Cholera is a water-borne, acute gastrointestinal infection caused by Vibrio cholerae. Spread by contaminated water or food, cholera – Greek for diarrhoea – causes profuse diarrhoea and vomiting. Many sufferers die of profound dehydration, sometimes within a matter of hours.

Where does it occur?

Cholera remains a global threat. The world is currently suffering the seventh cholera pandemic, and more than 60 countries report outbreaks each year.

Epidemics tend to occur where living conditions are poor: where there is overcrowding, inadequate access to safe drinking water or proper latrines, and insufficient rubbish collection.

How is a person infected?

A person becomes infected on ingesting the bacteria. If food or water supplies are contaminated, outbreaks can spread very rapidly.

What are the symptoms?

Cholera has a very short incubation period. Once inside the gastrointestinal tract, the bacteria multiply and produce a toxin, which causes the cells lining the intestine to secrete huge amounts of fluid. This leads to profuse, watery diarrhoea and vomiting. Most people will suffer only a mild infection, but the illness can be very severe.

Serious cases can lead to severe dehydration and, without rapid treatment, death.

How is it diagnosed and treated?

A rapid diagnostic test is available, but confirmation from a laboratory is still required, especially in declaring an outbreak. In epidemic situations, once cholera is confirmed, individual diagnosis is based on clinical symptoms alone.

Treatment consists of the immediate replacement of fluids and electrolytes. Most patients can be treated using oral rehydration solution (ORS), which is a mixture of water, glucose and electrolytes (sodium and potassium).

In more serious cases, fluids and electrolytes are administered by intravenous infusion. Patients in such a serious condition require the care of highly skilled and experienced medical staff.

Can cholera be prevented?

To prevent infection, there are two cholera vaccines pre-qualified by the WHO, but they both require two doses at least a week apart, reducing the effectiveness of vaccination campaigns once outbreaks are declared. Moreover, the vaccines’ efficacy is only around 70 per cent.

Improved hygiene practices, and treatment are still important components of the cholera response. The provision of safe water and effective sanitation remain essential during all outbreaks. 

MSF and cholera

MSF has developed cholera treatment kits in order to provide rapid assistance in epidemics.

When an epidemic seems imminent, MSF will begin setting up dedicated cholera treatment centres and oral rehydration points as close as possible to the population at risk. Patients in a more serious condition are transferred to the treatment centres, while more moderate cases are treated at the rehydration points. Staff work to raise the community’s awareness of the disease and how it is spread, and to promote hygiene messages. Water and sanitation staff will ensure there are sufficient latrines available, adequate quantities of safe water, and soap.

In 2012, MSF staff introduced the use of the two-dose oral vaccine as part of its response to an outbreak of cholera in Guinea.

In most situations, MSF teams are able to limit the fatality rate to less than one per cent.

MSF treated 46,900 people for cholera in 2014.

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