Cholera

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    <title>Cholera</title>
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'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 |doi-access=free}}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519 | hdl-access = free }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;&lt;nowiki&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=&lt;/nowiki&gt;[https://archive.org/details/medicalanthropol00mcel_718](https://archive.org/details/medicalanthropol00mcel_718) |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [[https://archive.org/details/medicalanthropol00mcel_718/page/n395](https://archive.org/details/medicalanthropol00mcel_718/page/n395&lt;nowiki&gt;) 375]|isbn=978-0-8133-4384-6}}&lt;/nowiki&gt;&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=[http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans](http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans), Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=[https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26](https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26) October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web | title=General Information – Cholera | website=CDC | date=5 August 2020 | url=[https://www.cdc.gov/cholera/general/index.html#three](https://www.cdc.gov/cholera/general/index.html#three) | access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 |doi-access=free}}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=[https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google](https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google) |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=[www.who.int|language=en](http://www.who.int|language=en)}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=[http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=[https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=[https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html](https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html) |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=[http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others](http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others) — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=[https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine](https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine) |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=[http://www.immunize.org/fda/](http://www.immunize.org/fda/) |archive-url=[https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/](https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/) |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=[https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html](https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html) |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=[https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330](https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330) |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=[https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43](https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43) |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=[https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563](https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563) |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878 |doi-access=free }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=[www.ecdc.europa.eu](http://www.ecdc.europa.eu)}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=[www.who.int](http://www.who.int) |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=[http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All](http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All) Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=[www.historyofmedicine.com|language=en-us|access-date=23](http://www.historyofmedicine.com|language=en-us|access-date=23) July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=[www.cdc.gov|language=en-us|access-date=4](http://www.cdc.gov|language=en-us|access-date=4) April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = [https://books.google.com/books?id=kRAInwEACAAJ|](https://books.google.com/books?id=kRAInwEACAAJ|) publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062 | doi-access = free }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[[http://www.legatum.sk/en:ahr](http://www.legatum.sk/en:ahr):bayes-cholera-as-treated-by-dr-rubini-158-10355 [www.legatum.sk](http://www.legatum.sk)]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web|title=Cholera Infantum, Tomatoes Will Relieve|url=[http://www.oldtimeremedies.co.uk/labels/cholera.html|date=13 October 2008|access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x | doi-access = free }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= [http://www.laskerfoundation.org/awards/show/treatment-of-cholera/](http://www.laskerfoundation.org/awards/show/treatment-of-cholera/) |title= Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=[https://www.who.int/news-room/fact-sheets/detail/cholera|title](https://www.who.int/news-room/fact-sheets/detail/cholera|title) = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
{{Authority control}}

[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
[[Category:Articles wey dey contain video clips]]</text>
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'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 |doi-access=free}}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519 | hdl-access = free }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;&lt;nowiki&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=&lt;/nowiki&gt;[https://archive.org/details/medicalanthropol00mcel_718](https://archive.org/details/medicalanthropol00mcel_718) |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [[https://archive.org/details/medicalanthropol00mcel_718/page/n395](https://archive.org/details/medicalanthropol00mcel_718/page/n395&lt;nowiki&gt;) 375]|isbn=978-0-8133-4384-6}}&lt;/nowiki&gt;&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=[http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans](http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans), Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26 October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web | title=General Information – Cholera | website=CDC | date=5 August 2020 | url=[https://www.cdc.gov/cholera/general/index.html#three](https://www.cdc.gov/cholera/general/index.html#three) | access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 |doi-access=free}}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=[https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google](https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google) |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=[www.who.int|language=en](http://www.who.int|language=en)}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=[http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=[https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=[https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html](https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html) |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=[http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others](http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others) — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=[https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine](https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine) |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=[http://www.immunize.org/fda/](http://www.immunize.org/fda/) |archive-url=[https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/](https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/) |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=[https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html](https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html) |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=[https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330](https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330) |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=[https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43](https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43) |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=[https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563](https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563) |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878 |doi-access=free }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=[www.ecdc.europa.eu](http://www.ecdc.europa.eu)}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=[www.who.int](http://www.who.int) |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=[http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All](http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All) Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=[www.historyofmedicine.com|language=en-us|access-date=23](http://www.historyofmedicine.com|language=en-us|access-date=23) July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=[www.cdc.gov|language=en-us|access-date=4](http://www.cdc.gov|language=en-us|access-date=4) April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = [https://books.google.com/books?id=kRAInwEACAAJ|](https://books.google.com/books?id=kRAInwEACAAJ|) publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062 | doi-access = free }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[[http://www.legatum.sk/en:ahr](http://www.legatum.sk/en:ahr):bayes-cholera-as-treated-by-dr-rubini-158-10355 [www.legatum.sk](http://www.legatum.sk)]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web|title=Cholera Infantum, Tomatoes Will Relieve|url=[http://www.oldtimeremedies.co.uk/labels/cholera.html|date=13 October 2008|access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x | doi-access = free }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= [http://www.laskerfoundation.org/awards/show/treatment-of-cholera/](http://www.laskerfoundation.org/awards/show/treatment-of-cholera/) |title= Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=[https://www.who.int/news-room/fact-sheets/detail/cholera|title](https://www.who.int/news-room/fact-sheets/detail/cholera|title) = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
{{Authority control}}

[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
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'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 |doi-access=free}}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519 | hdl-access = free }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;&lt;nowiki&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=&lt;/nowiki&gt;[https://archive.org/details/medicalanthropol00mcel_718](https://archive.org/details/medicalanthropol00mcel_718) |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [[https://archive.org/details/medicalanthropol00mcel_718/page/n395](https://archive.org/details/medicalanthropol00mcel_718/page/n395&lt;nowiki&gt;) 375]|isbn=978-0-8133-4384-6}}&lt;/nowiki&gt;&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans, Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26 October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web | title=General Information – Cholera | website=CDC | date=5 August 2020 | url=[https://www.cdc.gov/cholera/general/index.html#three](https://www.cdc.gov/cholera/general/index.html#three) | access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 |doi-access=free}}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=[https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google](https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google) |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=[www.who.int|language=en](http://www.who.int|language=en)}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=[http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=[https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=[https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html](https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html) |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=[http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others](http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others) — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=[https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine](https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine) |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=[http://www.immunize.org/fda/](http://www.immunize.org/fda/) |archive-url=[https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/](https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/) |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=[https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html](https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html) |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=[https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330](https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330) |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=[https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43](https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43) |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=[https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563](https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563) |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878 |doi-access=free }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=[www.ecdc.europa.eu](http://www.ecdc.europa.eu)}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=[www.who.int](http://www.who.int) |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=[www.historyofmedicine.com|language=en-us|access-date=23](http://www.historyofmedicine.com|language=en-us|access-date=23) July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=[www.cdc.gov|language=en-us|access-date=4](http://www.cdc.gov|language=en-us|access-date=4) April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = [https://books.google.com/books?id=kRAInwEACAAJ|](https://books.google.com/books?id=kRAInwEACAAJ|) publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062 | doi-access = free }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[[http://www.legatum.sk/en:ahr](http://www.legatum.sk/en:ahr):bayes-cholera-as-treated-by-dr-rubini-158-10355 [www.legatum.sk](http://www.legatum.sk)]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web|title=Cholera Infantum, Tomatoes Will Relieve|url=[http://www.oldtimeremedies.co.uk/labels/cholera.html|date=13 October 2008|access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x | doi-access = free }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= [http://www.laskerfoundation.org/awards/show/treatment-of-cholera/](http://www.laskerfoundation.org/awards/show/treatment-of-cholera/) |title= Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=[https://www.who.int/news-room/fact-sheets/detail/cholera|title](https://www.who.int/news-room/fact-sheets/detail/cholera|title) = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
{{Authority control}}

[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
[[Category:Articles wey dey contain video clips]]</text>
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      <comment>Removed hyperlink in |website=[www.ecdc.europa.eu](http://www.ecdc.europa.eu) → |website=ecdc.europa.eu</comment>
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      <text bytes="68712" sha1="02dzudn0x8dahydktlv6h81kzwionqz" xml:space="preserve">{{Databox}}
'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 |doi-access=free}}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519 | hdl-access = free }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;&lt;nowiki&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=&lt;/nowiki&gt;[https://archive.org/details/medicalanthropol00mcel_718](https://archive.org/details/medicalanthropol00mcel_718) |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [[https://archive.org/details/medicalanthropol00mcel_718/page/n395](https://archive.org/details/medicalanthropol00mcel_718/page/n395&lt;nowiki&gt;) 375]|isbn=978-0-8133-4384-6}}&lt;/nowiki&gt;&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans, Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26 October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web | title=General Information – Cholera | website=CDC | date=5 August 2020 | url=[https://www.cdc.gov/cholera/general/index.html#three](https://www.cdc.gov/cholera/general/index.html#three) | access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 |doi-access=free}}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=[https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google](https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google) |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=who.int|language=en}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=[http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=[https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=[https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html](https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html) |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=[http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others](http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others) — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=[https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine](https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine) |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=[http://www.immunize.org/fda/](http://www.immunize.org/fda/) |archive-url=[https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/](https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/) |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=[https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html](https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html) |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=[https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330](https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330) |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=[https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43](https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43) |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=[https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563](https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563) |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878 |doi-access=free }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=ecdc.europa.eu}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=[www.who.int](http://www.who.int) |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=historyofmedicine.com|language=en-us|access-date=23 July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=cdc.gov|language=en-us|access-date=4 April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = [https://books.google.com/books?id=kRAInwEACAAJ|](https://books.google.com/books?id=kRAInwEACAAJ|) publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062 | doi-access = free }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[[http://www.legatum.sk/en:ahr](http://www.legatum.sk/en:ahr):bayes-cholera-as-treated-by-dr-rubini-158-10355 [www.legatum.sk](http://www.legatum.sk)]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web|title=Cholera Infantum, Tomatoes Will Relieve|url=[http://www.oldtimeremedies.co.uk/labels/cholera.html|date=13 October 2008|access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x | doi-access = free }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= [http://www.laskerfoundation.org/awards/show/treatment-of-cholera/](http://www.laskerfoundation.org/awards/show/treatment-of-cholera/) |title= Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=[https://www.who.int/news-room/fact-sheets/detail/cholera|title](https://www.who.int/news-room/fact-sheets/detail/cholera|title) = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
{{Authority control}}

