Cholera

Overview

Cholera is an infection of the bowel caused by a type of bacteria. It can cause very watery diarrhoea (loose, watery stools) and vomiting. The main danger is dehydration, which means the body loses too much water and salt. With quick treatment, most people recover fully.

Cholera is not common in the UK or other countries with safe water and modern sanitation. It is still common in some parts of the world where clean water and toilets are limited, especially during humanitarian crises or after disasters.

Anyone can get cholera, but people living in or travelling to areas with poor water and sanitation are most at risk. Children and older adults can become dehydrated faster, so they need careful watching.

Symptoms

Common symptoms

• Sudden, very watery diarrhoea that can look like rice water
• Vomiting
• Feeling very thirsty
• Dry mouth and dry skin
• Passing little or no urine
• Muscle cramps and weakness
• Feeling dizzy or light-headed

Symptoms in children

• Being unusually sleepy or hard to wake
• Sunken eyes or a sunken soft spot on a baby’s head
• No tears when crying
• Few or no wet nappies
• Dry mouth and lips
• Fast heartbeat or fast breathing

Symptoms in older adults

• Confusion or feeling more muddled than usual
• Weakness and dizziness when standing
• Dry mouth, sunken eyes, and loose skin
• Very little urine
• Fast heartbeat
• Fainting or near-fainting

Causes

Main causes

• Drinking water contaminated with the cholera bacteria, often from unsafe water supplies
• Eating food contaminated by unsafe water, dirty hands, or flies
• Eating raw or undercooked shellfish from contaminated water
• Poor sanitation and open defecation that can get into water sources

Risk factors

• Living in or travelling to a place where cholera is present
• Using unsafe water for drinking, cooking, or washing
• Living in crowded settings without good toilets or clean water, such as refugee camps
• Having less stomach acid, which can happen with some health conditions or medicines
• Being malnourished
• Children and older adults are at higher risk of serious dehydration

When to see a doctor

See a doctor urgently if:

• You have very watery diarrhoea, especially after travel to an outbreak area
• You have signs of dehydration: thirst, dry mouth, little urine, dizziness
• You cannot keep fluids down
• A child or older adult is sleepy, confused, or not drinking

Book a routine appointment if:

• You have mild diarrhoea and need advice about fluids
• You are planning travel to an area where cholera is a risk
• You want to ask about cholera vaccination for travel

Diagnosis

A doctor may suspect cholera from your symptoms and recent travel or living situation. They will check for dehydration and may ask for a stool sample to confirm the bacteria. In an outbreak, quick tests can be done.

Tests that may be done

• Stool sample or rectal swab to look for cholera bacteria
• Blood tests to check salt levels and kidney function
• Urine tests or measuring urine output to check hydration
• Physical exam for signs of dehydration, such as dry mouth, fast heartbeat, and low blood pressure

What to expect at your appointment

You may be asked about where you have travelled, what water you drank, and whether others are unwell. If you are dehydrated, treatment may start straight away while tests are pending. Most tests are quick.

Treatment

The main treatment is to replace water and salts lost through diarrhoea and vomiting. This is called rehydration. It can be done with an oral rehydration solution (a special drink of water, sugar, and salt) or, for severe cases, fluids given through a vein. Quick treatment saves lives.

Self-care at home

• Drink small sips of oral rehydration solution often. You can buy it from a pharmacy or use a recipe from a health worker.
• Keep breastfeeding or feeding your child if they can drink.
• Wash hands with soap and safe water before eating and after using the toilet.
• Clean surfaces and prepare food safely.
• Rest and keep checking how much urine you pass.

Medical treatments

In hospital or a clinic, healthcare workers may give fluids and salts through a vein if you are very dehydrated. They will monitor your urine, salt levels, and kidney function. In some cases, a doctor may prescribe antibiotics to shorten the illness and reduce spread, but fluids are the most important treatment. Antibiotics are only given by a healthcare professional.

When is surgery considered?

Surgery is not part of the usual treatment for cholera.

Living with this condition

Recovery usually takes a few days. Keep drinking fluids, even when you start to feel better. Watch for signs of dehydration and get help if they return. Good handwashing and safe water help protect others.

Lifestyle tips

• Drink only safe water: boiled, bottled, or treated.
• Wash hands with soap often, especially before eating and after toileting.
• Use safe toilets and keep food away from flies.
• Wash fruits and vegetables with safe water, and cook shellfish well.
• If you have cholera, avoid preparing food for others until you are better.

Diet and exercise

Eat small, simple meals as you feel able. There is no special diet that cures cholera, but food helps you recover. Rest until you feel stronger. Ask a health worker when it is safe to return to normal activities.

Mental health and emotional wellbeing

Having a sudden illness like cholera can be scary, especially if you are far from home or in an outbreak. It is normal to feel anxious or overwhelmed. Talk to someone you trust, and ask your healthcare team for support. If you feel in crisis, contact your local emergency number or a crisis service in your area.

Prevention

Yes. Cholera is prevented mainly by safe water, good sanitation, and hand hygiene. Vaccines can help protect people who travel to or live in high-risk areas, but they do not replace safe water and hygiene.

Vaccines

There are oral cholera vaccines (drops or a drink) that a healthcare provider can discuss for travel or for people in outbreak areas. The vaccine is not routinely given to everyone in the UK. Ask your travel health service or doctor if it is recommended for you.

Screening programmes

Routine screening for cholera is not needed for most people. If you have been in an outbreak area and become unwell, see a doctor rather than waiting for screening.

Complications

If left untreated

• Severe dehydration, which can lead to shock
• Kidney failure
• Dangerous salt imbalances
• Death, often within hours if very severe dehydration is not treated

Long-term outlook

With quick rehydration, most people recover fully and have no lasting problems. Cholera is serious, but it is treatable. Getting help early makes a big difference.

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