Cholera is caused by a bacteria called Vibrio Cholera and is a severely infectious disease which can be deadly. Around 206 serogroups of V.cholerae have been identified. 

Spread: V. cholerae likes water and can be found in contaminated water, food which has been washed in contaminated water and food which has used human excrement to fertilise the food.

Spread through bad hygiene, eg not wahsing hands after using toilets. People can be infected, carrying the bacteria  for 7 - 14 days before becoming sick, and spreading cholera during this time affecting other people. 

Fish - shellfish and fish eaten which were found in contaminated water. 

Cholera is easily caught and cured, but can be deadly if not treated.

High risk patients include older people, young children, babies and immune compromised persons, persons who have recently been to an area hit by cyclones/tornadoes/hurricanes, anyone who has ingested contaminated water or food, healthcare workers

Also known as Blue death, cholera patients in the late stages are dehydrated and lack lustre, with a blue tinge to the skin.

Notifiable: YES



  • Boiling water is very effective in killing the cholera bacteria and also other pathogens which might be in the water.
  • Avoid fruit and vegetables washed in infected water. 
  • Good hygiene, wash hands after using toilet and before eating (with clean water)

Where is cholera found:

Infected water, infected shellfish from the waterproof. High risk areas include areas where sanitation is poor, 

After a natural disaster eg Beira, the city hardest hit by Cyclone Idai in Mozambique


Incubation period:

Symptoms can take between a few hours to 5 days. People can be carriers before showing the signs of diarrhoea. 


  • Acute onset of watery diarhoea, painless with small flecks of mcous in the stool (known as "rice water" stools)
  • Possible vomiting
  • Dehydration and death can happen within a few hours
  • Other symptoms: Cramps due to electolyte loss
  • Confusion
  • Weakness
  • Renal failure
  • Arrhythmias

Vibrio cholera increase in the small intestine and release toxins which cause diarrhoea and dehydration. It might not be obvious from the outset that the person has cholera, as the diarrhoea presents itself in a similar way to other types of diarhoea.


  • Dehydration
  • Sodium and potassium deficiency amongst others
  • Bedsores and skin lesions from moisture


Assess the dehyration levels of the person.
Aggressive rehydration therapy
  • Fluid replacement - oral rehydration in mild cases. Water needs to be pre-boiled first and come from safe resources 
  • In sever cases the infected person needs admission and intravenous infusions. 
  • Antibiotics in cases or mild to severe dehydration. Some cholera strains are however, drug resistant and is often specific to the area.  
  • The anitbiotic currently being used is Azithromycin and Ciproflaxacin depending on the area, in conjunction with zinc supplementation to persons younger than 5 (between 0 months and 5 years)
  • Management:
  • Stool specimen or rectal swab for accurate testing placed in Cary-Blair transport mediu if not able to process immediately
  • Training about hygiene, boiling water, 
  • Alert authorities immediately
  • Long term - sanitation needs to be improved, training of population as to how to prevent, and how to identify cholera, and how to rehydrate until medical help is available.
  • Allow eating and drinking as soon as possible
Please label the specimens clearly with cotton swab tip in the transport medium
Request MCs and Cholera. Cholera needs to be specified. Transport in a cool environment

 NEVER use anti-motility drugs eg Loperamide

National Guidelines for Cholera control

NICD Guidelines








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