For the first time in a century, the island country of Cuba is experiencing a cholera outbreak. Health officials have confirmed at least 137 cases of the bacterial disease including three fatalities.
The Cuban outbreak has prompted the Centers for Disease Control and Prevention (CDC) to issue a travel notice Friday for US travelers to the Caribbean island.
Federal health officials say the risk of contracting cholera for travelers in quite low. However, travelers to an area with a known outbreak should take steps to avoid getting sick.
The current outbreak in Cuba has been reported in Granma province in the cities of Manzanillo, Bayamo, Yara, and Campechuela Niquero.
Cholera is an acute bacterial intestinal disease caused by the bacterium Vibrio cholerae. The disease is characterized by sudden onset, profuse watery stools (given the appearance as rice water stools because of flecks of mucus in water) due to a very potent enterotoxin. The enterotoxin leads to an extreme loss of fluid and electrolytes in the production of diarrhea. It has been noted that an untreated patient can lose his bodyweight in fluids in hours resulting in shock and death.
The bacteria are acquired through ingestion of contaminated water or food through a number of mechanisms. Water is usually contaminated by the feces of infected individuals. Drinking water can be contaminated at the source, during transport or during storage at home. Food can get contaminated by soiled hands, during preparation or while eating.
Beverages and ice prepared with contaminated water and fruits and vegetables washed with this water are other examples. Some outbreaks are linked to raw or undercooked seafood.
The incubation for cholera can be from a few hours to 5 days. As long as the stools are positive, the person is infective. Some patients may become carriers of the organism, which can last for months.
There is an oral vaccine available in some countries but it is not available in the U.S. Cholera prevention is the same as in other causes of traveler’s diarrhea.
The CDC recommends the following basic steps for travelers to take to avoid getting cholera:
1. Drink and use safe water.*
• Bottled water with unbroken seals and canned or bottled carbonated beverages are safe to drink and use.
• Use safe water to brush your teeth, wash and prepare food, and make ice.
• Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse.
*Piped water sources, drinks sold in cups or bags, or ice may not be safe. All drinking water and water used to make ice should be boiled or treated with chlorine.
To be sure water is safe to drink and use:
• Boil it or treat it with water purification tablets, a chlorine product, or household bleach.
• Bring your water to a complete boil for at least 1 minute.
• To treat your water, use water purification tablets—brought with you from the United States or a locally available treatment product—and follow the instructions.
• If a chlorine treatment product is not available, you can treat your water with household bleach. Add 8 drops of household bleach for every 1 gallon of water (or 2 drops of household bleach for every 1 liter of water) and wait 30 minutes before drinking.
• Always store your treated water in a clean, covered container.
2. Wash your hands often with soap and safe water.*
• Before you eat or prepare food
• Before feeding your children
• After using the bathroom
• After changing diapers
• After taking care of someone ill with diarrhea
* If no soap is available, use an alcohol-based hand sanitizer (containing at least 60% alcohol).
3. Use toilets; do not defecate in any body of water.
• Use toilets, latrines, or other sanitation systems, such as chemical toilets, to dispose of feces.
• Wash hands with soap and safe water after using the bathroom.
• Clean toilets and surfaces contaminated with feces by using a solution of 1 part household bleach to 9 parts water.
4. Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables.*
• Boil it, cook it, peel it, or leave it.
• Be sure to cook shellfish (such as crabs and crayfish) until they are very hot all the way through.
• Do not bring perishable seafood back to the United States.
*Avoid raw foods other than fruits and vegetables you have peeled yourself.
5. Clean up safely—in the kitchen and in places where the family bathes and washes clothes
• Wash yourself, your children, diapers, and clothes at least 30 meters away from drinking water sources.
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