[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
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'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 |doi-access=free}}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519 | hdl-access = free }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;&lt;nowiki&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=&lt;/nowiki&gt;[https://archive.org/details/medicalanthropol00mcel_718](https://archive.org/details/medicalanthropol00mcel_718) |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [[https://archive.org/details/medicalanthropol00mcel_718/page/n395](https://archive.org/details/medicalanthropol00mcel_718/page/n395&lt;nowiki&gt;) 375]|isbn=978-0-8133-4384-6}}&lt;/nowiki&gt;&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans, Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26 October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web | title=General Information – Cholera | website=CDC | date=5 August 2020 | url=[https://www.cdc.gov/cholera/general/index.html#three](https://www.cdc.gov/cholera/general/index.html#three) | access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 |doi-access=free}}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=[https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google](https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google) |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=who.int|language=en}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=[http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=[https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=[https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html](https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html) |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=[http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others](http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others) — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=[https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine](https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine) |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=[http://www.immunize.org/fda/](http://www.immunize.org/fda/) |archive-url=[https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/](https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/) |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=[https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html](https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html) |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=[https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330](https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330) |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=[https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43](https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43) |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=[https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563](https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563) |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878 |doi-access=free }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=ecdc.europa.eu}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=who.int |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=historyofmedicine.com|language=en-us|access-date=23 July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=cdc.gov|language=en-us|access-date=4 April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = [https://books.google.com/books?id=kRAInwEACAAJ|](https://books.google.com/books?id=kRAInwEACAAJ|) publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062 | doi-access = free }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[[http://www.legatum.sk/en:ahr](http://www.legatum.sk/en:ahr):bayes-cholera-as-treated-by-dr-rubini-158-10355 [www.legatum.sk](http://www.legatum.sk)]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web|title=Cholera Infantum, Tomatoes Will Relieve|url=[http://www.oldtimeremedies.co.uk/labels/cholera.html|date=13 October 2008|access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x | doi-access = free }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= [http://www.laskerfoundation.org/awards/show/treatment-of-cholera/](http://www.laskerfoundation.org/awards/show/treatment-of-cholera/) |title= Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=[https://www.who.int/news-room/fact-sheets/detail/cholera|title](https://www.who.int/news-room/fact-sheets/detail/cholera|title) = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
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[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
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'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 |doi-access=free}}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519 | hdl-access = free }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;&lt;nowiki&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=&lt;/nowiki&gt;[https://archive.org/details/medicalanthropol00mcel_718](https://archive.org/details/medicalanthropol00mcel_718) |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [[https://archive.org/details/medicalanthropol00mcel_718/page/n395](https://archive.org/details/medicalanthropol00mcel_718/page/n395&lt;nowiki&gt;) 375]|isbn=978-0-8133-4384-6}}&lt;/nowiki&gt;&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans, Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26 October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web | title=General Information – Cholera | website=CDC | date=5 August 2020 | url=[https://www.cdc.gov/cholera/general/index.html#three](https://www.cdc.gov/cholera/general/index.html#three) | access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 |doi-access=free}}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=[https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google](https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google) |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=who.int|language=en}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=[http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=[https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=[https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html](https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html) |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=[http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others](http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others) — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=[https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine](https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine) |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=[http://www.immunize.org/fda/](http://www.immunize.org/fda/) |archive-url=[https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/](https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/) |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=[https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html](https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html) |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=[https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330](https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330) |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=[https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43](https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43) |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=[https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563](https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563) |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878 |doi-access=free }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=ecdc.europa.eu}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=who.int |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=historyofmedicine.com|language=en-us|access-date=23 July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=cdc.gov|language=en-us|access-date=4 April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = [https://books.google.com/books?id=kRAInwEACAAJ|](https://books.google.com/books?id=kRAInwEACAAJ|) publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062 | doi-access = free }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[[http://www.legatum.sk/en:ahr](http://www.legatum.sk/en:ahr):bayes-cholera-as-treated-by-dr-rubini-158-10355 [www.legatum.sk](http://www.legatum.sk)]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web|title=Cholera Infantum, Tomatoes Will Relieve|url=[http://www.oldtimeremedies.co.uk/labels/cholera.html|date=13 October 2008|access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x | doi-access = free }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= [http://www.laskerfoundation.org/awards/show/treatment-of-cholera/](http://www.laskerfoundation.org/awards/show/treatment-of-cholera/) |title= Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/cholera|title = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
{{Authority control}}

[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
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'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 |doi-access=free}}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519 | hdl-access = free }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;&lt;nowiki&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=&lt;/nowiki&gt;[https://archive.org/details/medicalanthropol00mcel_718](https://archive.org/details/medicalanthropol00mcel_718) |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [[https://archive.org/details/medicalanthropol00mcel_718/page/n395](https://archive.org/details/medicalanthropol00mcel_718/page/n395&lt;nowiki&gt;) 375]|isbn=978-0-8133-4384-6}}&lt;/nowiki&gt;&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans, Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26 October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web | title=General Information – Cholera | website=CDC | date=5 August 2020 | url=[https://www.cdc.gov/cholera/general/index.html#three](https://www.cdc.gov/cholera/general/index.html#three) | access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 |doi-access=free}}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=who.int|language=en}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=[http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf](http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf) |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=[http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others](http://www.historyofvaccines.org/content/timelines/others|archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others) — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=[http://www.immunize.org/fda/](http://www.immunize.org/fda/) |archive-url=https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/ |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563 |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878 |doi-access=free }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=ecdc.europa.eu}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=who.int |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=historyofmedicine.com|language=en-us|access-date=23 July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=cdc.gov|language=en-us|access-date=4 April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = [https://books.google.com/books?id=kRAInwEACAAJ|](https://books.google.com/books?id=kRAInwEACAAJ|) publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062 | doi-access = free }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[[http://www.legatum.sk/en:ahr](http://www.legatum.sk/en:ahr):bayes-cholera-as-treated-by-dr-rubini-158-10355 [www.legatum.sk](http://www.legatum.sk)]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web|title=Cholera Infantum, Tomatoes Will Relieve|url=[http://www.oldtimeremedies.co.uk/labels/cholera.html|date=13 October 2008|access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x | doi-access = free }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= [http://www.laskerfoundation.org/awards/show/treatment-of-cholera/](http://www.laskerfoundation.org/awards/show/treatment-of-cholera/) |title= Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/cholera|title = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
{{Authority control}}

[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
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'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 |doi-access=free}}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519 | hdl-access = free }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;&lt;nowiki&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=&lt;/nowiki&gt;[https://archive.org/details/medicalanthropol00mcel_718](https://archive.org/details/medicalanthropol00mcel_718) |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [[https://archive.org/details/medicalanthropol00mcel_718/page/n395](https://archive.org/details/medicalanthropol00mcel_718/page/n395&lt;nowiki&gt;) 375]|isbn=978-0-8133-4384-6}}&lt;/nowiki&gt;&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans, Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26 October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web |title=General Information – Cholera |website=CDC | date=5 August 2020 |url=https://www.cdc.gov/cholera/general/index.html#three |access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 |doi-access=free}}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=who.int|language=en}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=http://www.historyofvaccines.org/content/timelines/others |archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=http://www.immunize.org/fda/ |archive-url=https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/ |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563 |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878 |doi-access=free }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=ecdc.europa.eu}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=who.int |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=historyofmedicine.com|language=en-us|access-date=23 July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=cdc.gov|language=en-us|access-date=4 April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = [https://books.google.com/books?id=kRAInwEACAAJ|](https://books.google.com/books?id=kRAInwEACAAJ|) publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062 | doi-access = free }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[[http://www.legatum.sk/en:ahr](http://www.legatum.sk/en:ahr):bayes-cholera-as-treated-by-dr-rubini-158-10355 [www.legatum.sk](http://www.legatum.sk)]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web|title=Cholera Infantum, Tomatoes Will Relieve|url=[http://www.oldtimeremedies.co.uk/labels/cholera.html|date=13 October 2008|access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x | doi-access = free }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= http://www.laskerfoundation.org/awards/show/treatment-of-cholera/ |title=Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/cholera|title = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
{{Authority control}}

[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
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'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 |doi-access=free}}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519 | hdl-access = free }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;&lt;nowiki&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=&lt;/nowiki&gt;[https://archive.org/details/medicalanthropol00mcel_718](https://archive.org/details/medicalanthropol00mcel_718) |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [[https://archive.org/details/medicalanthropol00mcel_718/page/n395](https://archive.org/details/medicalanthropol00mcel_718/page/n395&lt;nowiki&gt;) 375]|isbn=978-0-8133-4384-6}}&lt;/nowiki&gt;&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans, Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26 October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web |title=General Information – Cholera |website=CDC | date=5 August 2020 |url=https://www.cdc.gov/cholera/general/index.html#three |access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 |doi-access=free}}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=who.int|language=en}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=http://www.historyofvaccines.org/content/timelines/others |archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=http://www.immunize.org/fda/ |archive-url=https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/ |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563 |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878 |doi-access=free }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=ecdc.europa.eu}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=who.int |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=historyofmedicine.com|language=en-us|access-date=23 July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=cdc.gov|language=en-us|access-date=4 April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = [https://books.google.com/books?id=kRAInwEACAAJ|](https://books.google.com/books?id=kRAInwEACAAJ|) publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062 | doi-access = free }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[http://www.legatum.sk/en:ahr:bayes-cholera-as-treated-by-dr-rubini-158-10355 legatum]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web |title=Cholera Infantum, Tomatoes Will Relieve |url=http://www.oldtimeremedies.co.uk/labels/cholera.html |date=13 October 2008 |access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x | doi-access = free }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= http://www.laskerfoundation.org/awards/show/treatment-of-cholera/ |title=Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/cholera|title = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
{{Authority control}}

[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
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'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 }}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519  }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;&lt;nowiki&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=&lt;/nowiki&gt;[https://archive.org/details/medicalanthropol00mcel_718](https://archive.org/details/medicalanthropol00mcel_718) |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page= [[https://archive.org/details/medicalanthropol00mcel_718/page/n395](https://archive.org/details/medicalanthropol00mcel_718/page/n395&lt;nowiki&gt;) 375]|isbn=978-0-8133-4384-6}}&lt;/nowiki&gt;&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans, Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26 October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web |title=General Information – Cholera |website=CDC | date=5 August 2020 |url=https://www.cdc.gov/cholera/general/index.html#three |access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 }}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=who.int|language=en}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=http://www.historyofvaccines.org/content/timelines/others |archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=http://www.immunize.org/fda/ |archive-url=https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/ |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563 |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878  }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=ecdc.europa.eu}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=who.int |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=historyofmedicine.com|language=en-us|access-date=23 July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=cdc.gov|language=en-us|access-date=4 April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M | url = [https://books.google.com/books?id=kRAInwEACAAJ|](https://books.google.com/books?id=kRAInwEACAAJ|) publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062  }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[http://www.legatum.sk/en:ahr:bayes-cholera-as-treated-by-dr-rubini-158-10355 legatum]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web |title=Cholera Infantum, Tomatoes Will Relieve |url=http://www.oldtimeremedies.co.uk/labels/cholera.html |date=13 October 2008 |access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x  }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= http://www.laskerfoundation.org/awards/show/treatment-of-cholera/ |title=Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/cholera|title = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
{{Authority control}}

