Cholera is an acute bacterial infection of the intestine, characterized in its severe form by the sudden onset of painless, watery diarrhoea (known as “rice-water stool”) and vomiting, which can result in rapid, severe dehydration. . Both children and adults can be infected.

Symptoms(Ranges from mild to severe)

  • watery diarrhea(known as “rice-water stool”)
  • vomiting
  • severe dehydration

Infectious Agents

Cholera is caused by the bacterium Vibrio cholerae O1 (classical and El Tor) and O139.

Mode of Transmission

Cholera is transmitted mainly by the faecal–oral route. Transmission can occur through:

  • ingesting contaminated water, including accidental ingestion of contaminated surface water
  • eating contaminated food – especially fruits and vegetables contaminated through water or soil, or during preparation (e.g. rice, millet and food from street vendors) – and contaminated seafood
  • person-to-person transmission; for example, when caring for cholera patients or through direct contact with bodies of deceased cholera patients (e.g. washing the body for funeral ceremonies
  • indirect contamination (of hands) through poor hygiene practices and lack of soap; and through wound infections arising from environmental exposure, especially brackish water from occupational accidents among fishermen


Safe water, adequate sanitation and health education for proper hygiene and food safety are important prevention measures. Infants are best protected by exclusive breastfeeding for 6 months and continued breastfeeding for 2 years or beyond, with safe and adequate complementary foods introduced at 6 months. Infants who are artificially fed need specific support and close monitoring.

Safe drinking-water

Prevention of cholera in any community relies mainly on adequate water, sanita- tion and hygiene; this requires the following:

Provision of adequate facilities for disposal of human waste. The minimum emergency standard is one latrine for every 20 people.

Provision of adequate supplies for hand-washing, bathing and laundry needs. The minimum emergency standard is 250–500 g of soap per person per month.

Promotion of hygiene – including use of latrines and prevention of human defecation on the ground, or in or near water; disposal of children’s waste in latrines; thorough hand-washing before eating, after defecation, before food preparation, and after cleaning children or changing their diapers.

Promotion of food safety – through:

provision of clean, appropriately cooled and spatially adequate food storage facilities (for both uncooked and cooked food, and clean cooking utensils), and adequate quantities of water and fuel for cooking and re-heating

promotion of “five keys to safer food” – keep clean, separate raw and cooked food, cook food thoroughly, keep food at safe temperatures, use clean water and cooking tools.Promotion of breastfeeding – by providing information on the importance and protective qualities of breastfeeding for all infants and young children, and especially for those who are ill.


  1. Cholera, 2007. Weekly Epidemiological Record, 1 August 2008, Vol. 83, 31:269–284. Geneva, World Health Organization (WHO) (The Weekly Epidemiological Record (WER) (, accessed 9 August 2010).
  2. Quarterly Epidemiological Report, Epidemiology Unit. Sri Lanka, Ministry of Health, Nutrition & Welfare (Weekly Epidemiological Report).

Further Reading

Prevention of foodborne disease: five keys to safer food [various resources]. Geneva, WHO, 2009 (Five keys to safer food manual ( accessed 10 August 2010).