Introduction

Cholera is a potentially fatal bacterial infection caused by consuming contaminated food or water.

Not everyone who becomesinfectedwill develop symptoms, but those who do will usually experience:

• severe,watery Traveller's diarrhoea
• feeling and being sick
• stomachcramps

These symptoms generally develop within a few days of infection, although they can sometimes occur after just a few hours.

Without treatment,the combination of diarrhoea and vomiting can cause a person to quickly become dehydrated and go into shock (where there's asudden massive drop in blood pressure). In the most severe cases, cholera can be fatal.

At-risk areas

Cholera can spread if food and, in particular,waterbecome contaminated with the stools of an infected person. This is why cholerais most widespread in regions of the world with poor sanitation, such as parts of:

• sub-Saharan Africa
• south and south-east Asia
• the Middle East
• central America and the Caribbean

Mass outbreaks of cholera often occur after natural disasters or during war, as a result of overcrowding in poor living conditions and a lack of access to clean water.

The World Health Organization estimates that there are 1.4 to 4.3 million cases of choleraworldwide every year. The condition is also responsible for many thousands of deaths.

There haven't been any cases of cholera originating in England and Wales for over 100 years, althoughtravellers do occasionally bring the infection back with them.However, this is rare, with only six cases of cholera reportedin England and Wales during 2013/14.

Advice for travellers

If you're travelling to parts of the world known to be affected by cholera, you should take somebasic precautions to prevent a cholera infection and other causes of travellers' diarrhoea .

For example, you should:

• only drink water that's been recently boiled, or drink from a bottle that's been properly sealed
• avoid eating ice cream and don't have ice in your drinks
• avoid uncooked fruit and vegetables, unless you've washed them in safe water or peeled them yourself
• avoid shellfish, seafood and salads

ORS comes as a sachet containing a mixture of salts and glucose, which is dissolved in water. It's ideal for replacing the fluids and minerals that are lost when a person becomes dehydrated.

ORS sachets are available from pharmacists, camping shops and travel clinics. If you're travelling to regions of the world affected by cholera, you should take ORS sachets with you as a precaution.

When a person with cholera is very severely dehydrated, intravenous antibiotics may berecommended to shorten the duration of diarrhoea and speed uprehydration.

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