Overview
Cholera is an acute diarrheal illness caused by the bacterium Vibrio cholerae. It spreads through water or food contaminated with the bacteria, most often in areas without access to clean water and proper sanitation.
Key Fact
Warning
AT A GLANCE
Disease Summary
Symptoms
Common Symptoms
Most people with cholera have mild symptoms or none at all. When symptoms do occur, they typically include the following.
Watery Diarrhea
Vomiting
Muscle Cramps
Thirst
Danger Signs
Seek urgent medical attention immediately if any of the following develop.
Sunken Eyes
Little or No Urination
Skin That Stays Pinched
Extreme Fatigue or Irritability
Diagnosis
Clinical Assessment
Stool Testing
Rapid Dipstick Test
Laboratory Tests
Rapid Cholera Dipstick Test
Quickly confirms Vibrio cholerae infection, particularly useful in outbreak settings and remote areas.
Stool Culture
The definitive method for confirming Vibrio cholerae and identifying the specific strain involved.
Electrolyte Panel
Assesses the severity of dehydration and guides fluid and electrolyte replacement.
Laboratory Note
Treatment for suspected cholera begins based on clinical symptoms and is not delayed for laboratory confirmation.
Treatment
Oral Rehydration Solution (ORS)
The single most important treatment for cholera. Replaces fluids and electrolytes lost through diarrhea and vomiting, and successfully treats the majority of cases alone.
Intravenous Fluids
Used for people with severe dehydration who cannot drink enough fluids on their own.
Treatment Note
With prompt rehydration, over 99 percent of people with cholera survive. Antibiotics may be added for severely ill patients to shorten the duration of illness.
Prevention
Access clean drinking water
Drinking treated, boiled, or bottled water significantly reduces the risk of cholera infection.
Practise safe food handling
Thoroughly cooking food and avoiding raw or undercooked seafood from unclear sources reduces exposure.
Wash hands regularly
Frequent handwashing, especially before eating and after using the toilet, helps prevent the fecal-oral spread of cholera.
Consider oral cholera vaccination
WHO-prequalified oral cholera vaccines are available and can help prevent and control outbreaks in at-risk areas.
Prevention Note
Improved sanitation and access to clean water remain the most effective long-term measures for preventing cholera at a community level.
Risk Factors
High Risk
These individuals are more likely to develop severe illness or complications.
- Young children
- People with limited access to healthcare
- People with pre-existing malnutrition
Increased Risk
These groups have a higher chance of acquiring cholera.
- People living in areas with unsafe drinking water
- People affected by flooding or natural disasters
- People living in crowded settings with poor sanitation
Exposure Factors
Environmental and behavioural factors that increase the risk of cholera transmission.
- Contaminated water sources
- Inadequate sewage treatment
- Consuming raw or undercooked seafood from contaminated waters
Risk Note
Cholera risk rises sharply during flooding, conflict, or displacement, when access to clean water and sanitation is disrupted.
Complications
Severe Dehydration
Rapid fluid loss can lead to shock and organ failure if not treated promptly.
Electrolyte Imbalance
Loss of key electrolytes can affect heart rhythm and muscle function.
Shock
Untreated severe dehydration can progress to shock, a life-threatening drop in blood flow to organs.
Complication Note
With prompt rehydration, death from cholera is rare. Without treatment, up to half of severe cases can be fatal.
When to Seek Medical Care
Signs of Severe Dehydration
Sunken eyes, extreme thirst, or little urination require immediate medical care.
Persistent Watery Diarrhea
Ongoing large-volume diarrhea, especially with vomiting, needs prompt evaluation and rehydration.
Confusion or Extreme Weakness
Can indicate advanced dehydration and requires emergency care.
Emergency Advice
Do not wait for symptoms to worsen. Begin oral rehydration immediately and seek care as soon as severe diarrhea or vomiting develops.
Prognosis
Excellent with Prompt Rehydration
Over 99 percent of people survive cholera when rehydration treatment begins promptly.
Poor if Untreated
Without treatment, up to half of people with severe cholera can die from dehydration.
Full Recovery is Typical
Most people recover fully within a few days once adequately rehydrated.
Prognosis Note
Cholera affects an estimated 1.3 to 4 million people worldwide each year. Rapid access to rehydration treatment is the single greatest factor in survival.
Differential Diagnosis
Typhoid Fever
Typhoid fever shares the same fecal-oral transmission route and risk conditions as cholera, but typically presents with prolonged fever rather than sudden severe watery diarrhea.
Other Diarrheal Illnesses
Many bacterial, viral, and parasitic infections cause diarrhea. Cholera is distinguished by the volume and watery character of the diarrhea and by stool testing.
Food Poisoning
Common food poisoning usually causes milder, shorter-lived symptoms compared to the rapid, severe dehydration seen in cholera.
Clinical Note
In areas where cholera is not common, laboratory testing is important to distinguish it from other causes of severe diarrhea.
References
World Health Organization (WHO)
World Health Organization guidance on cholera epidemiology, prevention, and vaccination.
Centers for Disease Control and Prevention (CDC)
Clinical guidance and public health information on cholera transmission and treatment.