Cholera

What is cholera?

Cholera is a gastroenteritis disease caused by the Vibrio cholerae bacteria (O1 and O139 strains).  These strains are distinct from other vibrio species that typically cause milder illnesses and have not been reported to cause epidemic cholera.

How is cholera transmitted?

Cholera spreads when people eat or drink food or water that has been contaminated with the cholera bacteria. It can also spread from person to person through poor hygiene, especially in households where someone is sick.

What are the symptoms of cholera? 

People with cholera often have no or mild symptoms, but in some cases, it can be very serious.

Symptoms of cholera typically include:

• Watery diarrhoea, which is sometimes described as "rice-water stools" because it is  milky white

• Vomiting

• Fever

Untreated severe cases can result in rapid dehydration, electrolyte disturbances, acute renal failure, shock, and death.

The time between exposure and when symptoms first appear is usually 2 to 3 days, though it can be as short as a few hours or as long as 5 days.

Those infected can spread the illness while they are sick and for a few days after they feel better. The individual will not carry the infection long-term, although the bacteria may remain in their body for several months.

What are the risk factors?

Risk factors for people living in places with:

• Unsafe drinking water

• Poor sanitation

• Inadequate hygiene

How is cholera treated?

If symptoms are mild, drinking oral rehydration solutions can help restore fluids and important body salts. Severe cases need hospital care, prompt intravenous fluids, oral rehydration solution and antibiotics.

How to prevent cholera?

Preventing cholera starts with basic hygiene and food safety. This includes having access to clean water, handling and cooking food properly, and maintaining good personal hygiene. In healthcare settings, it is also important to follow standard safety measures and contact precautions.

Oral cholera vaccination is available in Singapore. Travellers going to higher-risk countries such as those experiencing cholera outbreaks or areas with poor water and sanitation infrastructure may benefit. As the vaccine does not offer complete protection, you will still need to practise safe eating and drinking habits to avoid getting sick. Please consult your doctor 4 to 6 weeks prior to travelling for a health risk assessment for advice on required or recommended vaccinations.

Practising safe food and drink habits

• Wash your hands regularly with soap, especially before handling food or eating, and after going to the toilet. If water is not available, use an alcohol-based hand sanitiser that contains at least 60% alcohol.

• Drink only bottled or boiled water (1 minute at full boil), or canned drinks. Avoid tap water and ice. Use iodine tablets and portable water filters to purify water if necessary.

• Eat food that is fully cooked and served hot. Eat fruits which can be peeled (wash before peeling). Avoid eating raw or undercooked meat and seafood, salads, unpasteurised milk or milk products, food prepared in unhygienic conditions and food purchased from street vendors.