podcast series from the University of Oxford, Prof Peter Millican highlights that even historically, there have been heightened transmission risks in areas with disrupted sanitation and water systems, such as refugee camps during humanitarian crises.

It is also not uncommon to contract the disease by consuming raw or undercooked shellfish. Research shows that the bacteria can infect crabs, shrimp, and other shellfish by adhering to their shells, which contain vast quantities of chitin.

Most of those infected remain asymptomatic or show only mild to moderate symptoms.

Only 1 out of 10 develop severe symptoms, watery diarrhoea or rice water stools being the hallmark. Other symptoms include:

• Nausea
• Vomiting
• Dehydration

Cholera has also earned the moniker of ‘blue death’ as a severely dehydrated body has a blue-grey tone. Patients with blood type O may experience more severe symptoms.

Dehydration can cause additional cholera symptoms, such as:

• Fatigue 
• Dry mouth and skin
• Increased thirst
• Reduced urination
• Irregular heartbeat
• Electrolyte imbalance leading to shock
• Muscle cramps
• Kidney failure

Severe watery diarrhoea indicates the onset of cholera. To confirm the diagnosis, your healthcare provider may order a stool test/culture.

The primary focus of cholera treatment is the restoration of lost fluids. Usually, the following rehydration therapies are the first line of treatment:

This is a combination of water, sugar, potassium, and sodium, available over-the-counter in powder and liquid forms. The powder can be had by mixing it with boiled or bottled water. Timely administration of ORS can treat cholera in the majority of patients.

Severely dehydrated patients may need intravenous (IV) fluids, which should only be administered by qualified medical professionals. 

Antibiotics also play a role in cholera treatment, primarily used to lessen the severity of symptoms and speed up the healing. But they do not address dehydration. Moreover, mass administration of antibiotics can also lead to antimicrobial resistance.

• Drink only bottled, chemically treated, or boiled water.
• Avoid raw or undercooked seafood, meat, fruits, and vegetables.
• Washing hands with clean water and soap, especially before eating or cooking food, after using the toilet, and after caring for someone with diarrhoea. If water is unavailable, opt for an alcohol-based sanitiser containing at least 60% alcohol.
• Use proper toilets for defecating
• Disinfect toilets with bleach periodically.

Currently, there are three approved vaccines by WHO. Speaking about the efficacy of the vaccines, the experts say, “The anti-cholera vaccines available today have shown to be highly effective in preventing cholera. Studies have indicated that these vaccines offer above 80% protection in the first six months after vaccination, with protection remaining strong at about 65% for up to two years post-vaccination. It's a vital tool in cholera outbreak management and in preventing the spread of this waterborne disease, especially in areas where access to clean water and sanitation is challenging.”

Medically reviewed by:

Dr Asim Maldar, Dr. Aasim Maldar