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There was a time when the word “cholera” struck fear into the hearts of people living in American cities. Cholera epidemics occurred in areas where people lived closely together and relied on poorly managed public water and sewers. Cholera that got from a sewer into the water supply could spread a deadly disease like a wild fire. In the years between 1832 and 1866, cholera pandemics could start in a distant country like India and spread across the globe into cities like New York. Although the last outbreak in the US was over 100 years ago, cholera still kills about 100,000 people around the world every year.
Cholera is caused by the bacteria Vibrio cholerae. These bacteria produce poisons called toxins that attack the lining of the digestive system. Only about 10 percent of people who become infected have a severe reaction. This reaction causes a watery and profuse diarrhea so extreme that it can empty a person of body fluids. Unless fluids are replaced, blood pressure drops quickly, followed by kidney failure and shock. Death can result within hours. For pregnant women who survive the diarrhea, loss of a pregnancy is common, occurring in up to about 30 percent of women.
How Cholera Spreads
Cholera does not spread from person to person directly. A person who is infected sheds the bacteria in diarrhea. In areas of the world where sewage can contaminate the water supply, other people get infected by eating food or drinking water contaminated by the bacteria. Cholera bacteria may also live in areas where salt and fresh water mix. Shellfish from these waters may be infected. A few people in the U.S. have been infected from eating raw shellfish from brackish water in the Gulf of Mexico.
In developed counties with secure waste water disposal and safe drinking water, cholera is now very rare. Only a few cases occur in the U.S. every year. However, in countries like Africa, Southeast Asia, and Haiti, cholera outbreaks still occur, especially if there is a natural disaster that overwhelms sewers and clean water supplies. In fact, cholera has been increasing in these areas. The biggest risk for an American, is travelling to a part of the world where cholera may occur.
Cholera Diagnosis, Treatment, and Prevention
You are unlikely to come into contact with cholera unless you travel to an area where there have been outbreaks. If you travel to any of these areas and you are pregnant, may be pregnant, or may become pregnant, talk to your doctor before you leave. There is a vaccine that will reduce your risk of cholera by about 70 percent. This vaccine has recently been cleared for safety during pregnancy. If the risk is high enough, and you need to travel, your doctor may order the vaccine for you.
You can check to see where a cholera vaccination is recommended or required at the CDC website. The main symptom of cholera is profuse diarrhea, called rice water stool. Other symptoms include:
- Muscle cramps, especially in the legs
- Dry skin that loses its elasticity
- Thirst and irritability
- Weakness and dizziness from low blood pressure
Cholera is diagnosed by finding the bacteria in a stool sample. If your doctor suspects cholera from your symptoms and your travel history, you will be started on intravenous fluid replacement, even before a diagnosis is made. Fluid replacement is the most important part of treatment. Cholera is a bacterial infection, and the infection will respond to antibiotics.
Prevention of Cholera
The best way to prevent cholera and protect your pregnancy is not to travel to any areas of the world where there is a risk of cholera. Ask your doctor about a vaccination if you must travel. If you are in an area where you are at risk:
- Wash your hands frequently and always wash before preparing or eating food.
- Use only bottled and capped water and beverages, including water you use to brush your teeth.
- Do not use ice unless you know the water is safe. Do not use unsafe water to clean vegetables or fruits or kitchenware.
- If you don’t have bottled water, boil water for one minute before using.
- Avoid raw shellfish, and uncooked fruits or vegetables unless you peel them yourself. Follow the rule of boil it, cook it, peel it, or leave it.
Be thankful if you live in a part of the world where the efficiency of sewage treatment and the safety of drinking water is taken for granted. For many pregnant women who are less fortunate, cholera is still a real and frightening possibility.