Cholera

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What is the prognosis of cholera?

The prognosis (outcome) of cholera can range from excellent to poor, depending on the severity of the dehydration and how quickly the patient is given and responds to treatments. Death (mortality) rates in untreated cholera can be as high as 50%-60% during large outbreaks but can be reduced to about 1% if treatment protocols (see above treatment section) are rapidly put into action. In general, the less severe the symptoms and the less time people have dehydration symptoms, the better the prognosis; in many people, if dehydration is quickly reversed, the prognosis is often excellent.

Is it possible to prevent cholera? Are cholera vaccines available?

Yes, cholera can be prevented by several methods. Developed countries have an almost zero incidence of cholera because they have widespread water-treatment plants, food-preparation facilities that usually practice sanitary protocols, and most people have access to toilets and hand-washing facilities. Although these countries may have occasional lapses or gaps in these methods, they have prevented many disease outbreaks, including cholera.

Individuals can prevent or reduce the chance they may get cholera by thorough hand washing, avoiding areas and people with cholera, drinking treated water or similar safe fluids, and eating cleaned and well-cooked food. In addition, there are vaccines available that can help prevent cholera, although they are not available in the U.S., and their effectiveness ranges from 50%-90%, depending on the studies reported. The vaccines are oral preparations, because injected vaccines have not proved to be very effective. Two vaccines (Shanchol and Dukoral) are composed of killed V. cholerae bacteria and don't contain the enterotoxin B subunit. Unfortunately, both offer protection for only about two years, although one report suggests that Shanchol is about 65% effective over five years. Both vaccines are usually given in two doses, about one to six weeks apart. Unfortunately, the vaccines have limited availability; their recommended use is for people going to areas of known outbreaks with the likely possibility the person may be exposed to cholera. Some researchers suggest this limited oral vaccine availability should be changed and cite data that oral vaccine may help limit outbreaks, even after they have begun.

Research is ongoing; a research study in Haiti will try to determine if a two-dose vaccine in people will suffice to protect a difficult to treat (rural poor) population from cholera and thus save many lives. There are over 30 universities researching this disease (cholera's epidemiology, pathology, immunology, vaccine production, and other problems) currently worldwide.

In 2015, about 2 million doses of oral cholera vaccine were shipped to various outbreak areas, and currently available information suggests that there was a significant reduction in transmission of cholera; the study will be concluded in 2018.

Medically Reviewed by a Doctor on 11/18/2015
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