Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. The infection is often mild or without symptoms, but sometimes it can be severe. Approximately one in 20 infected persons has severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these persons, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients die.

In January 1991, epidemic cholera appeared in South America and quickly spread to several countries. A few cases have occurred in the United States among persons who traveled to South America or ate contaminated food brought back by travelers. Cholera has been very rare in industrialized nations for the last 100 years; however, the disease is still common today in other parts of the world, including the Indian subcontinent and sub-Saharan Africa.

A person may get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The cholera bacterium may also live in the environment in brackish rivers and coastal waters.

In the United States, cholera was prevalent in the 1800s but has been virtually eliminated by modern sewage and water treatment systems. However, as a result of improved transportation, more persons from the United States travel to parts of Africa, Asia, or Latin America where epidemic cholera is occurring . U.S. travelers to areas with epidemic cholera may be exposed to the cholera bacterium.

The risk for cholera is very low for U.S. travelers visiting areas with epidemic cholera. When simple precautions are observed, contracting the disease is unlikely. Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water and carbonated, bottled beverages with no ice. Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.

A recently developed oral vaccine for cholera is licensed and available in other countries (Dukoral from SBL Vaccines). The vaccine appears to provide somewhat better immunity and have fewer adverse effects than the previously available vaccine. However, CDC does not recommend cholera vaccines for most travelers, nor is the vaccine available in the United States .

U.S. and international public health authorities are working to enhance surveillance for cholera, investigate cholera outbreaks, and design and implement preventive measures. The Centers for Disease Control and Prevention investigates epidemic cholera wherever it occurs and trains laboratory workers in proper techniques for identification of V. cholerae.

Chronic Fatigue Syndrome-chronic fatigue syndrome differs from the more typical feelings of fatigue; it is a debilitating disorder that interferes with a person's ability to participate in the activities of daily life Chronic Granulomatous Disease (CGD)-Chronic granulomatous disease (CGD) is actually a group of rare, inherited disorders of the immunesystem that are caused by defects in the immune system cells called phagocytes.

No effective vaccine has yet been developed for malaria. If you will be visiting an area of risk you will receive advice on how to minimize your risk and also a prescription for appropriate oral malaria prevention medication to take during your trip. No cholera vaccine is available in the United States, but fortunately the risk of cholera to travelers is negligible.

Cholera should be suspected when a child older than 5 years or an adult develops severe dehydration from acute watery diarrhoea (usually with vomiting), or any patient older than 2 years has acute watery diarrhoea when cholera is known to be occurring in the area. Younger children also develop cholera, but the illness may be difficult to distinguish from other causes of acute watery diarrhoea, especially rotavirus.