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Cholera

KEY POINTS

  1. Cholera is a bacterial infection of the intestinal tract causing severe, non-bloody diarrhea fluid and electrolyte losses by way of a toxin secreted by the causative organism, Vibrio cholerae.
  2. Cholera is present in most parts of the world where food and water purity is questionable.
  3. Vaccine targets: Those 18-64 yrs old traveling to cholera habitats.

Disease: Cholera can be fatal due to the massive loss of body fluids and electrolytes that may be near impossible to replace quickly enough. Vibrio cholerae only invades the GI tract. Cholera tends to occur in epidemics, not sporadic cases.

Prevalence: Most frequently epidemics occur in India, Asia, Africa, and South Pacific

Transmission: Fecal-oral

Treatment:

  1. Intravenous fluids and electrolytes in prodigious replacement amounts and rates.
  2. Azithromycin, doxycycline, ciprofloxacin, or erythromycin

Prevention:

  1. Avoid suspicious food and water.
  2. Vaccine (Vaxchora)
  • A live, attenuated vaccine administered by mouth as a single dose.
  • Vaccine Administration:
    • To be administered at least 10d pre-exposure to cholera.
    • Is not to be given if recipient have been on oral antibiotics less than or equal to 14d prior.
    • Should not eat or drink anything 60min pre or post-vaccine.
  • Side-Effects, usually within 7d of vaccine:
    • Fatigue
    • Headache
    • Abdominal Pain
    • Nausea
    • Poor Appetite
  •  Special Considerations
    • The vaccine can be shed in the feces for at least 7 days and so can be transmitted to close contacts, potentially risky for immune-compromised individuals.