Cholera: Symptoms, Oral Rehydration and Prevention

Cholera is an acute diarrhoeal infection caused by eating food or drinking water contaminated with the bacterium Vibrio cholerae. It can cause severe watery diarrhoea and dehydration that kill within hours if untreated. Yet cholera is easy to treat: most people recover with prompt oral rehydration solution (ORS). Nigeria experiences outbreaks, particularly during the rainy season and where clean water and sanitation are limited.

Key facts

Symptoms can start from 12 hours to 5 days after swallowing the bacteria.
Most infected people have mild or no symptoms but can still spread the bacteria.
Severe cholera causes large amounts of “rice-water” diarrhoea and rapid dehydration.
Oral rehydration solution successfully treats most patients.
Safe water, sanitation and handwashing prevent cholera. Oral vaccines are used in outbreaks.

How cholera spreads

Drinking water contaminated with sewage, including from wells, rivers and poorly stored water
Eating food washed or prepared with contaminated water, or handled by someone with unwashed hands
Eating raw or undercooked seafood from contaminated water
Poor sanitation, open defecation and flooding, which spread faeces into water sources

Symptoms

Sudden, profuse, painless watery diarrhoea, often pale and cloudy like water in which rice has been washed
Vomiting
Leg cramps

Signs of dehydration

Intense thirst and dry mouth
Sunken eyes
Passing little or no urine
Skin that goes back slowly when pinched
Weakness, restlessness or drowsiness
Fast, weak pulse and low blood pressure in severe cases

Treatment

Start oral rehydration immediately

If someone has watery diarrhoea during a cholera outbreak, start giving ORS straight away and take them to a health facility or cholera treatment centre.

ORS sachets are available cheaply at pharmacies and free in outbreaks. Mix one sachet with the amount of clean water stated on the pack, usually 1 litre.
Give small, frequent sips. If the person vomits, wait 10 minutes and continue more slowly.
Keep going as long as diarrhoea continues.

If ORS sachets are not available

As a temporary measure, mix 6 level teaspoons of sugar and half a level teaspoon of salt in 1 litre of clean, boiled and cooled water. Measure carefully, as too much salt can be harmful. Get proper ORS and medical care as soon as possible.

In a health facility

Severe dehydration is treated with intravenous fluids, usually Ringer’s lactate.
Antibiotics such as doxycycline are given to people with severe cholera to shorten illness.
Children receive zinc supplements, which shorten diarrhoea.
Continue breastfeeding and feeding during and after the illness.

Prevention

Safe water

Drink and use water that is boiled, chlorinated or from a safe, sealed source.
Store water in clean, covered containers and use a clean cup or tap to draw it out.

Hygiene and food

Wash hands with soap and water after using the toilet, cleaning a child, and before preparing or eating food.
Eat food that is freshly cooked and still hot. Peel fruit yourself.
Avoid raw or undercooked seafood and street food of uncertain safety during outbreaks.

Sanitation

Use toilets or latrines, and keep them clean.
Dispose of children’s faeces safely.
Clean and disinfect areas contaminated with vomit or diarrhoea using chlorine solution.

Vaccination

Oral cholera vaccines are used in outbreaks and high-risk areas, often in mass campaigns. They complement, but do not replace, clean water and sanitation.

When to see a doctor

Go to a health facility or cholera treatment centre immediately for sudden watery diarrhoea, especially during an outbreak, while giving ORS on the way. Seek emergency care for signs of dehydration: very little urine, sunken eyes, extreme thirst, drowsiness or inability to drink. Babies, young children and older adults can become dangerously dehydrated very quickly.

Cholera: Symptoms, Oral Rehydration and Prevention

Key facts

How cholera spreads