Please note: As of December 2020, the maker of the cholera vaccine will temporarily stop making and selling this vaccine. The cholera vaccine may be in limited supply or unavailable.
What is cholera?
Cholera is a disease caused by bacteria called Vibrio cholerae. Cholera bacteria spread from one person to another in places where sanitation is poor and there is limited access to safe drinking water.
You can get sick with cholera by drinking water or eating food contaminated with cholera bacteria. Cholera symptoms include diarrhea, nausea, dizziness, and vomiting. People with severe cholera have large amounts of watery diarrhea. Often described as “rice-water stool,” cholera diarrhea can have a pale, milky appearance. Cholera can lead to death if a person becomes dehydrated from loss of fluids and electrolytes.
Who is at risk?
Most international travelers do not get cholera because they do not visit areas with active cholera transmission and usually have good access to safe food and water.
Cholera is found in countries around the world but is extremely rare in the United States and other industrialized nations.
- Africa: Benin, Burundi, Cameroon, Democratic Republic of the Congo, Ethiopia, Kenya, Malawi, Mozambique, Nigeria, Somalia, Sudan, Uganda
- Asia: Bangladesh, India, Yemen
- Americas: Haiti
- Pacific: Philippines
What can travelers do to prevent cholera?
Travelers can protect themselves against cholera, even travelers going to areas of active cholera transmission, by taking the following steps:
Choose food and drinks carefully
- Only eat foods that are cooked and served hot
- Avoid food that has been sitting on a buffet
- Eat raw fruits and vegetables only if you have washed them in clean water or peeled them
- Only drink beverages from factory-sealed containers
- Avoid ice because it may have been made from unclean water
- Drink pasteurized milk
Wash hands carefully
- Wash hands often with soap and water for 20 seconds, especially after using the bathroom and before eating
- If soap and water aren’t available, use an alcohol-based hand sanitizer that contains at least 60% alcohol
- Keep your hands away from your face and mouth
A licensed cholera vaccine called Vaxchora® (lyophilized CVD 103-HgR, Emergent BioSolutions) is available in the United States for adults 18-64 years old. It prevents severe diarrhea caused by the most common types of cholera-causing bacteria. Most U.S. travelers don’t get vaccinated because very few visit areas with active cholera.
Adults traveling to countries that have areas of active cholera transmission should ask their healthcare provider the following questions when considering the vaccine:
- How common is cholera in the specific area where I am going?
- How common is cholera infection among travelers going to this area?
- Which activities may put me at risk for cholera?
- Will I be able to receive rapid treatment (if needed) at my destination?
How is cholera treated?
The most important step in treating cholera is to replace lost body fluids (rehydration). Antibiotics can shorten the length of illness and help prevent fluid loss (dehydration) in people with severe cholera. Zinc treatment has also been shown to help improve cholera symptoms in children.
If you traveled and feel sick, particularly if you have a fever, talk to a healthcare provider and tell them about your travel. Avoid contact with other people while you are sick.
If you need medical care abroad, see Getting Health Care Abroad.
- Cholera – Yellow Book chapter