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Cholera

Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It can lead to rapid and potentially fatal dehydration if left untreated. Within the UK, indigenous Cholera has been eradicated [27]. All reported cases of cholera in the UK are as a result of people catching the infection while travelling abroad.The disease is found throughout the world particularly in countries where sanitation is poor, particularly parts of Africa, India, Central and South America, South East Asia and more recently in parts of the Caribbean.


How is it contracted?
Cholera is usually transmitted via infected water that has been contaminated by faeces, and less commonly via food. The disease infects the small bowel and is known to infect only humans. 

Who is at risk
Outbreaks are common in slums, refugee camps and areas affected by natural disasters. Every year, there are an estimated 3–5 million cases and 100,000–120,000 deaths due to cholera worldwide, although this is believed to be vastly under reported [25].

Signs and symptoms
The disease has a short incubation period, of two hours to five days, before people present with symptoms; most notably the rapid onset of watery diarrhoea, and vomiting. Of these individuals, 80% have mild or moderate symptoms, while around 20% develop acute watery diarrhoea with severe dehydration, which can be exacerbated by an inability to retain fluids orally and can lead to circulatory collapse. However, around 75% of infected people do not develop any symptoms, although they can excrete the bacteria for 7–14 days after infection, potentially infecting other people.

Outcome
Death is uncommon in people who receive adequate treatment, even in severe cases. 

Treatment
Antibiotic therapy is required, in conjunction with rapid and adequate fluid replacement as individuals can die quickly if they are not treated promptly.

Recommendations for travellers
Short-term travel has an extremely low risk and is in the order of 2 or 3 cases per million travellers [26]. Prevention is focused on ensuring safe food and water, particularly in countries where cholera is more common. Travellers should be particularly wary of drinking untreated water and ice, and eating shellfish, salads, unwashed fruit and vegetables. Good personal hygiene is essential and travellers should ensure that they wash their hands prior to eating and after visiting the bathroom. Vaccination should also be considered, and planned ahead of travel, for those who think they will be unable to take adequate precautions in highly endemic or epidemic settings e.g aid workers, overseas volunteers, and backpackers to remote areas. An oral vaccine is available in the UK which protects against the disease. The standard primary course of vaccination consists of two doses with an interval of at least one week but less than six weeks between doses. A third dose is required for children under 6 years old. 

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Cholera vaccination. Here’s the point...

While readily treatable, prompt access to treatment is required and this may not always be possible in endemic regions. As cholera is a notifiable disease in the UK, for public health management of cases, contacts and outbreaks, all suspected cases should be notified to the local health protection unit immediately [28] Between 2004 and 2013, 147 laboratory- confirmed cases were reported in the England and Wales [29]