Cholera can quickly become fatal. In the most severe cases, the rapid loss of large amounts of fluids and electrolytes can lead to death within two to three hours. In less extreme situations, people who don’t receive treatment may die of dehydration and shock hours to days after cholera symptoms first appear.
Although shock and severe dehydration are the most devastating complications of cholera, other problems can occur, such as:
- Low blood sugar (hypoglycemia). Dangerously low levels of blood sugar (glucose) the body’s main energy source may occur when people become too ill to eat. Children are at greatest risk of this complication, which can cause seizures, unconsciousness and even death.
- Low potassium levels (hypokalemia). People with cholera lose large quantities of minerals, including potassium, in their stools. Very low potassium levels interfere with heart and nerve function and are life-threatening.
- Kidney (renal) failure. When the kidneys lose their filtering ability, excess amounts of fluids, some electrolytes and wastes build up in your body — a potentially life-threatening condition. In people with cholera, kidney failure often accompanies shock.
Cholera is rare in the United States with the few cases related to travel outside the U.S. or to contaminated and improperly cooked seafood from the Gulf Coast waters.
If you’re traveling to cholera-endemic areas, your risk of contracting the disease is extremely low if you follow these precautions:
- Wash hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water aren’t available, use an alcohol-based hand sanitizer.
- Drink only safe water, including bottled water or water you’ve boiled or disinfected yourself. Use bottled water even to brush your teeth. Hot beverages are generally safe, as are canned or bottled drinks, but wipe the outside before you open them. Avoid adding ice to your beverages unless you made it yourself using safe water.
- Eat food that’s completely cooked and hot and avoid street vendor food, if possible. If you do buy a meal from a street vendor, make sure it’s cooked in your presence and served hot.
- Avoid sushi, as well as raw or improperly cooked fish and seafood of any kind.
- Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and fruits that can’t be peeled, such as grapes and berries.
- Be wary of dairy foods, including ice cream, which is often contaminated, and unpasteurized milk.
For adults traveling to areas affected by cholera, a vaccine is now available in the United States. The Food and Drug Administration recently approved Vaxchora, a vaccine for the prevention of cholera. It is a liquid dose taken by mouth at least 10 days before travel.
A few countries offer oral vaccines as well. Contact your doctor or local office of public health for more information about these vaccines. Keep in mind that no country requires immunization against cholera as a condition for entry.