Cholera is an acute diarrhea disease caused by toxins produced by Vibrio cholerae bacteria. In the United States, because of advanced water and sanitation systems, cholera is not a major threat; however, everyone, especially travelers, should be aware of how the disease is transmitted and what can be done to prevent it.

Cholera is reportable to the Iowa Department of Public Health by Iowa Administrative Code 641 IAC 1.


Most individuals infected with cholera develop mild illness involving only diarrhea. Less commonly, infected individuals will develop more severe illnesses characterized by profuse watery stools, nausea, some vomiting and leg cramps. These symptoms may become more severe because of rapid loss of body fluids, dehydration and shock can occur in the most severe cases. Without rehydration therapy, death may occur within hours if severe illness is untreated. With proper treatment, the risk of fatal illness is significantly reduced.


V. cholerae is usually transmitted by eating or drinking food or water contaminated by stool or vomit of infected persons (e.g., via sewage). The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The bacteria may live in the environment in brackish rivers and coastal waters so individuals may also become ill by ingesting raw or undercooked shellfish harvested from polluted waters. A few persons in the United States have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill.

Risk Factors

Any person who eats or drinks food or water contaminated by the bacteria is at risk of becoming ill. Those traveling to areas where cholera is more common and those with weakened immune systems are at an increased risk of becoming ill.


Although the risk of cholera infection is low in the United States, travelers to coastal regions and those traveling to areas where cholera is typically found are at an increased risk of becoming ill.

General Tips:

  • Do not eat raw or undercooked fish or shellfish, including ceviche.
  • Always wash hands thoroughly with soap and water before eating or preparing food, after using the toilet, and after changing diapers.
  • After changing diapers, wash the child’s hands and your own.
  • In a child care, dispose of feces in a sanitary manner.

When traveling:

  • “Boil it, cook it, peel it, or forget it.”
  • Drink only bottled or boiled water, keeping in mind that bottled carbonated water is safer than un-carbonated water.
  • Ask for drinks without ice unless the ice is made from bottled or boiled water.
  • Avoid popsicles and flavored ices that may have been made with contaminated water.
  • Eat foods that have been thoroughly cooked and that are still hot and steaming.
  • Avoid raw vegetables and fruits that cannot be peeled. Vegetables like lettuce are easily contaminated and are very hard to wash well.
  • Peel your own raw fruits or vegetables and do not eat the peelings.
  • Avoid foods and beverages from street vendors.
  • Do not bring any perishable food back to the United States.


When diarrhea is present, aggressive fluid replacement is the mainstay of treatment. In addition your physician may prescribe certain antibiotics.


No cases of cholera were reported in 2021.

For more detailed information and statistics on all notifiable diseases, please see our current annual report located in the reports section of the CADE homepage.

Additional Resources