Culture and diversity

April 2010



Recommendations for prevention in travellers

Volume 39, No.4, April 2010 Pages 222-225

Amy A Neilson

Cora A Mayer

This article about cholera is part of our travel medicine series for 2010, providing a summary of prevention strategies and vaccination for infections that may be acquired by travellers. The series aims to provide practical strategies to assist general practitioners in giving travel advice, as a synthesis of multiple information sources which must otherwise be consulted.

Cholera is a severe diarrhoeal disease associated with worldwide pandemics. It affects vulnerable populations who lack adequate quality drinking water and sanitation. Travellers are generally at low risk of contracting cholera, even in endemic areas. It is prevented with general water and food precautions (also advisable for prevention of traveller’s diarrhoea). In some situations, the oral killed whole cell B subunit vaccine may be recommended for travellers considered at risk.

Cholera is an acute diarrhoeal infection caused by ingestion of the enterotoxin producing, motile, curved Gram negative bacillus Vibrio cholerae, first isolated by Koch in the late 19th century. Sudden onset of painless, profuse, watery (‘rice water’), secretory diarrhoea,1 with or without nausea and vomiting,2 can cause death due to dehydration in more than 50% of untreated severe cases,1 sometimes within hours of onset.3 Milder cases of diarrhoea without associated symptoms or complications are common. Approximately 75% of infections are asymptomatic,2–4 but pathogens are shed in the faeces for 7–14 days.3

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