Cholera: Causes, symptoms, treatment and prevention

    Cholera is an acute epidemic infectious disease. This means a cholera outbreak can spread very fast, infecting many people within a short period of time.

    What is cholera?

    Cholera is an acute epidemic infectious disease. This means a cholera outbreak can spread very fast, infecting many people within a short period of time.

    Causes of cholera:

    Cholera is caused when a bacterium called Vibrio cholerae enter human body through the mouth, by eating food or drinking water contaminated with cholera bacteria.

    Cholera is most common in places with poor sanitation and hygiene, crowding and limited water resources.

    Common causes include drinking or eating:

    1. Contaminated water supplies
    2. Ice-creams made from contaminated water
    3. Contaminated foods and drinks sold by street vendors
    4. Vegetables grown with or irrigated by contaminated water e.g. containing human wastes
    5. Raw fruits and vegetables cleaned/washed with contaminated waters
    6. Unpasteurized milk and milk products
    7. Raw or undercooked meat or shellfish
    8. Raw fish caught in contaminated water sources e.g. water polluted with sewage

    Symptoms of cholera

    It causes severe watery diarrhea, which can lead to dehydration (extreme loss of fluid and electrolytes), vomiting and even death if untreated immediately.

    Signs and symptoms of dehydration include:

    • Rapid heart rate
    • Loss of skin elasticity (the ability to return to original position quickly if pinched)
    • Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids
    • Low blood pressure
    • Thirst
    • Muscle cramps, especially leg cramps

    Severe dehydration can lead to shock and death in a matter of hours if not treated. Shock can lead to collapse of the circulatory system. It is a life-threatening condition and a medical emergency.

    Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection. If symptoms appear, they will do so between 12 hours and 5 days after exposure. They range from mild or asymptomatic to severe.

    "Those who recover cholera infection usually have long-term immunity against re-infection"


    Seek medical attention immediately if you experience symptoms of cholera such as leg cramps, vomiting, and diarrhea.

    A stool sample will be sent to a laboratory for testing, but if cholera is suspected, the patient must begin treatment even before the results come back.


    It is normally dehydration that leads to death from cholera, so the most important treatment is to give oral hydration solution (ORS).

    The treatment consists of large volumes of water mixed with a blend of sugar and salts.

    Severe cases of cholera require intravenous fluid replacement. An adult weighing 70 kilograms will need at least 7 liters of intravenous fluids.

    Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.

    Further medication is prescribed by a doctor.

    Prevention of cholera

    Cholera bacteria are usually found in food or water contaminated by feces from a person with the infection.

    Proper water and sewage treatment systems can eliminate the spread of cholera through contaminated water.

    Observe good sanitation and hygiene at all times. Hand washing with clean water is important to prevent the spread of disease.

    Use only clean water that has been boiled, chemically disinfected, or bottled water. To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant.

    Clean water is used for the following purposes:

    • Drinking
    • Preparing food or drinks
    • Making ice
    • Brushing your teeth
    • Washing your face and hands
    • Washing dishes and utensils that you use to eat or prepare food
    • Washing fruits and vegetables etc

    Avoid raw foods, including the following:

    • Unpeeled fruits and vegetables
    • Unpasteurized milk and milk products
    • Raw or undercooked meat or shellfish
    • Fish caught in tropical reefs, which may be contaminated

    Risk factors

    People most at risk of cholera infection:

    1. People who work in healthcare and treat individuals with cholera
    2. Relief workers who respond to cholera outbreaks
    3. People who are traveling in areas where cholera can still be transmitted that do not follow hygiene and food safety precautions

    Wide-spreading epidemics of cholera often occur due to water supplies that are contaminated with human waste and street food vendors.

    The following people are also at risk of a more severe reaction to cholera infection:

    1. people with achlorydia, a condition that removes hydrochloric acid from the stomach
    2. individuals with blood type O
    3. people who have chronic medical conditions
    4. those without access to ORT and other medical services


    Cholera infection is a life-threatening condition and a medical emergency.

    If cholera infection is not treated immediately, death can occur in otherwise healthy adults within hours. Children and infants are worse affected.

    Anti-diarrheal medicines are not used because they prevent the bacteria from being flushed out of the body.

    Mass use of antibiotics for cholera treatment is not recommended because of the growing risk of bacterial resistance (WHO).

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