Cholera is endemic in Nepal. Every year the Kathmandu valley and scattered places around the country see more than 100 cases between May and September, with occasional larger outbreaks. Cholera is an acute infection of the small intestine caused by the bacterium Vibrio cholerae.
It causes profuse watery diarrhea that looks like rice water, vomiting, muscle cramps, decreased urine output and severe dehydration. The incubation period is usually 1–2 days, but can range from several hours to 3–5 days. It is usually transmitted by drinking contaminated water, and a large number of bacteria are needed to cause infection.
Prevention
Cholera can be prevented by drinking boiled, bottled or treated water. If bottled water isn't available and boiling is difficult, treat water with chlorine (sold as Piyush or Aquatabs in pharmacies) or iodine.
If you're doing relief or volunteer work in cholera-affected areas, make sure water safety rules are followed by you and by the people around you. Emphasize hand washing before eating and proper waste disposal, and wash your hands after touching anything that may be contaminated with an infected person's feces.
Municipal water is in short supply in Kathmandu, and many people buy water trucked in from different vendors and sources. This water must be boiled or treated before drinking. Bottled mineral water from established brands — particularly 1-liter bottles and 20-liter jars — seems safe, though it is expensive for the local population.
Being careful with what you eat and drink can prevent cholera.
Cholera vaccine
We don't promote cholera vaccine for travelers, except for those volunteering in areas where clean drinking water is hard to access — particularly in the monsoon months, when cholera surfaces in Kathmandu.
- Euvichol-Plus (EuBiologics, South Korea) is available at CIWEC. It is an oral, whole-cell killed vaccine with 65% protective efficacy after 2 doses. Protection begins 7–10 days after the primary series, and it can be given from 1 year of age.
- Dukoral, mostly available in Western countries, has 78% efficacy against V. cholerae O1. It is not available at CIWEC.
- Shanchol (Sanofi, India) is currently unavailable, and production of Vaxchora (an oral live attenuated vaccine) has been discontinued.
Treatment
If someone develops symptoms suggestive of cholera — severe watery diarrhea with signs of shock or circulatory collapse — start oral rehydration immediately and take them to the nearest medical facility. Fluid resuscitation is the key to treatment.
Antibiotics are used in patients with severe dehydration. Doxycycline is the first-line treatment for adults; azithromycin and ciprofloxacin are alternatives.