[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
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'''Cholera''' be an infection of de small intestine by sam strains of de bacterium ''Vibrio cholerae''.&lt;ref name=&quot;Fink2016&quot;&gt;{{cite book |last1=Finkelstein |first1=Richard A. |title=Medical Microbiology |url=https://archive.org/details/medicalmicrobiol0000unse_d4e1 |date=1996 |publisher=University of Texas Medical Branch at Galveston |isbn=978-0-9631172-1-2 |editor1-last=Baron |editor1-first=Samuel |edition=4th |chapter=Cholera, ''Vibrio cholerae'' O1 and O139, and Other Pathogenic Vibrios |pmid=21413330 |id=NCBIBook2 NBK8407}}&lt;/ref&gt;&lt;ref name=&quot;CDC2015Pro5&quot;&gt;{{cite web |date=6 January 2015 |title=Cholera – Vibrio cholerae infection Information for Public Health &amp; Medical Professionals |url=https://www.cdc.gov/cholera/healthprofessionals.html |url-status=live |archive-url=https://web.archive.org/web/20150320052724/http://www.cdc.gov/cholera/healthprofessionals.html |archive-date=20 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Symptoms fi range from none, to mild, to severe.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; De classic symptom be large amounts of watery diarrhea wey dey last a few days.&lt;ref name=&quot;WHO20102&quot;&gt;{{cite journal |date=March 2010 |title=Cholera vaccines: WHO position paper |url=https://www.who.int/wer/2010/wer8513.pdf |journal=Weekly Epidemiological Record |volume=85 |issue=13 |pages=117–28 |pmid=20349546 |archive-url=https://web.archive.org/web/20150413020218/http://www.who.int/wer/2010/wer8513.pdf |archive-date=13 April 2015}}&lt;/ref&gt; Vomiting den muscle cramps sanso fi occur.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt; Diarrhea fi be so severe wey e dey lead within hours to severe dehydration den electrolyte imbalance.&lt;ref name=&quot;WHO20102&quot; /&gt; Dis fi in turn result in sunken eyes, cold anaa cyanotic&lt;ref&gt;{{cite book |last1=Bailey |first1=Diane |url=https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |title=Cholera |date=2011 |publisher=Rosen Pub. |isbn=978-1-4358-9437-2 |edition=1st |location=New York |page=7 |archive-url=https://web.archive.org/web/20161203190215/https://books.google.com/books?id=7rvLPx33GPgC&amp;pg=PA7 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; skin, decreased skin elasticity, wrinkling of de hands den feet, den, in severe cases, death.&lt;ref name=&quot;Lancet2012&quot;&gt;{{cite journal |vauthors=Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB |date=June 2012 |title=Cholera |journal=[[The Lancet]] |volume=379 |issue=9835 |pages=2466–2476 |doi=10.1016/s0140-6736(12)60436-x |pmc=3761070 |pmid=22748592}}&lt;/ref&gt; Symptoms dey start two hours to five days after exposure.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera be caused by a number of types of ''Vibrio cholerae'', plus sam types wey dey produce more severe disease dan odas.&lt;ref name=&quot;WHO20102&quot; /&gt; E be spread mostly by unsafe water den unsafe chow wey be contaminated plus human feces wey dey contain de bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Undercooked shellfish be a common source.&lt;ref&gt;{{cite web |date=7 November 2014 |title=Sources of Infection &amp; Risk Factors |url=https://www.cdc.gov/cholera/infection-sources.html |url-status=live |archive-url=https://web.archive.org/web/20150312223337/http://www.cdc.gov/cholera/infection-sources.html |archive-date=12 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Humans be de only known host give fe bacteria.&lt;ref name=&quot;WHO20102&quot; /&gt; Risk factors for de disease dey include poor sanitation, insufficient clean drinking water, den poverty.&lt;ref name=&quot;WHO20102&quot; /&gt; Cholera fi be diagnosed by a stool test,&lt;ref name=&quot;WHO20102&quot; /&gt; anaa a rapid dipstick test, although de dipstick test be less accurate.&lt;ref&gt;{{cite web |date=10 February 2015 |title=Diagnosis and Detection |url=https://www.cdc.gov/cholera/diagnosis.html |url-status=live |archive-url=https://web.archive.org/web/20150315041832/http://www.cdc.gov/cholera/diagnosis.html |archive-date=15 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt;

Prevention methods against cholera dey include improved sanitation den access to clean water.&lt;ref name=&quot;Lancet2012&quot; /&gt; Cholera vaccines wey dem dey give by mouth dey provide reasonable protection for about six months, den confer de added benefit of protecting against anoda type of diarrhea wey ''E.&amp;nbsp;coli'' cause.&lt;ref&gt;{{Cite journal |last1=Clemens |first1=John D. |last2=Sack |first2=David A. |last3=Harris |first3=Jeffrey R. |last4=Chakraborty |first4=J. |last5=Neogy |first5=P. K. |last6=Stanton |first6=B. |last7=Huda |first7=N. |last8=Khan |first8=M. U. |last9=Kay |first9=Bradford A. |last10=Khan |first10=M. R. |last11=Ansaruzzaman |first11=M. |last12=Yunus |first12=M. |last13=Raghava Rao |first13=M. |last14=Svennerholm |first14=Ann-Mari |last15=Holmgren |first15=Jan |date=1 August 1988 |title=Cross-Protection by B Subunit-Whole Cell Cholera Vaccine Against Diarrhea Associated with Heat-Labile Toxin-Producing Enterotoxigenic Escherichia coli: Results of a Large-Scale Field Trial |url=https://academic.oup.com/jid/article-abstract/158/2/372/810193 |journal=The Journal of Infectious Diseases |volume=158 |issue=2 |pages=372–377 |doi=10.1093/infdis/158.2.372 |issn=0022-1899 |pmid=3042876 |url-access=subscription}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Xian |first1=Tew Hui |last2=Parasuraman |first2=Subramani |last3=Ravichandran |first3=Manickam |last4=Prabhakaran |first4=Guruswamy |date=16 December 2022 |title=Dual-Use Vaccine for Diarrhoeal Diseases: Cross-Protective Immunogenicity of a Cold-Chain-Free, Live-Attenuated, Oral Cholera Vaccine against Enterotoxigenic Escherichia coli (ETEC) Challenge in BALB/c Mice |journal=Vaccines |language=en |volume=10 |issue=12 |page=2161 |doi=10.3390/vaccines10122161 |pmc=9787504 |pmid=36560571 }}&lt;/ref&gt; Insyd 2017, na de US Food and Drug Administration (FDA) approve a single-dose, live, oral cholera vaccine dem call Vaxchora give adults aged 18–64 wey dey travel to an area of active cholera transmission.&lt;ref&gt;{{cite web |date=2017 |title=Cholera Fact Sheet |url=https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm |access-date=26 May 2020 |website=www.health.ny.gov}}&lt;/ref&gt; E dey offer limited protection to young kiddies. People wey survive an episode of cholera get long-lasting immunity for at least three years (de period dem test).&lt;ref name=&quot;immunity&quot;&gt;{{cite journal |last=Harris |first=Jason B |date=15 November 2018 |title=Cholera: Immunity and Prospects in Vaccine Development |journal=J Infect Dis |volume=218 |issue=Suppl 3 |pages=S141–S146 |doi=10.1093/infdis/jiy414 |pmc=6188552 |pmid=30184117}}&lt;/ref&gt;

De primary treatment give affected individuals be oral rehydration salts (ORS), de replacement of fluids den electrolytes by using slightly sweet den salty solutions.&lt;ref name=&quot;WHO20102&quot; /&gt; Rice-based solutions be preferred.&lt;ref name=&quot;WHO20102&quot; /&gt; Insyd kiddies, na dem sanso find zinc supplementation to improve outcomes.&lt;ref name=&quot;CDC2014Zinc&quot;&gt;{{cite web |date=7 November 2014 |title=Cholera – Vibrio cholerae infection Treatment |url=https://www.cdc.gov/cholera/treatment/index.html |url-status=live |archive-url=https://web.archive.org/web/20150311042338/http://www.cdc.gov/cholera/treatment/index.html |archive-date=11 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Insyd severe cases, intravenous fluids, such as Ringer's lactate, fi be required, den antibiotics fi be beneficial.&lt;ref name=&quot;WHO20102&quot; /&gt; De choice of antibiotic be aided by antibiotic sensitivity testing.&lt;ref name=&quot;CDC2015Pro5&quot; /&gt;

