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CholeraNovember 2000 Know before you go!Infectious diseases not necessarily common in Canada can occur and may even be widespread in other countries. Standards of hygiene and medical care may differ from those at home. Before departure, you should learn about the health conditions in the country or countries you plan to visit, your own risk of disease and the steps you can take to prevent illness. The risk is yours Risk assessment consultation Some facts from the experts Disease profileCholera is an acute intestinal infection caused by the bacterium Vibrio cholerae. The bacteria produces a toxin that causes an infected person to dehydrate through vomiting and profuse watery diarrhea. Two strains of cholera are now associated with infection: V. cholerae serogroup O1 and V. cholerae serogroup O139. Transmission
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Table 1: Reported Cholera Activity, by Area & Country, 1999 |
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Area | Country | Number of cases/ Number of deaths |
Area | Country | Number of cases/ Number of deaths |
Africa | Benin | 855 / 25 | Americas | Belize | 12 / not reported |
Burkina Faso | 93 / 6 | Brazil | 3,233 / 83 | ||
Burundi | 3,440 / 63 | Colombia | 42 / not reported | ||
Cameroon | 326 / 35 | Ecuador | 90 / not reported | ||
Chad | 217 / 18 | El Salvador | 134 / not reported | ||
Comoros | 1,180 / 42 | Guatemala | 2,077 / not reported | ||
Congo | 4,814 / 20 | Honduras | 56 / 3 | ||
Democratic Republic of Congo | 12,711 / 783 | Mexico | 9 / not reported | ||
Ghana | 9,432 / 260 | Nicaragua | 545 / 7 | ||
Guinea | 546 / 44 | Peru | 1,546 / 6 | ||
Kenya | 11,039 / 350 | USA | 6 (imported) / 0 | ||
Liberia | 215 / 0 | Venezuela | 376 / 4 | ||
Madagascar | 9,745 / 542 | Asia | Afghanistan | 24,639 / 152 | |
Malawi | 26,508 / 648 | Brunei Darussalam | 93 / 0 | ||
Mali | 6 / 3 | Cambodia | 1,711 / 130 | ||
Mozambique | 44,329 / 1,194 | China | 4,570 / not reported | ||
Niger | 1,186 / 85 | Hong Kong | 18 (11 imported) / 0 | ||
Nigeria | 26,358 / 2,085 | India | 3,839 / 6 | ||
Rwanda | 217 / 49 | Iran, Islamic Republic of... | 1,369 / 21 | ||
Sierra Leone | 834 / 5 | Iraq | 1,985 / 30 | ||
Somalia | 17, 757 / 693 | Japan | 40 / 0 | ||
South Africa | 68 / 2 | Malaysia | 535 / 0 | ||
Swaziland | 7 / 0 | Philippines | 330 / 0 | ||
Tanzania, United Republic of ... | 11,855 / 584 | Singapore | 11 / 0 | ||
Togo | 667 / 31 | Sri Lanka | 108 / 5 | ||
Uganda | 5,169 / 241 | Viet Nam | 169 / 0 | ||
Zambia | 11,535 / 535 | Oceania | Australia | 4 (imported) / 0 | |
Zimbabwe | 5,637 / 385 | New Zealand | 1 (imported) / 0 | ||
Europe | Austria | 1 (imported) / 0 | World Total: 254,310 / 9,175 |
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Germany | 3 (imported) / 0 | ||||
Netherlands | 2 (imported) / 0 | ||||
Russian Federation | 8 (5 imported) / 0 | ||||
Ukraine | 2 / 0 | ||||
Source: Weekly Epidemiological Record (WER), No. 31 (4 August, 2000), World Health Organization |
The incubation period for cholera ranges from less than 1 day to 5 days. Most persons infected with cholera do not become ill, although the bacterium is present in their feces for 7-14 days. When illness does occur, infection causes only mild or moderate diarrhea in roughly 90% of individuals. In 5-10% of cases, infected individuals develop severe, watery diarrhea and vomiting. The resulting loss of fluids in an infected individual can rapidly lead to severe dehydration. If not treated, death can occur within hours.
The most important treatment is rehydration, which consists of prompt replacement of water and salts lost through diarrhea and vomiting. Patients who have become severely dehydrated may be given intravenous fluids, while oral rehydration with glucose-electrolyte solutions may be adequate for mild cases. In serious cases, an effective antibiotic can be used to reduce diarrhea.
Most travellers visiting an area where cholera occurs are at very low risk of acquiring infection. The estimated risk of cholera in European or North American travellers to endemic areas is 1 or 2 cases per 1 million trips. Taking food and water precautions (see recommendations below) is the best means of preventing cholera infection.
Vaccination
An oral, live, attenuated cholera vaccine - CVD 103-HgR (Mutachol®) - is licenced in Canada and is partially effective against cholera; that is, against serogroup O1 only. The vaccine is administered as a single dose and is approved for adults and children over 2 years of age.
Vaccination is not recommended for the prevention of cholera in the majority of travellers to endemic areas for the following reasons:
However, travellers who may be at increased risk for acquiring cholera -for example, health professionals working in endemic areas, aid workers in refugee camps, travellers to remote cholera areas without access to safe water supplies - may wish to consider receiving the vaccine. Travellers should seek a detailed, individual risk assessment to determine their need for vaccination.
Because cholera is spread through contaminated food and water, Public Health Agency of Canada strongly recommends that travellers exercise general food and water precautions to minimize their risk of exposure. The key principles to remember are: boil it, cook it, peel it or leave it!
The Public Health Agency of Canada does not recommend the use of antibiotics as a preventive measure. However, following an individual risk assessment, antibiotics may be prescribed by a physician for use should diarrhea develop.
By taking a few food and water precautions and emphasizing personal hygiene while travelling, you can protect yourself against cholera. Remember: boil it, cook it, peel it, or forget it!
If you should develop nausea, stomach cramps, diarrhea or vomiting during travel to a cholera-endemic area or after returning, seek medical attention and report your recent travel history.
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Last Updated: 2000-11-02 |