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FACTBOX: What is cholera and how does it spread?

by Emma Batha | @emmabatha | Thomson Reuters Foundation
Monday, 25 October 2010 16:05 GMT
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  • Cholera, an acute diarrhoeal disease, can kill healthy adults from severe dehydration within hours. There are an estimated 3 - 5 million cholera cases and 100,000 to 120,000 deaths every year.

  • Cholera is caused by consuming water or food contaminated with the bacterium Vibrio cholerae. The short incubation period - two hours to five days - means outbreaks can mushroom suddenly. Epidemics have never been caused by dead bodies.

  • About three quarters of infected people do not become ill although the bacteria remain in their faeces for one to two weeks, potentially spreading infections to others if it is washed into water sources.

  • Of those who become ill, most have mild or moderate symptoms. Around a fifth develop acute watery diarrhoea which can prove fatal. People with low immunity, including malnourished children and people with HIV, are at most risk.

  • The first pandemic is believed to have originated in the Ganges delta in India during the 19th century. Subsequent pandemics have killed millions of people. The current (seventh) pandemic started in South Asia in 1961, and reached Africa in 1971 and the Americas in 1991.

  • The World Health Organisation (WHO) says new strains have recently been detected in parts of Asia and Africa. There are some signs these have caused higher fatality rates. There are also indications that global warming creates a favourable environment for the bacteria.

  • The number of cholera cases reported to WHO is rising. From 2004 to 2008, cases increased by 24 percent compared with the period from 2000 to 2004. The number of reported cases is thought to be only a fraction of actual cases because of poor monitoring and frequent under-reporting, often motivated by a fear of trade sanctions and lost tourism.

  • Outbreaks can occur anywhere with poor water supplies, sanitation, food safety and hygiene. Areas at particular risk include slums, refugee camps and regions ravaged by war or natural disasters. A major epidemic killed 50,000 people in the Congolese city of Goma in 1994 when cholera swept through refugee camps sheltering people fleeing the Rwandan genocide.

  • Cholera is treatable if caught promptly. Up to 80 percent of cases can be treated with oral rehydration salts. Severely dehydrated patients need intravenous drips and antibiotics. But mass administration of antibiotics is not recommended as it has no effect on the spread of cholera and contributes to increasing resistance.

  • Vaccines can provide short-term protection while countries take long-term prevention measures like improving water and sanitation. Dukoral is the only vaccine endorsed by WHO, but is expensive for poorer countries. A vaccine made by an Indian company is in the pipeline.

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