Cholera dey continue to affect an estimated 3–5&amp;nbsp;million people worldwide den dey cause 28,800–130,000&amp;nbsp;deaths a year.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref name=&quot;GBD2015De&quot;&gt;{{cite journal |last1=Wang |first1=Haidong |last2=Naghavi |first2=Mohsen |last3=Allen |first3=Christine |last4=Barber |first4=Ryan M. |last5=Bhutta |first5=Zulfiqar A. |last6=Carter |first6=Austin |last7=Casey |first7=Daniel C. |last8=Charlson |first8=Fiona J. |last9=Chen |first9=Alan Zian |last10=Coates |first10=Matthew M. |last11=Coggeshall |first11=Megan |last12=Dandona |first12=Lalit |last13=Dicker |first13=Daniel J. |last14=Erskine |first14=Holly E. |last15=Ferrari |first15=Alize J. |date=October 2016 |title=Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 |journal=Lancet |volume=388 |issue=10053 |pages=1459–1544 |doi=10.1016/s0140-6736(16)31012-1 |pmc=5388903 |pmid=27733281 |last16=Fitzmaurice |first16=Christina |last17=Foreman |first17=Kyle |last18=Forouzanfar |first18=Mohammad H. |last19=Fraser |first19=Maya S. |last20=Fullman |first20=Nancy |last21=Gething |first21=Peter W. |last22=Goldberg |first22=Ellen M. |last23=Graetz |first23=Nicholas |last24=Haagsma |first24=Juanita A. |last25=Hay |first25=Simon I. |last26=Huynh |first26=Chantal |last27=Johnson |first27=Catherine O. |last28=Kassebaum |first28=Nicholas J. |last29=Kinfu |first29=Yohannes |last30=Kulikoff |first30=Xie Rachel}}&lt;/ref&gt; To date, seven cholera pandemics occur, plus de most recent dey begin insyd 1961, den dey continue today.&lt;ref&gt;{{cite news|title=Cholera's seven pandemics|url=http://www.cbc.ca/news/technology/cholera-s-seven-pandemics-1.758504|access-date=15 July 2018|work=CBC|date=9 May 2008}}&lt;/ref&gt; De illness be rare insyd high-income countries, wey e dey affect kiddies most severely.&lt;ref name=&quot;WHO20102&quot; /&gt;&lt;ref&gt;{{cite web |date=27 October 2014 |title=Cholera – Vibrio cholerae infection |url=https://www.cdc.gov/cholera/index.html |url-status=live |archive-url=https://web.archive.org/web/20150317031930/http://www.cdc.gov/cholera/index.html |archive-date=17 March 2015 |access-date=17 March 2015 |publisher=[[Centers for Disease Control and Prevention]]}}&lt;/ref&gt; Cholera dey occur as both outbreaks den chronically insyd certain areas. Areas plus an ongoing risk of disease dey include [[Africa]] den Southeast Asia.&lt;ref name=&quot;WHO20102&quot; /&gt; De risk of death among those wey be affected usually be less dan 5%, dem give improved treatment, buh fi be as high as 50% widout such access to treatment.&lt;ref name=&quot;WHO20102&quot; /&gt; Na dem find descriptions of cholera as early as de 5th century BCE insyd Sanskrit literature.&lt;ref name=&quot;Lancet2012&quot; /&gt; Insyd Europe, na dem initially use cholera as a term to describe any kind of gastroenteritis, wey na dem no use am give dis disease til de early 19th century.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book |author1=Charles E. Rosenberg |url=https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |title=The Cholera Years the United States in 1832, 1849, and 1866. |date=2009 |publisher=University of Chicago Press |isbn=978-0-226-72676-2 |location=Chicago |page=74 |archive-url=https://web.archive.org/web/20151109080652/https://books.google.com/books?id=k2pL9c00rl4C&amp;pg=PA74 |archive-date=9 November 2015 |url-status=live}}&lt;/ref&gt; Na de study of cholera insyd England by John Snow between 1849 den 1854 lead to significant advances insyd de field of epidemiology secof ein insights about transmission via contaminated water, wey na a map of de same be de first recorded incidence of epidemiological tracking.&lt;ref name=&quot;Lancet2012&quot; /&gt;&lt;ref&gt;{{cite book |last1=Timmreck |first1=Thomas C. |url=https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |title=An introduction to epidemiology |date=2002 |publisher=Jones and Bartlett Publishers |isbn=978-0-7637-0060-7 |edition=3. |location=Sudbury, MA |page=77 |archive-url=https://web.archive.org/web/20161203190442/https://books.google.com/books?id=yyrbKemADL4C&amp;pg=PA77 |archive-date=3 December 2016 |url-status=live}}&lt;/ref&gt; 
Di main symptoms of cholera na serious [[diarrhea]] and [[vomiting]] of clear water-like fluid.&lt;ref name=&quot;Lancet2004&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Nair GB, Siddique AK | title = Cholera | url = https://archive.org/details/sim_the-lancet_2004-01-17_363_9404/page/223 | journal = Lancet | volume = 363 | issue = 9404 | pages = 223–33 | date = January 2004 | pmid = 14738797 | doi = 10.1016/S0140-6736(03)15328-7 | s2cid = 208793200 }}&lt;/ref&gt; These symptoms dey usually start suddenly, like half day go reach five days after person chop (ingest) the bacteria.&lt;ref&gt;{{cite journal | vauthors = Azman AS, Rudolph KE, Cummings DA, Lessler J | title = The incubation period of cholera: a systematic review | journal = The Journal of Infection | volume = 66 | issue = 5 | pages = 432–8 | date = May 2013 | pmid = 23201968 | pmc = 3677557 | doi = 10.1016/j.jinf.2012.11.013 }}&lt;/ref&gt;

The diarrhea dey often describe am as “rice water” type, and e fit even get fishy smell.&lt;ref name=Lancet2004 /&gt; Person wey no receive treatment for cholera fit dey pass about {{convert|10|to|20|litre|USgal|sigfig=1}} of diarrhea every day.&lt;ref name=Lancet2004 /&gt;

Serious cholera, if no treatment, fit kill about half of di people wey e affect.&lt;ref name=Lancet2004 /&gt; If di heavy diarrhea no get treatment, e fit cause life-threatening [[dehydration]] and imbalance of [[electrolyte]] for body.&lt;ref name=Lancet2004 /&gt;

Estimates of people wey get infection but no show symptoms (asymptomatic) compare to those wey dey sick (symptomatic) don range from 3 to 100.&lt;ref&gt;{{cite journal | vauthors = King AA, Ionides EL, Pascual M, Bouma MJ | title = Inapparent infections and cholera dynamics | url = https://archive.org/details/sim_nature-uk_2008-08-14_454_7206/page/877 | journal = Nature | volume = 454 | issue = 7206 | pages = 877–80 | date = August 2008 | pmid = 18704085 | doi = 10.1038/nature07084 | s2cid = 4408759 | bibcode = 2008Natur.454..877K | hdl = 2027.42/62519  }}&lt;/ref&gt;

Cholera dem dey also call am “blue death”&lt;ref name=&quot;Greenough&quot;&gt;{{cite journal|last1=Greenough|first1=William B. |title=The blue death Disease, disaster, and the water we drink|pmc=2171164|journal=The Journal of Clinical Investigation|volume=118|issue=1|page=4|doi=10.1172/JCI34394|date=2 January 2008}}&lt;/ref&gt; because person skin fit turn [[Cyanosis|bluish-gray]] as body dey lose plenty fluid too much.&lt;ref name=&quot;McE2009&quot;&gt;{{cite book|author1=McElroy, Ann |author2=Townsend, Patricia K. |title=Medical Anthropology in Ecological Perspective|url=https://archive.org/details/medicalanthropol00mcel_718 |url-access=limited |location=Boulder, CO|publisher= Westview|year= 2009|page=375 |isbn=978-0-8133-4384-6}}&lt;/ref&gt;
Fever no dey common, and if e show, e fit mean say secondary infection don join. Patients fit become very weak or sleepy (lethargic), and dem fit get sunken eyes, dry mouth, cold and sweaty skin, or wrinkled hands and legs.

[[Kussmaul breathing]], wey be deep and heavy breathing style, fit happen because of [[acidosis]] from loss of [[Human feces|stool]] [[bicarbonate]] and [[lactic acidosis]] wey come from poor blood flow ([[perfusion]]).

[[Blood pressure]] dey drop because of dehydration, while pulse for body dey fast but weak (thready). Urine wey person dey pass go reduce as time dey go on.

Muscle cramps and weakness, confusion or changed awareness, [[seizures]], and even [[coma]] fit happen because of [[electrolyte imbalance]]—this one dey happen plenty especially for children.&lt;ref name=Lancet2004 /&gt;
## Cause

{{Main|Vibrio cholerae}}
[[File:Cholera bacteria SEM.jpg|thumb|[[Scanning electron microscope]] image of ''Vibrio cholerae'']]
[[File:Vibrio cholerae.jpg|thumb|''[[Vibrio cholerae]]'', di bacteria wey dey cause cholera]]

### Transmission

[[Transmission (medicine)|Transmission]] of cholera dey happen usually through [[fecal-oral route]], meaning say contaminated food or water wey come from poor [[sanitation]] dey carry am pass enter person body.&lt;ref name=&quot;WHO2010&quot; /&gt;

For [[Developed country|developed countries]], most cholera cases dey come from contaminated food, while for [[Developing country|developing countries]] e dey mostly come from water.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Cholera bacteria fit dey inside [[shellfish]] and [[plankton]].&lt;ref name=&quot;Lancet2004&quot; /&gt; Food transmission fit happen when people harvest seafood like [[oyster]]s from water wey sewage don contaminate, because ''Vibrio cholerae'' dey gather inside small water organisms like [[planktonic]] [[copepod|crustaceans]], and oysters dey chop those organisms.&lt;ref name=&quot;bakerinstitute.org&quot;&gt;{{cite AV media|url=http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|title=Oceans, Climate, and Health: Cholera as a Model of Infectious Diseases in a Changing Environment|publisher=James A Baker III Institute for Public Policy|people=[[Rita Colwell]]|access-date=23 October 2013|location=Rice University|archive-url=https://web.archive.org/web/20131026030733/http://bakerinstitute.org/videos/civic-scientist-lecture-series-rita-colwell-oceans-climate-and-health-cholera-model-infectious-diseases-changing-environment/|archive-date=26 October 2013}}&lt;/ref&gt;

Cholera outbreaks dey increase in frequency, spread, and intensity because of [[Climate change and infectious diseases#Cholera and other vibrio infections|climate change]].&lt;ref name=&quot;:162&quot;&gt;Cissé, G., R. McLeman, H. Adams, P. Aldunce, K. Bowen, D. Campbell-Lendrum, S. Clayton, K.L. Ebi, J. Hess, C. Huang, Q. Liu, G. McGregor, J. Semenza, and M.C. Tirado, 2022: [[https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf](https://www.ipcc.ch/report/ar6/wg2/downloads/report/IPCC_AR6_WGII_Chapter07.pdf) Chapter 7: Health, Wellbeing, and the Changing Structure of Communities]. In: [[https://www.ipcc.ch/report/ar6/wg2/](https://www.ipcc.ch/report/ar6/wg2/) Climate Change 2022: Impacts, Adaptation and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change] [H.-O. Pörtner, D.C. Roberts, M. Tignor, E.S. Poloczanska, K. Mintenbeck, A. Alegría, M. Craig, S. Langsdorf, S. Löschke, V. Möller, A. Okem, B. Rama (eds.)]. Cambridge University Press, Cambridge, UK and New York, NY, USA, pp. 1041–1170, doi:10.1017/9781009325844.009.&lt;/ref&gt;&lt;ref name=&quot;(Walker, 2018)22&quot;&gt;{{cite journal |vauthors=Walker JT |date=September 2018 |title=The influence of climate change on waterborne disease and Legionella: a review |journal=Perspectives in Public Health |volume=138 |issue=5 |pages=282–286 |doi=10.1177/1757913918791198 |pmid=30156484 |s2cid=52115812}}&lt;/ref&gt;&lt;ref name=&quot;:92&quot;&gt;{{Cite journal |last1=Bekele |first1=Bezawit Kassahun |last2=Uwishema |first2=Olivier |last3=Bisetegn |first3=Lydia Daniel |last4=Moubarak |first4=Antonia |last5=Charline |first5=Mugeniwayesu |last6=Sibomana |first6=Pacifique |last7=Onyeaka |first7=Chinyere Vivian Patrick |date=2025-04-30 |title=Cholera in Africa: A Climate Change Crisis |journal=Journal of Epidemiology and Global Health |language=en |volume=15 |issue=1 |doi=10.1007/s44197-025-00386-x |issn=2210-6014 |pmc=12043531 |pmid=40304931 |article-number=68}}&lt;/ref&gt;

