Controlling Spread of Cholera

Table of Contents

A. Isolation and Quarantine Requirements

Food handlers with cholera must be excluded from work.

Minimum Period of Isolation of Patient

Food-handlers should not return to work until at least 24 hours after diarrhea has ended.  Others until diarrhea has ended.

Minimum Period of Quarantine of Contacts

Contacts with diarrhea, who are food handling facility employees, shall be considered the same as a case and handled in the same fashion. No restrictions otherwise.

B. Protection of Contacts of a Case

Persons who shared food or water with a case during their infectious period should be observed for 5 days from last exposure for signs of illness. Preventive antibiotic therapy is usually not recommended for household contacts in the United States since secondary spread is rare. Immunization of contacts is not indicated.

C. Managing Special Situations

Locally Acquired Case

A locally acquired case of cholera is an unusual occurrence as most cases occur among travelers returning from areas experiencing epidemic cholera. If it is determined during the course of an investigation that a case or suspect case does not have a recent travel history to an endemic country, contact IDPH/CADE at (800) 362-2736 as soon as possible for assistance in instituting an investigation to determine source of infection and mode of transmission.

Reported Incidence Is Higher than Usual/Outbreak Suspected

If an outbreak is suspected, or if multiple cases are reported among people who have not traveled out of the United States, investigate to determine the source of infection and mode of transmission. A contaminated vehicle (such as water or food) should be sought and applicable preventive or control measures should be instituted. Since person-to-person transmission is theoretically possible, special emphasis should be placed on personal cleanliness and sanitary disposal of feces. Consult with IDPH/CADE at (800) 362-2736. CADE can help determine a course of action to prevent further cases and can perform surveillance for other cases that may cross several town lines and therefore be difficult to identify at a local level. If a bioterrorist event is suspected, IDPH and other response authorities will work closely with LPHA(s) and provide instructions/information on how to proceed.

D. Preventive Measures

Environmental Measures

Implicated food items from Iowa or elsewhere in the United States must be removed from the environment. A decision about testing implicated food items can be made in consultation with the Department of Inspections and Appeals, Food and Consumer Safety Division (DIA). If a commercial product is suspected, DIA will coordinate follow-up with relevant outside agencies.

Note: The role of the DIA is to provide policy and technical assistance with the environmental investigation such as interpreting the Iowa Food Code, conducting a Hazard Analysis Critical Control Point (HACCP) risk assessment, initiating enforcement actions and collecting food samples.

Personal Preventive Measures/Education

To avoid exposure, recommend that individuals:

  • Not eat raw or undercooked fish or shellfish. Despite good sanitation, even shellfish harvested from coastal United States waters have periodically been contaminated with V. cholerae.
  • Always wash their 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 their own.
  • In a child care, dispose of feces in a sanitary manner.
  • When caring for someone with diarrhea, scrub their hands with plenty of soap and water after cleaning the bathroom, helping the person use the toilet, or changing diapers, soiled clothes, or soiled sheets.

International Travel

Travelers going to cholera endemic areas should pay attention to what they eat and drink. Avoiding risky foods may help protect against other illnesses, including traveler’s diarrhea, typhoid fever, dysentery, and hepatitis A.

Travelers should:

  • “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 their own raw fruits or vegetables and do not eat the peelings.
  • Avoid foods and beverages from street vendors.
  • Avoid undercooked or raw fish or shellfish, including ceviche.
  • Not bring any perishable food back to the United States.

For more information regarding international travel and the cholera vaccines, contact the CDC’s Traveler’s Health Office at (800) 232-4636 (general number) or through the Internet at www.cdc.gov/travel 

At the present time, the manufacture and sale of cholera vaccine in the United States has been discontinued. It is not recommended for travelers because of the brief and incomplete immunity if offers. No cholera vaccination requirements exist for entry or exit in any country.

Two vaccines available in other countries may be more effective but neither is available in the U.S. (Dukoral®, Biotec AB and Shanchol®).

Iowa Dept. of Public Health, Reviewed  7/1