Signs and Symptoms of Cholera

By Kathleen Doheny. Medically reviewed by Tom Iarocci, MD. May 7th 2016

Cholera is a potentially deadly bacterial disease spread by contaminated food or water, causing an acute and potentially fatal intestinal infection, usually with diarrhea.While it’s extremely rare in the U.S., cholera has been a major health concern in many countries, including Cuba, Africa, Southeast Asia, Mexico and Haiti.

Globally, about 3 to 5 million cases of cholera occur annually, according to the World Health Organization, with about 100,000 deaths. Even so, the risk is extremely low for anyone visiting areas that have cholera if you take simple precautions, according to the Centers for Disease Control and Prevention (CDC).

Becoming aware of the signs and symptoms of cholera, and knowing what to do, greatly minimizes the risk, says physician Phyllis Kozarsky, MD, a travel health expert and professor of medicine at Emory University School of Medicine in Atlanta and chief medical editor of The Yellow Book, a CDC travel health guide.

“Cholera is a very treatable disease, even when it’s severe,” says Kozarsky, who is also a consultant for the CDC’s travelers’ health website. “The problem is getting people to treatment quickly,” she says.

Acute Symptoms of Cholera

Cholera is caused by a bacterium called Vibrio cholera. When you eat food or drink water contaminated with these bacteria, it can lead to an acute intestinal infection.

Cholera isn’t likely to spread by casual contact with someone who has it, according to the CDC.

Typically, cholera is more common in countries without modern water treatment and with poor sanitation. However, most vacationers or business travelers who ingest only a few bacteria from food and drinks do not become ill. “It takes a lot of cholera organisms to make someone sick,” Kozarsky says.

Be aware that symptoms may not appear right away, though. “The incubation period can range from about two hours to five days,” Kozarsky says.

You may also experience these signs of cholera, which can cause life-threatening dehydration:

  • Painful stomach cramps,
  • Watery diarrhea,
  • Nausea and vomiting, and
  • Dry mouth and excessive thirst.

Exposure to cholera bacteria, for instance, is much less likely to make you sick than exposure to the norovirus that often sickens cruise ship passengers, Kozarsky says. In those who do become infected with cholera, about 80 percent have a mild or moderate infection, according to the World Health Organization, not the severe disease marked by profuse diarrhea, vomiting and leg cramps. If it’s the severe form, death can occur within hours without treatment; dehydration can occur within three hours of symptoms. In the Haiti outbreak of 2010, death was as early as two hours after symptom onset, and the median time of death was only 12 hours after symptoms began.

Take These Safety Precautions

Two vaccines to protect against cholera exist, but are not available in the US. The CDC doesn’t recommend the vaccines for most travelers because they only work for a brief period of time and most people won’t catch the disease. 

Prevention is the best idea. If you travel to an area with known cholera, take a look at the CDC’s recommendations for travelers and consider the following tips: 

  • Do not drink or sip the tap water.
  • Choose bottled water, or disinfect drinking water with chemicals.
  • Use treated water even when washing dishes, brushing teeth, preparing food or making ice cubes.
  • Wash your hands often with soap and water or a sanitizing alcohol-based solution.
  • Eat only well-cooked food.
  • Don’t eat sushi and undercooked or raw seafood.
  • Avoid food from street vendors.
  • Avoid raw vegetables and eat only fruits that can be peeled.
  • Avoid foods that lack acidity and are moist, such as seafood and dairy products.

Next Steps

  • Before departing for an area with a history of cholera, check in the with CDC travelers’ health website, It offers updated information about cholera outbreaks and spells out the precautions you should take.
  • If you develop diarrhea, feel dehydrated or both, seek medical help right away. “It’s important to see a healthcare provider,” Kozarsky says. “If you suspect cholera or dehydration, drink lots of fluids.”
  • Once you reach medical help, you will likely be given oral rehydration solutions and intravenous fluids to restore your fluid balance.
  • Doctors will also give you a course of antibiotics once any vomiting has stopped, to shorten the duration of your illness.

For Caregivers

Any dehydrating diarrhea is serious, and the young and very old are particularly at risk. If a loved one has returned from a country with a known cholera problem and develops extreme diarrhea, urge them to seek medical help. Their healthcare provider can treat or rule out cholera, as well as other potentially serious health problems. 

Related Articles

Traveler's Diarrhea

Types of Waterborne Diseases

Home Remedies for Diarrhea

How to Avoid Traveler's Diarrhea

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