Another reason to begin your immunization program early is that many of the programs require a series of shots over several weeks or months. As well, some vaccinations cannot be administered at the same time. Ask your physician about your immunization requirements. Cholera - is spread through water. The vibrio cholera bacterium invades the intestine and releases a toxin that causes massive fluid loss through diarrhea.
Patients die from dehydration.
A vaccination is available but is relatively ineffective against modern strains of cholera. The disease can be treated with anti-biotics and requires hospitalisation. Basically, avoid areas with reported cholera outbreaks. You might be able to get a certificate without having the injection from a doctor or health center sympathetic to the difficulties of travel in Africa. Check out this list of Cholera-infected countries .