Cholera

What is cholera?

Cholera is a serious bacterial illness that may cause severe diarrhoea and dehydration. It is rare in Australia, with almost all cases being in people who were infected while overseas.1 Cholera is a notifiable disease in Australia.2 That means health authorities must be notified if you have the disease.

Signs and symptoms of cholera

Symptoms of cholera can be mild or severe. It usually takes two to three days for symptoms to appear. However, they can also appear within hours of being infected, or as long as five days after infection.3

Symptoms can be similar to those of a gastrointestinal illness and include4:

• excessive watery diarrhoea
• vomiting and nausea
• cramps in the legs or abdomen (tummy)
• feeling weak and tired
• dizziness and headache
• dry mouth and feelings of thirst
• urinating less than usual
• dehydration

What causes cholera?

Cholera is caused by bacteria called Vibrio cholerae. The main source of cholera infections is contaminated water. The illness is common in countries with poor sanitation and poor access to clean drinking water. It’s rare in Australia and other countries with modern sewage and water treatment.

People with cholera can pass the bacteria in their poo. If they don’t wash their hands thoroughly after using the toilet, they may contaminate any food they prepare. In areas where there is inadequate treatment of sewage water supplies can easily become contaminated. If this contaminated water supply is used to grow crops, bacteria may be found in foods such as raw or undercooked seafood, raw fruits and vegetables, and grains.

In rare cases, people in Australia can get cholera by eating contaminated imported food. But you’re not likely to catch it from someone else who has the infection.

Is cholera dangerous?

Left untreated, cholera can be fatal. The bacteria produce a toxin in the small intestine, which causes the body to excrete (get rid of) large amounts of water. This leads to diarrhoea and a rapid loss of fluids and electrolytes (salts), which causes dehydration. Severe dehydration can cause kidney failure. If not treated, dehydration can lead to shock, coma and death within hours.5

Signs of dehydration include:

• rapid heart rate
• loss of elasticity in the skin
• low blood pressure
• dry mucous membranes (e.g. inner lining of nose and mouth).

Who is at risk of cholera?

While cholera is rare in Australia, you’re at increased risk if you travel to countries with poor sanitation. Cholera is found in over 50 developing countries, mainly in Africa, South and Southeast Asia, and Haiti. Areas most at risk are those affected by famine, war or natural disasters, poor communities, and refugee camps.

Other risk factors include6:

• having low levels of stomach acid — cholera can’t survive in an acidic environment
• living with someone else who has cholera
• eating raw or undercooked shellfish from areas known to have the bacteria
• having type O blood — this group is twice as likely to develop cholera, although it’s not known why.

How is cholera diagnosed?

Cholera is diagnosed by examining a sample of stool (poo) under the microscope to look for the bacteria. If your doctor suspects you have cholera, they will request a stool sample.

How do you treat cholera?

Cholera is usually treated with an oral rehydration solution (a water solution with sugar and salt in it). People who are severely dehydrated may need to be given fluids intravenously (through a needle or tube). Sometimes antibiotics may be given which can reduce the time and severity of the illness.7

When should you see your doctor?

Because of the seriousness of the illness, it’s important to see your doctor as soon as you have symptoms. This will ensure you receive early treatment.

Can you prevent cholera?

The most important thing to prevent cholera is to take extra precautions when travelling in countries where cholera is found. This includes:

• only drinking bottled or treated water and avoiding ice in drinks
• avoiding eating uncooked vegetables and fruit — only eat fruit that you can peel yourself 

If you are travelling to an area where there is a high risk of exposure to cholera, you may wish to ask your health practitioner about a cholera vaccine. This preventative vaccine is privately funded.8 It may be worth considering so speak to your doctor or pharmacist.

Sources

1NSW Health, Cholera fact sheet, https://www.health.nsw.gov.au/Infectious/factsheets/Pages/cholera.aspx

2Australian Government, National Health Security (National Notifiable Disease List) Instrument, https://www.legislation.gov.au/Details/F2022C00605

3Healthdirect, Cholera, https://www.healthdirect.gov.au/cholera

4Healthdirect, Cholera, https://www.healthdirect.gov.au/cholera

5Center for Diseases Control and Prevention, Cholera, https://www.cdc.gov/cholera/illness.html

6Mayo Clinic, Cholera, https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-20355287

7NSW Health, Cholera fact sheet, https://www.health.nsw.gov.au/Infectious/factsheets/Pages/cholera.aspx

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Disclaimer

General advice only – this information should not replace the information provided to you by your health care professional. If symptoms are severe or persist, please speak to your health care professional. Information current as of date of publishing.