- sick: > 170,000
- dead: > 3,600 by Dec.31, 2010

- death rate ↓, more people have access to safe water, but cholera still spreading
- cases in Dominican Republic & other countries (including Canada, France, USA)

- global travel ↑ → cases of cholera will be imported from countries such as Haiti and Cameroon
- medical and relief personnel are traveling back and forth
- e.g.: since emergence of cholera in Haiti, 33 cholera cases identified in the USA among people who had traveled to Hispaniola or consumed seafood brought back from Hispaniola to the United States

Strains of bacterium Vibrio Cholerae that produce cholera toxin

- 12 to 24 hrs after swallowing contaminated water or food → acute, profuse watery diarrhea → quickly profound loss of fluid & electrolytes, acidosis, and shock
- acidosis → vomiting, and low potassium levels → painful leg cramps
- within hours, a person can become severely dehydrated & may lose < 10% of his/her body weight, go into hypovolemic shock, & die

- oral rehydration solution (replaces electrolytes & makes gut absorb fluid)
- those more severely affected → many liters of Ringer's lactate solution, given rapidly through several intravenous lines

- 3-5 million cases annually, with 100,000-120,000 deaths
- in the United States, 1- 8 cases of cholera are diagnosed each year among people returning or coming from cholera-affected areas
- some strains of the cholera bacterium live naturally in warm & brackish waters along Gulf Coast, occasionally found in filter feeding shellfish, like oysters and crabs, usually during the warmest months of year. Every year, 1-2 people in the United States are diagnosed with cholera after eating raw oysters or lightly cooked crabs

- severe diarrhea & vomiting within a few days of a trip to country where cholera is common or who have recently eaten raw shellfish from warm waters → consider cholera
- assess patient immediately for dehydration & begin rehydration therapy if indicated
- send stool sample to lab & specifically request it be cultured for vibrios (cholera is diagnosed by isolating V cholerae bacteria from patient's stools, & then testing it for cholera toxin)
- if patient well enough → home with oral rehydration solution + advise them to return or call 911 if diarrhea or vomiting worsens - antibiotics to treat severe cholera. Most strains susceptible to fluoroquinolones (ciprofloxacin)
- call local health department to report a suspected case; a public health official → talk to patient about how they may have acquired infection; sanitarian → visit the home to make sure sanitary conditions will prevent further spread

- safe drinking water systems and sewage treatment plants
- until water and sewage systems are safe, people can treat water in their homes
- drink only water that has been has been boiled, carbonated, or disinfected, and avoid ice
- eat food that has been well cooked, and eat it hot
- eat only fruits and vegetables that you peel yourself
- avoid fresh salads and raw seafood
- don't bring back food in luggage, especially seafood
- “Boil it, cook it, peel it, or forget it”