There are many types (strains) of the Vibrio cholera bacteria. Some of them cause more serious illnesses than others. Because of this, some people who get cholera have no symptoms; others have symptoms that are not very bad, and others have very bad symptoms.
Cholera still affects many people throughout the world. Estimates from 2010 say that between 3 million and 5 million people get cholera every year, and 58,000–130,000 people die from the disease every year. Today, cholera is considered a pandemic. However, it is most common in developing countries, especially in children.
People usually get cholera by eating food or drinking water that is unclean. When people have cholera, they have a lot of diarrhea, and the cholera bacteria stays alive in their feces. In developing countries, often there is not good sanitation. Cholera can spread if this diarrhea gets into water that other people use. For example, if sewage (human waste) gets into a river, people can get cholera if they:
- Drink the water from the river.
- Eat food that they have washed in the river.
- Eat fish that live in the river, if they are not cooked well enough to kill the cholera bacteria.
Cholera is very rarely spread directly from person to person.
Signs and symptoms
Cholera's main symptoms are very bad diarrhea and vomiting clear fluid. These symptoms usually start suddenly. They start half a day to five days after the person gets infected. (This is called cholera's "incubation period".)
If they do not get treatment, about half of people with very bad cholera die. People with very bad cholera can have so much diarrhea that they do not have enough water and electrolytes (salts) left in their bodies to survive. Cholera has been nicknamed the "blue death" because a person dying of cholera may lose so many body fluids that their skin turns bluish-gray.
Other symptoms may include:
- Lethargy (having no energy)
- Eyes that look sunken into the head, dry mouth, and saggy skin (from dehydration)
- Changes in breathing
- Hypotension (low blood pressure)
- Tachycardia (fast heart rate)
- Shock caused by dehydration (called hypovolemic shock)
- Seizures (especially in children)
- Coma, especially in children
Some strains of the Vibrio cholera bacteria have different genes than others, which make them more dangerous. These more dangerous strains of cholera bacteria caused the 2010 epidemic in Haiti and the 2004 outbreak in India. A person who gets these strains of cholera can die within two hours of getting sick. This means there is very little time to get the person treated.
There is no cure for cholera. However, there are different treatments that can help. For example:
- Giving fluids to treat dehydration, either by mouth or through a needle placed into a vein (intravenously).
- Giving important electrolytes like potassium and sodium chloride (salt)
- Giving antibiotics (sometimes). These will make symptoms go away faster and not be as bad. However, people will recover without them if they are not too dehydrated. Because of this, antibiotics are suggested for people who have very bad cholera and are very dehydrated.
- Patients should keep eating; this helps their intestines return to normal.
- Wash their hands with soap and/or ash after using the toilet, and before touching food or eating.
- Sterilize (remove germs from) all water used for drinking, washing, or cooking. The best and least expensive ways to do this are to boil water or to add chlorine. If this is not possible, using a cloth filter for water is better than nothing.
- Wash all fruits and vegetables using safe water. Peel fresh fruits before eating them.
- Not put their untreated feces in rivers, oceans, or anywhere in the open environment. This can be avoided by using dry toilets, especially if governments do not properly treat sewage.
- Follow all suggestions from public health agencies like the World Health Organization and the Centers for Disease Control and Prevention about how to prevent spreading cholera (or other diseases).
Governments could stop outbreaks or epidemics from happening by improving sanitation. For example, cholera is very uncommon in developed countries because they have good sanitation and because they add chemicals to their water to kill germs. Even after people start to get cholera, it is possible for governments to stop the disease from spreading, though:
- Sterilization: Any material that touched a cholera patient should be cleaned with disinfectant and washed in hot water, using chlorine bleach if possible. Hands that touched cholera patients or their things, like clothing or blankets, should be carefully cleaned and disinfected with water that has chlorine in it, or with other effective antimicrobial agents (chemicals that will kill bacteria).
- Sewage: Proper treatment can kill enough cholera bacteria for wastewater to go back into the environment. Dry toilets can be promoted where sewage treatment is not so good.
- Sources: Warnings about possible cholera in the water should be posted around contaminated water sources, with directions on how to kill the bacteria in the water through things like boiling or adding chlorine for possible use.
Cholera probably started in the Indian subcontinent. As early as the 5th century BC, people in the Ganges River delta area wrote about cholera. The disease first spread to Russia in 1817 by trade routes (over both land and sea). Later, cholera spread to the rest of Europe, and from Europe to North America and the rest of the world.
Seven cholera pandemics have happened in the past 200 years. The latest started in Indonesia in 1961. There have also been many serious outbreaks. The worst outbreak in recent history happened in Haiti after the earthquake there in 2010. Between October 2010 and August 2015, more than 700,000 Haitians got cholera, and over 9,000 died. The outbreak was caused by a United Nations base where Nepalese soldiers were living. The soldiers would dump human waste into the Artibonite River, which many Haitians used for drinking, cooking, and bathing.
Since cholera became common in the 19th century, it has killed tens of millions of people. Just in Russia, between 1847 and 1851, more than one million people died of cholera. During the second pandemic, which lasted from 1827-1835, the disease killed 150,000 Americans. Between 1900 and 1920, in India, up to eight million people died of cholera.
in 1854, an English doctor named John Snow was the first person to realize that contaminated water caused cholera. Today, countries in Europe and North America filter and add chlorine to their water supplies. This has made cholera very uncommon in these countries.
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- Information about cholera in Simple English from the CDC
- CDC facts about cholera
- WHO facts about cholera
- Rehydration Project talks about ORSs (oral rehydration solutions)