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Cholera: advising travellers

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Cholera is a disease of global public health concern. Travellers may venture to parts of the world where cholera is endemic or where large outbreaks are occurring. In order to make an appropriate decision about disease risk and the advice to give regarding prevention, the travel health advisor must understand the aetiology of the disease and the indications for vaccination where appropriate.

This article provides an overview of cholera and cholera vaccination to help nurses advise those travelling overseas.

What is cholera?

Cholera is an acute intestinal infection that can result in severe diarrhoea. It is caused by a Gram negative bacterium of the Vibrio family, a genus which has many serotypes.

Toxigenic Vibrio cholerae O1 and O139 (currently confined to Asia), are the only serotypes to cause epidemic cholera. V cholerae O1 has two biotypes, Classical and El Tor. These biotypes can be further divided into three serotypes: Ogawa, Inaba and Hikojima.1,2 Since the 19th century, cholera has occurred in large pandemics, which have started in Asia. The seventh (on-going) global pandemic, caused by the El Tor biotype, started in Indonesia in 1961. The disease can be endemic to a country but cases can reach epidemic proportions where the right factors exist.2

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