People wey get cholera dey pass watery diarrhea, and this stool (wey people dey call “rice-water”) fit contaminate water wey other people dey use.&lt;ref name=&quot;Sherris&quot;&gt;{{cite book|title=Sherris Medical Microbiology|url=https://archive.org/details/sherrismedicalmi0000unse_q1i3|publisher=McGraw Hill|year=2004|isbn=978-0-8385-8529-0|edition=4th|pages=[https://archive.org/details/sherrismedicalmi0000unse_q1i3/page/376 376]–7|editor1=Ryan KJ |editor2=Ray CG}}&lt;/ref&gt;

One single diarrhea event fit increase the number of ''V. cholerae'' for environment by one million times.&lt;ref&gt;{{Cite web|url=https://www.niaid.nih.gov/diseases-conditions/cholera-biology-and-genetics|title=Cholera Biology and Genetics {{!}} NIH: National Institute of Allergy and Infectious Diseases|website=[www.niaid.nih.gov|date=7 February 2011 |language=en|access-date=5 December 2017}}&lt;/ref&gt;

The contamination source usually be people wey get cholera, especially when dem no treat their diarrhea and e enter water bodies, [[groundwater]], or [[drinking water]] systems. Drinking contaminated water or eating food wey dem wash with that water, or eating shellfish from infected water, fit cause infection.

Cholera rarely dey spread directly from person to person.&lt;ref name=&quot;CDC 2020&quot;&gt;{{cite web |title=General Information – Cholera |website=CDC | date=5 August 2020 |url=https://www.cdc.gov/cholera/general/index.html#three |access-date=11 March 2021}}&lt;/ref&gt;

''V. cholerae'' also fit survive outside human body for natural water sources, either alone or together with [[phytoplankton]], [[zooplankton]], or dead organic and inorganic matter.&lt;ref name=&quot;NEJOct2009review&quot;&gt;{{cite journal | vauthors = Nelson EJ, Harris JB, Morris JG, Calderwood SB, Camilli A | title = Cholera transmission: the host, pathogen and bacteriophage dynamic | journal = Nature Reviews. Microbiology | volume = 7 | issue = 10 | pages = 693–702 | date = October 2009 | pmid = 19756008 | pmc = 3842031 | doi = 10.1038/nrmicro2204 }}&lt;/ref&gt;

Drinking such water fit still cause infection even without human fecal contamination. However, environmental conditions fit reduce how strong the bacteria be.&lt;ref name=&quot;NEJOct2009review&quot; /&gt;

Both toxic and non-toxic strains dey exist. Non-toxic strains fit later become toxic through [[bacteriophage]] infection.&lt;ref name=&quot;Archivist_1997&quot;&gt;{{cite journal |title=Cholera phage discovery |journal=Archives of Disease in Childhood |date=1 March 1997 |volume=76 |issue=3 |page=274 |doi=10.1136/adc.76.3.274 |pmc=1717096 |last1=Archivist }}&lt;/ref&gt;

### Susceptibility

Normally, about 100 million bacteria must enter body before cholera fit start for healthy adult.&lt;ref name=Lancet2004 /&gt; But this amount reduce for people wey get low [[gastric acid]], like those wey dey use [[proton pump inhibitors]].&lt;ref name=Lancet2004 /&gt;

Children dey more vulnerable, especially ages two to four.&lt;ref name=Lancet2004 /&gt; Blood group also dey affect risk—people with [[type O blood]] dey more likely to get infection.&lt;ref name=Lancet2004 /&gt;

People with weak immune system, like those with [[HIV/AIDS|AIDS]] or malnourished children, fit suffer severe cholera if dem get infected.&lt;ref name=&quot;WHOpreventionandcontrolofoutbreaks&quot;&gt;[[http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf](http://www.emro.who.int/csr/Media/PDF/cholera_whopolicy.pdf) Prevention and control of cholera outbreaks: WHO policy and recommendations]&lt;/ref&gt;

Even healthy adults still fit get severe case, so each case must be monitored based on fluid loss with help from health professionals.

The genetic mutation linked to [[cystic fibrosis]] (delta-F508) fit actually give some protection. People wey carry one copy of the gene (heterozygous carriers) dey more resistant to ''V. cholerae'' infection.&lt;ref name=&quot;Bertranpetit_1996&quot;&gt;{{cite book |doi=10.1002/9780470514887.ch6 |chapter=Genetic and Geographical Variability in Cystic Fibrosis: Evolutionary Considerations |title=Ciba Foundation Symposium 197 – Variation in the Human Genome |series=Novartis Foundation Symposia |year=2007 |last1=Bertranpetit |first1=Jaume |last2=Calafell |first2=Francesc |volume=197 |pages=97–118 |pmid=8827370 |isbn=978-0-470-51488-7}}&lt;/ref&gt;

For this model, the defect for ion channel protein (cystic fibrosis transmembrane conductance regulator) dey interfere with how bacteria dey attach to intestine lining, so e reduce infection effect.

== Mechanism ==
[[File:Cholera role of biofilm in intestinal colonization.jpg|thumb|upright=1.4|The role of biofilm in the intestinal colonization of Vibrio cholerae]]

When person drink or swallow cholera bacteria, most of the bacteria no survive the strong acidic condition inside human stomach.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot;&gt;{{cite journal |vauthors=Almagro-Moreno S, Pruss K, Taylor RK |title=Intestinal Colonization Dynamics of Vibrio cholerae |journal=PLOS Pathogens |volume=11 |issue=5 |article-number=e1004787 |date=May 2015 |pmid=25996593 |pmc=4440752 |doi=10.1371/journal.ppat.1004787 }}&lt;/ref&gt;

The few wey survive go conserve energy and stored nutrients by shutting down protein production as dem dey pass through the stomach. When dem reach the small intestine, dem must pass through thick mucus layer before dem fit reach the intestinal wall where dem go attach and grow.&lt;ref name=&quot;BliskaAlmagro-Moreno2015&quot; /&gt;

Once Vibrio cholerae reach the intestinal wall, dem no need flagella again for movement. So dem stop producing flagellin protein in order to conserve energy and nutrients by adjusting the proteins dem dey express based on new environment.

On reaching the intestinal wall, Vibrio cholerae start produce toxic proteins wey cause watery diarrhea in infected person. This watery stool carry new generations of bacteria go outside body into drinking water if sanitation no dey proper.&lt;ref&gt;{{cite journal |last1=Wolfe |first1=Marlene |last2=Kaur |first2=Mehar |last3=Yates |first3=Travis |last4=Woodin |first4=Mark |last5=Lantagne |first5=Daniele |title=A Systematic Review and Meta-Analysis of the Association between Water, Sanitation, and Hygiene Exposures and Cholera in Case–Control Studies |journal=American Journal of Tropical Medicine and Hygiene |date=2 August 2018 |volume=99 |issue=2 |pages=534–545 |doi=10.4269/ajtmh.17-0897 |pmid=29968551 |pmc=6090371}}&lt;/ref&gt;

The cholera toxin (CTX or CT) na protein complex made of six subunits: one A subunit and five B subunits connected by disulfide bond. The B subunits form ring shape wey fit bind GM1 ganglioside receptors on intestinal epithelial cells. The A1 part of A subunit na enzyme wey dey ADP-ribosylate G proteins, while A2 chain fit into B-ring structure.

After binding, the toxin enter cell through receptor-mediated endocytosis. Inside cell, disulfide bond break, and A1 subunit release to interact with ADP-ribosylation factor 6 (Arf6).&lt;ref name=&quot;O&quot;&gt;{{cite journal |vauthors=O'Neal CJ, Jobling MG, Holmes RK, Hol WG |title=Structural basis for the activation of cholera toxin by human ARF6-GTP |url=https://archive.org/details/sim_science_2005-08-12_309_5737/page/1093 |journal=Science |volume=309 |issue=5737 |pages=1093–1096 |date=August 2005 |doi=10.1126/science.1113398}}&lt;/ref&gt;

This activation make permanent modification of Gs alpha subunit of heterotrimeric G protein, leading to continuous production of cyclic AMP (cAMP). This cause secretion of water, sodium, potassium, and bicarbonate into intestinal lumen, resulting in severe dehydration.

The gene for cholera toxin enter Vibrio cholerae through horizontal gene transfer, usually carried by CTXφ bacteriophage.

