The El Tor pandemic strain grows in many foods and can persist in aquatic environments. After initial outbreaks, cholera can disappear or become endemic and remain a public health threat. High attack rates are more common in areas with poor sanitation and inadequate water supplies. In previous epidemics, documented vehicles of transmission have included contaminated water, raw or undercooked shellfish and other seafood, moist-grain gruels, and leftover rice. When the profuse watery diarrhea and vomiting associated with severe cholera are not treated, patients may die from dehydration in hours.
Therapeutic antibiotics can decrease the volume of stool produced.
The impact of epidemic cholera can be diminished by organized control efforts. Public health officials should establish surveillance networks in areas with cholera, or at risk for cholera, and establish oral rehydration facilities throughout the country. The risk to U.S. travelers of acquiring cholera in endemic areas is low. Cholera vaccination confers only brief and incomplete protection and is not recommended. A traveler who develops severe watery diarrhea, or diarrhea and vomiting, during or following travel to an area with known cholera should seek medical attention immediately.