CDC Warns Clinicians of Cholera in Returning Travelers

The Centers for Disease Control and Prevention (CDC) warned clinicians to be prepared to treat cholera in returning travelers as the infections globally increase at “unprecedented” rates.

Thus far in 2022, eight travelers with cholera have returned to the US from Pakistan, Iraq, and Bangladesh, according to the CDC guidance for healthcare providers.

“Although cholera in travelers is rare and sustained community transmission in the United States is unlikely, widespread cholera outbreaks in other countries highlight the need for clinicians in the United States to be prepared to treat travelers with cholera, as they could arrive in the United States at any time,” the agency says.

The CDC currently considers 25 countries to have active cholera transmission.

The agency urges clinicians to obtain patients’ travel history when evaluating them for acute onset of watery diarrhea. In addition, stool sample testing for cholera is recommended if these patients have returned from the affected regions.

Cholera is an extremely virulent acute diarrhoeal infection caused by the ingestion of food or water contaminated with the bacterium Vibrio cholerae. Symptoms of the infection typically appear between 12 hours and 5 days after exposure and may include:

• Profuse watery diarrhea
• Vomiting
• Thirst
• Leg cramps.
• Restlessness or irritability
• If untreated, cholera can kill within hours

As cholera cases rise worldwide, the International Coordinating Group (ICG) temporarily suspended the standard two-dose vaccination regimen and moved to a single-dose approach due to the vaccine shortage.

“The global trend is moving towards more numerous, more widespread and more severe outbreaks, due to floods, droughts, conflict, population movements and other factors that limit access to clean water and raise the risk of cholera outbreaks,” the World Health Organization (WHO) said in October.