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Avoid Cholera

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The current cholera epidemic in Zimbabwe has hit more than 91,000 and left almost 5,000 dead. Zimbabwe’s health system was once the envy of Africa, but nearly a decade of economic collapse has left hospitals and clinics in a shambles.

Boil it, cook it, peel it, or forget it

If you are going to travel through Zimbabwe, you risk contracting this disease. It can be deadly if not treated.

Vibrio Cholera is one of the most common organisms in surface waters of the world. It occurs in both freshwater and marine habitats and lives in associations with aquatic animals. Some species live in mutualism with fish and other marine life. Other species are pathogenic for fish, eels, frogs and many other vertebrates and invertebrates including humans.

V. cholerae is a pathogen (from Greek πάθος pathos "suffering, passion" ) of humans. It is characterised as a sudden onset of profuse painless watery stools or diarrhea with rapid dehydration.

Up to 80% infected persons may experience mild or no symptoms. In severe cases there is acute onset of profuse watery diarrhea (so called "Rice water" stools, due to the similarity to actual cooked rice water).

Occasional vomiting, rapid dehydration and circulatory collapse can occur as a consequence. Infected individuals may loose up to 30 litres of fluid per day in stools. Severe cases can develop symptoms of shock within 2 hours. Without proper treatment, death can occur within hours. For every 1 symptomatic infected individual there are approximately 40 asymptomatic cases or carriers in the community.

Transmission occurs when there is ingestion of water contaminated with faeces or vomit from infected individuals. Occasionally food contaminated by faeces is transferred by flies or peoples hands.

Treatment consists of rapid rehydration. Eighty to ninety percent of infected people can be successfully treated with oral rehydration (8 teaspoons of sugar and a ฝ teaspoon of salt in litre of safe water). If dehydration is more severe, intravenous fluids should be administered. Antibiotics are not routinely used in the treatment of cholera. A recently developed oral vaccine for cholera is licensed and available. (Dukoral from SBL Vaccines).

The vaccine appears to provide somewhat better immunity and have fewer adverse effects than the previously available vaccine. However, CDC does not recommend cholera vaccines for most travelers.

Further information about Dukoral can be obtained from the manufacturers: Dukoral ฎ SBL Vaccin AB, SE-105 21 Stockholm, Sweden. Telephone +46-8-7351000, e-mail:

The risk for cholera is very low for U.S. or European travelers visiting areas with epidemic cholera. When simple precautions are observed, contracting the disease is unlikely. All travelers to areas where cholera has occurred should observe the following recommendations developed by CDC.

  • Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water and carbonated bottled beverages

  • Avoid ice in your drinks. You have no guarantee that pure water was used.

  • Brush your teeth with bottled water.

  • Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.

  • Avoid undercooked or raw fish or shellfish.

  • Make sure all vegetables are cooked and avoid salads - they are washed in water that may be contaminated.

  • Avoid foods and beverages from street vendors who wash their wares in water that may be contaminated.

  • Do not bring perishable seafood back home after visiting an epidemic country

  • A simple rule of thumb is "Boil it, cook it, peel it, or forget it. "

The global picture of cholera changes periodically, so travelers should seek updated information on countries of interest.

Dr. Swart has been involved in Communicable disease control since 2004 and is an authority on Malaria, tropical and infectious diseases in Africa.

The Centers for Disease Control and Prevention maintains a travelers’ information telephone line on which callers can receive recent information on cholera and other diseases of concern to travelers. Data for this service are obtained from the World Health Organization.

The number is 877-FYI-TRIP (394-8747) or check out

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