Scientists study how gene expression change as bacteria pass through stomach, mucus layer, and intestinal wall.&lt;ref name=&quot;DiRita&quot;&gt;{{cite journal |vauthors=DiRita VJ, Parsot C, Jander G, Mekalanos JJ |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=PNAS |volume=88 |issue=12 |pages=5403–5407 |date=June 1991 |pmid=2052618 |pmc=51881 |doi=10.1073/pnas.88.12.5403}}&lt;/ref&gt;

Inside intestine, regulatory proteins TcpP/TcpH and ToxR/ToxS activate ToxT, which turn on virulence genes responsible for toxin production and colonization.&lt;ref name=&quot;DiRita&quot; /&gt;

== Genetic structure ==
Vibrio cholerae strains from pandemics show genetic variation. Two main clusters exist: Cluster I and Cluster II. Cluster I include older strains from 1960s and 1970s, while Cluster II contain strains from 1980s and 1990s, especially from Africa.&lt;ref&gt;{{cite journal |vauthors=Lan R, Reeves PR |title=Pandemic spread of cholera: genetic diversity and relationships within the seventh pandemic clone of Vibrio cholerae determined by amplified fragment length polymorphism |journal=Journal of Clinical Microbiology |volume=40 |issue=1 |pages=172–181 |date=January 2002 |pmid=11773113 |pmc=120103 |doi=10.1128/JCM.40.1.172-181.2002}}&lt;/ref&gt;

== Antibiotic resistance ==
In many parts of the world, cholera bacteria don develop resistance to antibiotics. For example, in Bangladesh, many cases resist tetracycline, trimethoprim-sulfamethoxazole, and erythromycin.&lt;ref name=&quot;NEJM2006&quot; /&gt;

Scientists have developed diagnostic methods to detect multi-drug resistant strains quickly.&lt;ref name=&quot;Mackay&quot;&gt;{{cite book|title=Real-Time PCR in microbiology: From diagnosis to characterization|publisher=Caister Academic Press|year=2007|isbn=978-1-904455-18-9}}&lt;/ref&gt;

New antibiotics have also shown effectiveness against Vibrio cholerae in laboratory studies.&lt;ref name=&quot;Ramamurthy&quot;&gt;{{cite book |title=Vibrio cholerae: Genomics and molecular biology |url=https://archive.org/details/vibriocholeraege0000unse |publisher=Caister Academic Press |year=2008 |isbn=978-1-904455-33-2 |chapter=Antibiotic resistance in Vibrio cholerae |last=Ramamurthy |first=T. |page=[https://archive.org/details/vibriocholeraege0000unse/page/195 195]}}&lt;/ref&gt;

== Diagnosis ==

[[File:Rapid diagnostic test strip.jpg|thumb|A rapid dipstick test fit show whether Vibrio cholerae dey present]]

There be rapid dipstick test wey doctors fit use check if Vibrio cholerae bacteria dey inside sample.&lt;ref name=&quot;NEJM2006&quot; /&gt; If the test come back positive, doctors go do further testing to check whether the bacteria don develop resistance to antibiotics.&lt;ref name=&quot;NEJM2006&quot; /&gt;

For epidemic situation, doctor fit diagnose cholera just by asking patient history and doing quick physical examination. Treatment like rehydration therapy and oral hydration solutions fit start even before laboratory confirmation, especially for places where cholera dey common.&lt;ref&gt;{{Cite web |title=Cholera - Diagnosis and treatment |url=https://www.mayoclinic.org/diseases-conditions/cholera/diagnosis-treatment/drc-20355293 |access-date=4 September 2022 |website=Mayo Clinic}}&lt;/ref&gt;

Stool samples and swab samples wey collect early during sickness (before antibiotics start) na the best samples for laboratory diagnosis. If cholera outbreak dey suspected, the most common bacteria wey cause am na Vibrio cholerae O1.

If Vibrio cholerae serogroup O1 no show, laboratory go check for Vibrio cholerae O139. But if neither O1 nor O139 show, then stool sample must go reference laboratory for further investigation.{{citation needed|date=August 2020}}

Any infection with Vibrio cholerae O139 must be reported and treated same way like O1 cholera cases. Any diarrheal disease from this bacteria dey classified as cholera and must be reported, especially for places like United States.&lt;ref name=&quot;CDC_Diag&quot;&gt;{{cite web|url=https://www.cdc.gov/cholera/pdf/Laboratory-Methods-for-the-Diagnosis-of-Epidemic-Dysentery-and-Cholera.pdf|title=Laboratory Methods for the Diagnosis of Epidemic Dysentery and Cholera|year=1999|publisher=Centers for Disease Control and Prevention|access-date=30 June 2017|archive-url=https://web.archive.org/web/20170623024004/https://www.cdc.gov/cholera/pdf/laboratory-methods-for-the-diagnosis-of-epidemic-dysentery-and-cholera.pdf|archive-date=23 June 2017}}&lt;/ref&gt;

== Prevention ==
[[File:It doesn't hurt, but it tickles. A U.S. Navy hospital corpsman, member of a USAID military health team, inoculates a flo - NARA - 541855.jpg|thumb|upright=1.3|Preventive inoculation against cholera in 1966]]

World Health Organization (WHO) dey advise say make people focus on prevention, preparedness, and response to control how cholera dey spread.&lt;ref name=&quot;who.int&quot; /&gt; Dem still emphasize say strong surveillance system dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Governments get role for all these areas.

=== Water, sanitation and hygiene ===

Although cholera fit kill person, preventing am dey usually easy if proper sanitation practices dey followed well. For developed countries, because dem get better water treatment and sanitation systems, cholera no dey common. For example, the last big cholera outbreak for United States happen for 1910–1911.&lt;ref name=&quot;moltke1&quot;&gt;{{cite news |title=CHOLERA KILLS BOY; EIGHTH DEATH HERE; All Other Suspected Cases Now in Quarantine and Show No Alarming Symptoms. |url=https://www.nytimes.com/1911/07/18/archives/cholera-kills-boy-eighth-death-here-all-other-suspected-cases-now.html |work=[[The New York Times]] |date=18 July 1911}}&lt;/ref&gt;&lt;ref name=&quot;moltke2&quot;&gt;{{cite news |title=More Cholera in Port |url=https://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412:250061412&amp;FMT=ABS&amp;FMTS=ABS:FT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |quote=A case of cholera developed today in the steerage of the Hamburg-American liner [[SMS Moltke (1877)|Moltke]], which has been detained at quarantine as a possible cholera carrier since Monday last. Dr. A.H. Doty, health officer of the port, reported the case tonight with the additional information that another cholera patient from the Moltke is under treatment at [[Swinburne Island]]. |newspaper=[[The Washington Post]] |date=10 October 1910 |access-date=11 December 2008 |archive-url=https://web.archive.org/web/20081216072507/http://pqasb.pqarchiver.com/washingtonpost_historical/access/250061412.html?dids=250061412%3A250061412&amp;FMT=ABS&amp;FMTS=ABS%3AFT&amp;date=OCT+10%2C+1910&amp;author=&amp;pub=The+Washington+Post&amp;desc=MORE+CHOLERA+IN+PORT&amp;pqatl=google |archive-date=16 December 2008}}&lt;/ref&gt; Cholera mainly be risk for developing countries, especially areas where access to WASH (water, sanitation and hygiene) infrastructure no dey good enough.

If sanitation practices dey properly introduced and followed quick, e fit stop outbreak. There be different points for cholera transmission chain where dem fit block the spread:&lt;ref&gt;{{Cite web|title=Cholera|url=https://www.who.int/news-room/fact-sheets/detail/cholera|access-date=20 August 2020|website=who.int|language=en}}&lt;/ref&gt;

* Sterilization: Proper disposal and treatment of all things wey fit contact stool of cholera patient (like cloth, bedsheet, etc.) dey very important. Dem suppose wash am for hot water and if possible use chlorine bleach. Anybody hand wey touch patient or their things must wash am well and disinfect am with chlorinated water or other strong antimicrobial agents.

* Sewage and fecal sludge management: For areas wey cholera dey, sewage and fecal waste need proper treatment so e no spread disease through human waste. Good sanitation and hygiene dey very important.&lt;ref name=&quot;who.int&quot; /&gt; Open defecation, release of untreated sewage, or dumping of fecal sludge from pit latrine or septic tank into environment must stop.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=AGQVBeNM_80C&amp;pg=PA5 |title=Urban Water Security: Managing Risks: UNESCO-IHP |last1=Cisneros |first1=Blanca Jimenez |last2=Rose |first2=Joan B. |date=24 March 2009 |publisher=[[CRC Press]] |isbn=978-0-203-88162-0 |language=en}}&lt;/ref&gt; For many cholera areas, sewage treatment no dey enough.&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=rd3zCAAAQBAJ&amp;pg=GBS.PA24 |title=Cholera and the Ecology of Vibrio cholerae |vauthors=Drasar BS, Forrest DB |date=6 December 2012 |publisher=Springer Science &amp; Business Media |isbn=978-94-009-1515-2 |page=24}}&lt;/ref&gt;&lt;ref&gt;{{Cite book |url=https://books.google.com/books?id=dAT9CgAAQBAJ&amp;pg=PA219 |title=A Companion to the Anthropology of Environmental Health |last=Singer |first=Merrill |date=31 May 2016 |publisher=[[John Wiley &amp; Sons]] |isbn=978-1-118-78699-4 |page=219}}&lt;/ref&gt; So dry toilet wey no need water and no dey cause water pollution fit be better option than flush toilet.&lt;ref&gt;{{cite news |last1=Gili |first1=Enrique |date=9 June 2015 |title=Starting a poop to compost movement |url=https://www.dw.com/en/global-ideas-haiti-poop-compost-toilets/a-18504469 |work=[[Deutsche Welle]]}}&lt;/ref&gt;

* Sources: Make people put warning for water sources wey fit be contaminated, plus instruction on how to clean water (like boiling or adding chlorine) before dem use am.

* Water purification: Any water wey people go drink, cook or wash with suppose be treated well. Dem fit boil am, use chlorine, ozone treatment, ultraviolet light, or filter am well. Boiling and chlorination be cheap and effective way to stop spread. Cloth filter or sari filter too fit reduce cholera well for poor communities like for Bangladesh. Better modern filters dey even more effective. Health education and proper hygiene practice dey very important.

WHO Africa still recommend say people suppose wash hand with soap or ash after toilet and before dem chop food or handle food to prevent cholera.&lt;ref&gt;{{cite web |title=Cholera and food safety |url=http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf |publisher=[[World Health Organization]] |access-date=20 August 2017 |archive-url=https://web.archive.org/web/20170821044840/http://who.insomnation.com/sites/default/files/pdf/fan_cholera%20fact%20sheet7.pdf |archive-date=21 August 2017}}&lt;/ref&gt;

&lt;gallery class=&quot;center&quot; widths=&quot;225px&quot; heights=&quot;200px&quot;&gt;
File:Unsafe disposal of faecal sludge or sewage in Haiti (6458176073).jpg|Dumping of sewage or fecal sludge from UN camp into lake near Port-au-Prince dey believed say e help spread cholera after Haiti earthquake for 2010, wey kill many people.
File:A SOIL EkoLakay toilet customer. (15921409131).jpg|Example of urine-diverting dry toilet for cholera-affected area for Haiti. This type of toilet stop disease spread through fecal-oral route because e no dey pollute water.
File:Cholera hospital in Dhaka.jpg|Cholera hospital for Dhaka, showing normal cholera treatment beds.
&lt;/gallery&gt;

=== Surveillance ===

[[File:Using Precipitation Data to Assess Risk of Cholera Outbreaks.webm|thumb|upright=1.3|A modelling approach using satellite data can help improve how we fit predict cholera risk areas for different parts of the world.]]

