Cholera is an infectious disease that spreads through a bacteria found in water and contaminated food called vibrio cholerae. The Cholera bacteria causes acute diarrheal infection or acute watery diarrhea which in severe cases can lead towards death if not treated timely. Cholera outbreaks are common after natural disasters such as floods and earthquakes due to damage to sanitation infrastructure.

Cholera is common in regions where there is lack of access to safe drinking water and proper sanitation system. Pakistan is among the countries where cholera is common. As per WHO, the disease is endemic in Pakistan. With the floods in the country, cholera along with other water borne diseases is spreading rapidly among flood affectees.

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In this article we will discuss the causes of cholera, its symptoms and treatment as well as preventive measures that can be taken to avoid the cholera infection. We will also discuss cholera outbreaks during natural disaster especially floods.

Causes of Cholera

Cholera is a disease that spreads through fecal-oral route which means that the disease is transmitted by fecal material passing into the mouth through contaminated or dirty water, food and hands that are not properly washed.

You can get cholera if you:

  1. Drink dirty water or any liquid, which is contaminated with human fecal matter.
  2. Eat food that is made with dirty water, or which is contaminated with fecal matter brought by flies.
  3. Eat vegetables or fruits that are grown with water having human waste.
  4. Eat raw or undercooked fish or sea food which is caught from water contaminated with sewage water.
  5. Eating food without washing hands with soap after using toilet.

Symptoms of Cholera

It takes cholera disease few hours or up to five days to shows its symptoms when bacteria enter the human body. Most cholera patients do not develop any symptoms or show very mild symptoms but for those who do the most common symptom of cholera is acute watery diarrhea accompanied by vomiting. Diarrhea and vomiting causes loss of water and electrolytes from body i.e., dehydration which if not treated immediately can lead to organ failure and can even cause death.

Symptoms of Dehydration are as follow:

  • profuse watery diarrhea, sometimes described as “rice-water stools”
  • vomiting
  • thirst
  • Irritability or restlessness
  • Lethargy
  • Trouble breathing

Health care providers should look for signs of dehydration when examining a patient with profuse watery diarrhea. These include:

  • rapid heart rate
  • dry mucous membranes
  • low blood pressure
  • Sunken eyes
  • Skin losing elasticity i.e., when pinched the skin does not go back to normal condition


Cholera’s symptoms and signs are usually very clear which makes it very easy for doctors and health experts to diagnose it. However, to confirm the diagnosis stool culture test to detect cholera causing bacteria is carried out. Different testing options are available in Pakistan, your doctor would recommend a test depending on your condition.


Cholera treatment is usually carried out in three steps,

i. Rehydration

The first and the most important treatment for cholera is rehydration of the patient through oral hydration solution (ORS). If you have a patient at home who has diarrhea and is vomiting immediately give them ORS. ORS can be bought from any medical store in packet form or can be made at home.

Making ORS at Home

Making ORS at home is an easy process,

  • Boil water and cool it down,
  • Take one liter of water(4 glasses), 6 teaspoon of sugar, half teaspoon of salt and squeeze one lemon to the mixture.
  • Mix all the ingredients together in a clean bottle, jug, or bowl.

Recommended Amount of Oral Rehydration Therapy (ORS)

For adults and older children, 1 liter of ORS per hour is recommended till the symptoms subside. While for children 20 ml/kg body weight per hour. For example, if body weight of a kid is 8kgs then they should be given 160ml of ORS per hour.

If the patient’s condition is not improving and symptoms are persistent or getting worse, they should me immediately taken to hospital so their intravenous rehydration therapy (can be given drips) is started.

Note: It is not recommended to give diarrhea patients drinks with high sugar content like juices, soft drinks or sherbets as they can worsen the symptoms. They should be given ORS, water, or broths.

i. Anti-Biotics

Anti-Biotics are given to patients with severe illness along with rehydration therapy. Do not take any antibiotics without doctor prescription.

ii. Zinc Treatment

Zinc treatment is done for children with cholera. Zinc supplements should not be taken without a doctor’s recommendation.

Note: In areas with cholera endemic, governments give cholera vaccine to protect population. If cholera is endemic in your area, check at nearest public health facility if they are providing cholera vaccine.

Prevention of Cholera

Cholera can be prevented by taking following measures:

i. Drinking Safe Water

Cholera is mainly transmitted through contaminated water and food. To protect your family and yourself from cholera either boil water before drinking, filter water or use water purification tablets.

ii. Eat Clean Food

You can take following steps to ensure that the food you are taking is safe and would not make you sick

  • Avoid food which source is unknown
  • Wash hands before preparing and eating food
  • Use clean water for preparing food
  • Wash fruits and vegetables properly with clean water
  • Peel fruits and vegetables before eating
  • Do not consume raw or undercooked fish or sea food
  • Avoid raw or undercooked meat
  • Do not drink unpasteurized milk
  • Eat freshly cooked and hot food
  • Cover cooked food properly to save them from flies

iii. Follow Hand Hygiene

Wash your hands properly with soap after using washroom or before every meal. Make sure that the water you are using for washing your hands is clean.

iv. Follow General Hygiene

Following general hygiene is also extremely important to protect yourself from catching cholera. You can take following steps to ensure your and your family’s safety:

  • Wash your hands and face,
  • Brush your teeth regularly,
  • Cut your nails and clean them regularly,
  • Keep your surroundings clean.

v. Keep your house and surroundings clean

Keeping your house and surroundings clean is extremely important to prevent cholera and numerous other diseases,

  • Make sure your washroom is properly cleaned and disinfected regularly,
  • During spring and monsoon intensity of flies is high which carry fecal matter that can cause cholera, make sure to properly insulate your house so flies cannot enter.

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