Cholera Information for Health Care Professionals

Areas of Active Cholera Transmission

CDC considers the countries below to have areas of active cholera transmission. For information about the level of cholera transmission and where it is occurring in a country, check the cholera section on each country’s destination page.

Cholera transmission for a given country is considered “active” when any of the following criteria are met:

  • World Health Organization (WHO) reports a cholera outbreak (e.g., annual reports, outbreak bulletins, disease outbreak news).
  • A country reports more than 100 suspected cholera cases in the previous 12 months as documented by reliable, publicly available sources such as WHO or the Ministries of Health.
  • CDC experts have reviewed available information and have determined that cholera is likely present even if not officially reported.

Cholera activity varies by location within each country. Every month, CDC reviews cholera surveillance data and classifies countries according to the levels in the table below

CHOLERA TRANSMISSION LEVEL AT THE DESTINATION

DEFINITION

VACCINATION RECOMMENDATION

CHOLERA TRANSMISSION LEVEL AT THE DESTINATION

Widespread

DEFINITION

≥50% of jurisdictions have reported cholera in the previous 12 months

VACCINATION RECOMMENDATION

When vaccine is available, consider vaccination for travelers going to any part of the country

CHOLERA TRANSMISSION LEVEL AT THE DESTINATION

Localized

DEFINITION

<50% of jurisdictions have reported cholera in the previous 12 months

VACCINATION RECOMMENDATION

When vaccine is available, consider vaccination only for travelers going to affected jurisdictions

CHOLERA TRANSMISSION LEVEL AT THE DESTINATION

Presumed

DEFINITION

No reliable surveillance information exists; presence of disease is based upon expert opinion

VACCINATION RECOMMENDATION

When vaccine is available, consider vaccination for travelers going to any part of the country

Assessing a Traveler’s Risk for Cholera Infection

Cholera in travelers is extremely rare but can occur among people visiting friends or family, healthcare workers, and response workers in outbreak settings. These groups may take longer trips and have limited access to safe food and water. In areas with cholera outbreaks, travelers should avoid unsafe food and water and wash their hands often to help prevent cholera. When assessing a traveler's risk for infection, clinicians should consider the following:

  • Level of transmission at the destination
  • Length of time spent in an outbreak setting
  • Risk for severe disease because of age or pre-existing medical conditions that would be worsened by dehydration
  • Ability to adhere to food and water precautions
  • Availability of medical care (intravenous rehydration) at the destination

Cholera Vaccine Information

CDC recommends CVD 103-HgR (Vaxchora) for travelers ages 2–64 years old going to areas of active toxigenic Vibrio cholerae O1 transmission (i.e., widespread, localized, or presumed). Vaccination against cholera is not routinely recommended because cholera is rare in travelers and most travelers do not visit areas of active transmission.

More Information

Collins JP, Ryan ET, Wong KK, et al. Cholera Vaccine: Recommendations of the Advisory Committee on Immunization Practices, 2022. MMWR Recomm Rep 2022;71(No. RR-2):1–8. DOI https://www.cdc.gov/mmwr/volumes/71/rr/rr7102a1.htm.