Surveillance and quick reporting dey very important to control cholera outbreaks fast. Cholera dey behave like seasonal disease for many countries wey get am, especially during rainy season. Surveillance system fit give early warning about outbreak, so authorities fit respond quick and prepare well. Good surveillance also help to know where risk dey high so prevention fit target the right places.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/control/en/index.html |title=Cholera: prevention and control |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=8 December 2008 |archive-url=https://web.archive.org/web/20081214042133/http://www.who.int/topics/cholera/control/en/index.html |archive-date=14 December 2008}}&lt;/ref&gt; For prevention to work well, cases must dey reported to national health authorities.&lt;ref name=Lancet2004 /&gt;

=== Vaccination ===

[[File:Euvichol-plus.jpg|thumb|Euvichol-plus oral vaccine for cholera]]

Spanish doctor Jaume Ferran i Clua develop the first successful cholera vaccine for 1885, the first wey immunize people against bacterial disease.&lt;ref&gt;{{Cite web|url=http://www.historyofvaccines.org/content/timelines/others |archive-url=https://web.archive.org/web/20150211100824/http://www.historyofvaccines.org/content/timelines/others|url-status=deviated|title=Others — Timelines — History of Vaccines|archive-date=11 February 2015}}&lt;/ref&gt; E vaccine work but e cause controversy and some people no accept am at that time. But later e prove say e dey effective: from 30,000 people wey e vaccinate, only 54 die.&lt;ref name=&quot;:0&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Waldemar Haffkine's Cholera Vaccines and the Ferran-Haffkine Priority Dispute |journal=[[Journal of the History of Medicine and Allied Sciences]] |date=1982 |volume=XXXVII |issue=4 |pages=399–422 |doi=10.1093/jhmas/xxxvii.4.399 |pmid=6759570}}&lt;/ref&gt;&lt;ref name=&quot;:1&quot;&gt;{{cite journal |last1=Bornside |first1=George H. |title=Jaime Ferran and Preventive Inoculation Against Cholera |url=https://archive.org/details/sim_bulletin-of-the-history-of-medicine_winter-1981_55_4/page/516 |journal=Bulletin of the History of Medicine |date=1981 |volume=55 |issue=4 |pages=516–532 |jstor=44441415 |pmid=7039738 }}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{cite journal |last1=Hawgood |first1=Barbara J |title=Waldemar Mordecai Haffkine, CIE (1860–1930): prophylactic vaccination against cholera and bubonic plague in British India |journal=[[Journal of Medical Biography]] |date=February 2007 |volume=15 |issue=1 |pages=9–19 |doi=10.1258/j.jmb.2007.05-59 |pmid=17356724 |s2cid=42075270}}&lt;/ref&gt;&lt;ref&gt;{{Cite journal |last1=Lopez |first1=Anna Lena |last2=Gonzales |first2=Maria Liza Antoinette |last3=Aldaba |first3=Josephine G. |last4=Nair |first4=G. Balakrish |date=September 2014 |title=Killed oral cholera vaccines: history, development and implementation challenges |journal=Therapeutic Advances in Vaccines |volume=2 |issue=5 |pages=123–136 |doi=10.1177/2051013614537819 |issn=2051-0136 |pmc=4144262 |pmid=25177492}}&lt;/ref&gt; Russian-French scientist Waldemar Haffkine too develop cholera vaccine for 1892.&lt;ref name=&quot;:0&quot; /&gt;&lt;ref name=&quot;:1&quot; /&gt;&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{webarchive|url=https://web.archive.org/web/20150924024552/http://www.haffkineinstitute.org/waldemar.htm|date=24 September 2015}}&lt;/ref&gt; E run big vaccination program for British India.&lt;ref name=&quot;:2&quot; /&gt;&lt;ref&gt;{{Cite news |date=11 December 2020 |title=Waldemar Haffkine: The vaccine pioneer the world forgot |language=en-GB |work=[[BBC News]] |url=https://www.bbc.com/news/world-asia-india-55050012 |access-date=20 January 2021}}&lt;/ref&gt;

People wey survive cholera fit get immunity for at least 3 years.&lt;ref name=&quot;immunity&quot;/&gt; Some safe oral vaccines dey available for cholera prevention.&lt;ref name=&quot;pmid21412922&quot;&gt;{{cite journal |vauthors=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=[[The Cochrane Database of Systematic Reviews]] |issue=3 |article-number=CD008603 |date=March 2011 |volume=2011 |pmid=21412922 |pmc=6532691 |doi=10.1002/14651858.CD008603.pub2 |editor=Sinclair D}}&lt;/ref&gt; WHO get three approved oral cholera vaccines: Dukoral, Sanchol, and Euvichol. Dukoral be inactivated oral vaccine wey get about 52% protection for first year and 62% for second year, with few side effects.&lt;ref name=&quot;pmid21412922&quot; /&gt; E dey available for more than 60 countries. But CDC no still recommend am for most travelers from United States go endemic countries.&lt;ref name=&quot;CDC_Vacc&quot;&gt;{{cite web |title=Is a vaccine available to prevent cholera? |work=[[Centers for Disease Control]] |url=https://www.cdc.gov/cholera/general/#vaccine |date=22 October 2010 |access-date=24 October 2010 |url-status=live |archive-url=https://web.archive.org/web/20101026085158/http://www.cdc.gov/cholera/general/#vaccine |archive-date=26 October 2010}}&lt;/ref&gt; US FDA vaccine called Vaxchora be oral live vaccine wey fit protect adults 18–64 years after single dose.&lt;ref&gt;{{Cite web |url=http://www.immunize.org/fda/ |archive-url=https://web.archive.org/web/20170415125256/http://www.immunize.org/fda/ |title=FDA Product Approval: View All |archive-date=15 April 2017}}&lt;/ref&gt;

Injectable vaccine dey too, e fit protect person for 2–3 years, but e work less for children under five years old.&lt;ref&gt;{{cite journal |vauthors=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=[[The Cochrane Database of Systematic Reviews]] |issue=8 |article-number=CD000974 |date=August 2010 |volume=2019 |pmid=20687062 |pmc=6532721 |doi=10.1002/14651858.CD000974.pub2 |editor=Graves PM}}&lt;/ref&gt; But as of 2010, availability still limited.&lt;ref name=WHO2010 /&gt; Work still dey go on to study mass vaccination role.&lt;ref&gt;{{cite web |url=https://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=[[WHO]] |work=Health topics |year=2008 |access-date=1 February 2010 |archive-url=https://web.archive.org/web/20100216224558/http://who.int/topics/cholera/vaccines/en/index.html |archive-date=16 February 2010}}&lt;/ref&gt; WHO recommend say high-risk people like children and HIV patients for endemic countries suppose receive vaccine.&lt;ref name=WHO2010 /&gt; If vaccination cover many people, herd immunity fit reduce cholera spread for environment.&lt;ref name=NEJM2006 /&gt;

WHO still talk say oral cholera vaccine fit be used for endemic areas, outbreak response, or humanitarian crisis where risk high.&lt;ref&gt;{{cite journal |title=News from the World Health Organization: Epidemiological Methods for Environmental Health Initiatives in WHO |url=https://archive.org/details/sim_international-journal-of-epidemiology_1993-10_22_5/page/961 |journal=International Journal of Epidemiology |date=1993 |volume=22 |issue=5 |pages=961–962 |doi=10.1093/ije/22.5.961 }}&lt;/ref&gt; OCV dey useful for different situations but no full agreement still dey on how to use am everywhere.&lt;ref&gt;{{cite journal |vauthors=Deen J, von Seidlein L, Luquero FJ, Troeger C, Reyburn R, Lopez AL, Debes A, Sack DA |date=January 2016 |title=The scenario approach for countries considering the addition of oral cholera vaccination in cholera preparedness and control plans |journal=[[The Lancet. Infectious Diseases]] |volume=16 |issue=1 |pages=125–129 |doi=10.1016/S1473-3099(15)00298-4 |pmid=26494426 |doi-access=}}&lt;/ref&gt;

=== Sari filtration ===

{{Main|Cloth filter}}

[[Image:Washing Utensils And Vegetables.png|thumb|240px|Women for village pond for Matlab, Bangladesh, dey wash utensils and vegetables. Woman for right dey put sari filter for water container to filter water for drinking.]]

For Bangladesh, people develop simple method called sari filter to reduce contamination of drinking water. Dem dey use old sari cloth (best one) or other cloth. Used cloth dey work better than new one because washing am many times reduce space between fibers. Water wey dem filter like this get fewer germs, so e safer pass before.&lt;ref name=Ram2010&gt;{{cite book |author=Ramamurthy T |title=Epidemiological and Molecular Aspects on Cholera |year=2010 |publisher=Springer |isbn=978-1-60327-265-0 |page=330 |url=https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |url-status=live |archive-url=https://web.archive.org/web/20151107134836/https://books.google.com/books?id=X1DI0Easu2YC&amp;pg=PA330 |archive-date=7 November 2015}}&lt;/ref&gt; For Bangladesh, this method reduce cholera cases by almost half.&lt;ref name=Merr2010&gt;{{cite book |author=Merrill RM |title=Introduction to epidemiology. |year=2010 |publisher=Jones and Bartlett Publishers |location=Sudbury, MA |isbn=978-0-7637-6622-1 |page=43 |url=https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |edition=5th |url-status=live |archive-url=https://web.archive.org/web/20151106194307/https://books.google.com/books?id=RMDBh6gw1_UC&amp;pg=PA43 |archive-date=6 November 2015}}&lt;/ref&gt; Dem dey fold sari 4 to 8 times.&lt;ref name=Ram2010 /&gt; After use, dem suppose rinse am and dry am under sun to kill bacteria.&lt;ref&gt;{{cite book |author=Starr C |title=Biology: Today and Tomorrow with Physiology |url=https://archive.org/details/biologytodaytomo0000star_h5w5 |year=2007 |publisher=[[Cengage Learning]] |isbn=978-0-7637-6622-1 |page=[https://archive.org/details/biologytodaytomo0000star_h5w5/page/563 563] |edition=2 |url-status=live |archive-url=https://web.archive.org/web/20151107022134/https://books.google.com/books?id=-bsFAAAAQBAJ&amp;pg=PA563 |archive-date=7 November 2015}}&lt;/ref&gt; Nylon cloth fit also work but e cost more and no easy to get.&lt;ref name=Merr2010 /&gt;

