Cholera 101: Why this ancient disease is making headlines in 2022

GOATS AND SODA – This has been a devastating year on the cholera front.

The World Health Organization states that 29 countries have reported cases of cholera this year — a notable increase from the average of fewer than 20 countries with outbreaks over the past five years. In addition, the fatality rate has almost tripled from roughly 1% to around 3%, prompting increased concern.

In recent years, the annual death toll from cholera has been about 100,000.

Several of those countries have not reported any cases of cholera in years. Lebanon, which had been cholera free since 1993, has reported 18 cases this year.

And in Haiti, which hadn’t reported a cholera case in over 3 years, Doctors Without Borders teams in Port-au-Prince report they are treating an estimated 100 patients daily.

“This rise in cholera cases and vaccine news is a reminder that an ancient disease – and one which is easily treatable and preventable — can still take a terrible toll in modern times.” 

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And now there are issues with the vaccine supply. Because of a limited supply of vaccines, the International Coordinating Group (ICG) — a group that manages vaccine supplies and is comprised of members from the WHO, Doctors Without Borders, UNICEF, and the Red Cross — has temporarily suspended the two-dose cholera vaccination strategy in favor of a single-dose.

The director general of WHO, Tedros Adhanom Ghebreyesus, says,

“The one-dose strategy has proven effective in previous outbreaks. Though evidence on how long protection lasts is limited.”

A single-dose regiment of the cholera vaccine does not provide immunity against the disease for as long as a two-dose regiment and is less effective at providing immunity to children.

However, the change in vaccination strategy is meant to allow more people to be vaccinated during the current outbreak and at a time when the supply of cholera vaccine is extremely limited.

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So far this year, 24 million doses of the cholera vaccine have shipped, and 8 million additional doses have been approved for emergency usage in 4 countries affected by the outbreak …


Cholera – Mayo Clinic 


A bacterium called Vibrio cholerae causes cholera infection. The deadly effects of the disease are the result of a toxin the bacteria produces in the small intestine. The toxin causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes).

Cholera bacteria might not cause illness in all people who are exposed to them, but they still pass the bacteria in their stool, which can contaminate food and water supplies.

Contaminated water supplies are the main source of cholera infection. The bacterium can be found in:

  • Surface or well water. Contaminated public wells are frequent sources of large-scale cholera outbreaks. People living in crowded conditions without adequate sanitation are especially at risk.
  • Seafood. Eating raw or undercooked seafood, especially shellfish, that comes from certain places can expose you to cholera bacteria. Most recent cases of cholera in the United States have been traced to seafood from the Gulf of Mexico.
  • Raw fruits and vegetables. Raw, unpeeled fruits and vegetables are a frequent source of cholera infection in areas where there’s cholera. In developing countries, uncomposted manure fertilizers or irrigation water containing raw sewage can contaminate produce in the field.
  • Grains. In regions where cholera is widespread, grains such as rice and millet that are contaminated after cooking and kept at room temperature for several hours can grow cholera bacteria.

Risk factors

Everyone is susceptible to cholera, with the exception of infants who get immunity from nursing mothers who have previously had cholera. Still, certain factors can make you more vulnerable to the disease or more likely to have severe signs and symptoms.

Risk factors for cholera include:

  • Poor sanitary conditions. Cholera is more likely to flourish in situations where a sanitary environment — including a safe water supply — is difficult to maintain. Such conditions are common to refugee camps, impoverished countries, and areas afflicted by famine, war or natural disasters.
  • Reduced or nonexistent stomach acid. Cholera bacteria can’t survive in an acidic environment, and ordinary stomach acid often serves as a defense against infection. But people with low levels of stomach acid — such as children, older adults, and people who take antacids, H-2 blockers or proton pump inhibitors — lack this protection, so they’re at greater risk of cholera.
  • Household exposure. You’re at increased risk of cholera if you live with someone who has the disease.
  • Type O blood. For reasons that aren’t entirely clear, people with type O blood are twice as likely to develop cholera compared with people with other blood types.
  • Raw or undercooked shellfish. Although industrialized nations no longer have large-scale cholera outbreaks, eating shellfish from waters known to harbor the bacteria greatly increases your risk.


Cholera can quickly become fatal. In the most severe cases, the rapid loss of large amounts of fluids and electrolytes can lead to death within hours. In less extreme situations, people who don’t receive treatment can die of dehydration and shock hours to days after cholera symptoms first appear.

Although shock and severe dehydration are the worst complications of cholera, other problems can occur, such as:

  • Low blood sugar (hypoglycemia). Dangerously low levels of blood sugar (glucose) — the body’s main energy source — can occur when people become too ill to eat. Children are at greatest risk of this complication, which can cause seizures, unconsciousness and even death.
  • Low potassium levels. People with cholera lose large quantities of minerals, including potassium, in their stools. Very low potassium levels interfere with heart and nerve function and are life-threatening.
  • Kidney failure. When the kidneys lose their filtering ability, excess amounts of fluids, some electrolytes and wastes build up in the body — a potentially life-threatening condition. In people with cholera, kidney failure often accompanies shock.


Cholera is rare in the United States with the few cases related to travel outside the U.S. or to contaminated and improperly cooked seafood from the Gulf Coast waters.

If you’re traveling to areas known to have cholera, your risk of contracting the disease is extremely low if you follow these precautions:

  • Wash your hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water aren’t available, use an alcohol-based hand sanitizer.
  • Drink only safe water, including bottled water or water you’ve boiled or disinfected yourself. Use bottled water even to brush your teeth.

    Hot beverages are generally safe, as are canned or bottled drinks, but wipe the outside before you open them. Don’t add ice to your drinks unless you made it yourself using safe water.

  • Eat food that’s completely cooked and hot and avoid street vendor food, if possible. If you do buy a meal from a street vendor, make sure it’s cooked in your presence and served hot.
  • Avoid sushi, as well as raw or improperly cooked fish and seafood of any kind.
  • Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and fruits that can’t be peeled, such as grapes and berries. SOURCE 
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