Per the US Centers for Disease Control and Prevention (CDC), cholera infections are rare and person-to-person transmission in the United States is unlikely; however, the CDC is urging providers to obtain a travel history when evaluating patients with acute-onset watery diarrhea. Further, the CDC recommends obtaining a stool sample for testing and starting aggressive treatment immediately while awaiting test results if cholera is suspected.

Cholera is an acute, potentially life-threatening diarrheal illness caused by the ingestion of water or food contaminated with the bacterium Vibrio cholerae. Symptoms may be mild or severe, with asymptomatic cases occurring frequently. Symptoms include abdominal cramping, severe watery gray-brown ("rice water") diarrhea, vomiting, leg cramping, malaise, and headache. Fever occurs infrequently. Fluid loss may approach 1 liter per hour, and dehydration secondary to the diarrhea can result in shock and circulatory collapse in some cases. Without treatment, the symptoms last from 1-7 days, with mortality rates as high as 50%.

Cholera's incubation period is 2 hours to 5 days, with an average of 2-3 days. While cholera exposure is commonly environmental, due to ingestion of contaminated food or water, person-to-person transmission is also thought to play a role, particularly in the rapid spread of cholera seen during epidemics. Cholera is 1 of 3 diseases with worldwide quarantine sanctions. (Yellow fever and plague are the others.)

An oral vaccine has been shown to be effective in conferring short-term protection during outbreaks, although food and water hygiene should remain the focus of prevention.

Cholera is endemic to countries with poor sewage and water treatment systems because it spreads rapidly through contaminated fecal contact. Few cases of cholera have ever been reported in the United States. Tourists to endemic areas are at higher risk for cholera.

Note: In an outbreak, appropriate disposal of feces, frequent hand washing, and efforts to maintain clean food and water supplies are imperative. Vibrio cholerae shedding in feces continues for 1-2 weeks after infection.