== Epidemiology ==

Cholera dey affect about 2.8 million people worldwide, and e dey cause around 95,000 deaths every year (uncertainty range: 21,000–143,000) as of 2015.&lt;ref&gt;{{cite journal |last1=Ali |first1=Mohammad |last2=Nelson |first2=Allyson R. |last3=Lopez |first3=Anna Lena |last4=Sack |first4=David A. |title=Updated Global Burden of Cholera in Endemic Countries |journal=PLOS Neglected Tropical Diseases |date=4 June 2015 |volume=9 |issue=6 |article-number=e0003832 |doi=10.1371/journal.pntd.0003832 |pmid=26043000 |pmc=4455997}}&lt;/ref&gt;&lt;ref name=&quot;Loz2012&quot;&gt;{{cite journal |last1=Lozano |first1=Rafael |display-authors=etal |title=Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 |journal=The Lancet |date=December 2012 |volume=380 |issue=9859 |pages=2095–2128 |doi=10.1016/S0140-6736(12)61728-0 |pmid=23245604 |pmc=10790329 |s2cid=1541253 |hdl=10536/DRO/DU:30050819 |url=https://repozitorij.upr.si/Dokument.php?id=7123&amp;dn=}}&lt;/ref&gt;

This thing dey happen mainly for developing countries.&lt;ref&gt;{{cite journal |last1=Reidl |first1=Joachim |last2=Klose |first2=Karl E. |title=Vibrio cholerae and cholera: out of the water and into the host |journal=FEMS Microbiology Reviews |date=June 2002 |volume=26 |issue=2 |pages=125–139 |doi=10.1111/j.1574-6976.2002.tb00605.x |pmid=12069878  }}&lt;/ref&gt;

For early 1980s, dem believe say death rate still dey pass three million people every year.&lt;ref name=&quot;Lancet2004&quot; /&gt; E dey hard to calculate exact number of cases because many no dey report am, especially when outbreak fit affect tourism for a country.&lt;ref name=&quot;NEJM2006&quot;&gt;{{cite journal | vauthors = Sack DA, Sack RB, Chaignat CL | title = Getting serious about cholera | url = https://archive.org/details/sim_new-england-journal-of-medicine_2006-08-17_355_7/page/649 | journal = The New England Journal of Medicine | volume = 355 | issue = 7 | pages = 649–51 | date = August 2006 | pmid = 16914700 | doi = 10.1056/NEJMp068144 | s2cid = 23145226 }}&lt;/ref&gt; As of 2004, cholera still dey both epidemic and endemic for many parts of the world.&lt;ref name=&quot;Lancet2004&quot; /&gt;

Recent big outbreaks include the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak. For October 2016, cholera outbreak start for war-torn Yemen.&lt;ref&gt;{{cite web|url=https://www.bbc.co.uk/news/world-middle-east-40369804 |title=The horrors of Yemen's spiralling cholera crisis |publisher=BBC |author=Johannes Bruwer |date=25 June 2017}}&lt;/ref&gt; World Health Organization (WHO) call am “the worst cholera outbreak in the world”.&lt;ref&gt;{{cite news|last1=Dwyer|first1=Colin |title=Yemen Now Faces 'The Worst Cholera Outbreak In The World,' U.N. Says|url=https://www.npr.org/sections/thetwo-way/2017/06/24/534236954/yemen-now-faces-the-worst-cholera-outbreak-in-the-world-u-n-says|access-date=25 June 2017|work=National Public Radio}}&lt;/ref&gt; For 2019, 93% of all reported 923,037 cholera cases come from Yemen (with 1911 deaths reported).&lt;ref name=&quot;who_report2020&quot; /&gt; Between September 2019 reach September 2020, global total case pass 450,000 and deaths pass 900; but numbers no dey fully accurate because some countries dey report suspected cases instead of confirmed ones, while others no dey report at all like Bangladesh, India and Philippines.&lt;ref name=&quot;who_report2020&quot; /&gt;

Even though we sabi plenty things about how cholera dey spread, scientists still no fully understand why outbreak dey happen for some places and no dey happen for others. Poor sanitation and lack of safe drinking water dey make am spread well-well. Rivers and water bodies fit carry the bacteria as reservoir, and seafood wey travel far fit also spread am.{{Citation needed|date=May 2026}} Cholera cases dey increase during both flood and drought times pass normal periods.&lt;ref&gt;{{cite journal |title=Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010 |journal=The American Journal of Tropical Medicine and Hygiene |date=5 March 2018 |volume=98 |issue=5 |pages=1269–1274 |doi=10.4269/ajtmh.17-0778 |pmid=29512484|pmc=5953376 }}&lt;/ref&gt;

Cholera don disappear from Americas for most part of 20th century, but e come back near the end, start from Peru outbreak.&lt;ref&gt;{{cite journal | vauthors = Blake PA | title = Epidemiology of cholera in the Americas | url = https://archive.org/details/sim_gastroenterology-clinics-of-north-america_1993-09_22_3/page/639 | journal = Gastroenterology Clinics of North America | volume = 22 | issue = 3 | pages = 639–60 | date = September 1993 | doi = 10.1016/S0889-8553(21)00094-7 | pmid = 7691740 }}&lt;/ref&gt; Later e continue with 2010s Haiti cholera outbreak&lt;ref name=&quot;ecdc_cholera&quot;&gt;{{Cite web|url=https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly|title=Cholera worldwide overview|date=30 May 2023|website=ecdc.europa.eu}}&lt;/ref&gt; and another outbreak during 2018–2023 Haitian crisis.&lt;ref&gt;{{cite news |title=Cholera - Haiti |url=https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON427 |access-date=1 February 2023 |work=who.int |language=en}}&lt;/ref&gt; As of August 2021, disease still dey endemic for Africa and some parts of East and West Asia (like Bangladesh, India and Yemen).&lt;ref name=&quot;ecdc_cholera&quot; /&gt; For Europe, cholera no dey endemic; all cases dem report am come from people wey travel go endemic areas.&lt;ref name=&quot;ecdc_cholera&quot; /&gt;

=== History of outbreaks ===

{{Main|History of cholera}}

File:Il cholera di Palermo del 1835.jpg|thumb|upright=1.3|Body disposal of people wey die during cholera epidemic for Palermo in 1835
File:Africa cholera2008b.jpg|thumb|upright=1.3|Map of 2008–2009 cholera outbreak for sub-Saharan Africa showing statistics as of 12 February 2009

The word cholera come from Greek word χολέρα (kholera), from χολή (kholē) wey mean “bile”. Cholera likely start for Indian subcontinent, because e don dey there for many centuries.&lt;ref name=&quot;Lancet2004&quot; /&gt;

References to cholera appear for European writings as far back as 1642, from Dutch doctor Jakob de Bondt description in his book De Medicina Indorum.&lt;ref&gt;{{Cite web|url=http://www.historyofmedicine.com/author/d/jacob-de-jacobus-bontius-bondt|title=All Entries by BONDT, Jacob de, Jacobus Bontius: HistoryofMedicine.com|website=historyofmedicine.com|language=en-us|access-date=23 July 2019}}&lt;/ref&gt; At that time, Europeans dey use word “cholera” for any serious diarrhea wey dey yellow. So de Bondt use the same word describe new disease. Later, around 1830s, people begin differentiate am from “cholera morbus” and “Asiatic cholera” (wey come from India).{{Citation needed|date=May 2026}}

Early outbreaks for Indian subcontinent happen because of overcrowding, poor living conditions, and stagnant water wey make bacteria grow well.&lt;ref name=&quot;Rosenberg&quot; /&gt; Disease begin spread through trade routes go Russia in 1817, then Europe, North America, and other parts of world.&lt;ref name=&quot;Lancet2004&quot; /&gt; Because of that, people start call am “Asiatic cholera”. Seven cholera pandemics don happen since 19th century; first one no reach Americas. Seventh pandemic start from Indonesia in 1961.&lt;ref&gt;&quot;Cholera's seven pandemics&quot;. CBC News. 22 October 2010.&lt;/ref&gt;

First cholera pandemic start for Bengal region near Calcutta between 1817 and 1824. E spread go Southeast Asia, Middle East, Europe, and Eastern Africa.&lt;ref name=&quot;Hays&quot;&gt;{{cite book|url=https://books.google.com/books?id=GyE8Qt-kS1kC|title=Epidemics and Pandemics: Their Impacts on Human History| vauthors = Hays JN |publisher=ABC-CLIO|year=2005|isbn=978-1-85109-658-9|page=193}}&lt;/ref&gt; Movement of British army and navy ships help spread am across Indian Ocean, Africa, Indonesia, China and Japan.&lt;ref&gt;{{Citation|last=McNeill|first=William H |title=Plagues and People|page=268}}.&lt;/ref&gt;

Second pandemic run from 1826 to 1837, affect North America and Europe. Better transport and trade plus migration make disease spread fast.&lt;ref&gt;{{cite book|title=Something New Under The Sun: An Environmental History of the Twentieth Century World (The Global Century Series).|year=2017|url=https://archive.org/details/isbn_9787508672526|author=McNeil J}}&lt;/ref&gt;

Third pandemic start in 1846 and end in 1860, reach North Africa and both North and South America. Irish immigrants bring am enter Canada during Great Famine.

Fourth pandemic run from 1863 to 1875, start from India go Naples and Spain, then reach USA via New Orleans in 1873. E spread through Mississippi River system.

Fifth pandemic (1881–1896) start for India go Europe, Asia, and South America. Sixth (1899–1923) reduce deaths because medicine don improve. Countries like Egypt, Arabia, Persia, India and Philippines suffer badly. Germany and Naples also get serious outbreaks.

Seventh pandemic start in 1961 for Indonesia, and new strain called El Tor appear and still dey persist as of 2018.&lt;ref&gt;{{Cite web|url=https://www.cdc.gov/cholera/index.html|title=Cholera – Vibrio cholerae infection |date=16 May 2017|website=cdc.gov|language=en-us|access-date=4 April 2018}}&lt;/ref&gt; E reduce around 1975 but never fully disappear, cases rise again for 1990s till today.

Cholera become big global disease in 19th century and don kill millions of people.&lt;ref&gt;[[Kelley Lee]] (2003) Health impacts of globalization: towards global governance. Palgrave Macmillan. p.131.&lt;/ref&gt; For Russia alone, between 1847 and 1851, more than 1 million people die.&lt;ref&gt;Geoffrey A. Hosking (2001). Russia and the Russians: a history. Harvard University Press. p.9.&lt;/ref&gt; It kill about 150,000 Americans during second pandemic.&lt;ref&gt;{{Cite book | author = Byrne JP | title = Encyclopedia of Pestilence, Pandemics, and Plagues: A–M |url=https://books.google.com/books?id=kRAInwEACAAJ |publisher = ABC-CLIO | year = 2008 | page = 99 | isbn = 978-0-313-34102-1}}&lt;/ref&gt; Between 1900 and 1920, about 8 million people die for India.&lt;ref&gt;J. N. Hays (2005). Epidemics and pandemics: their impacts on human history. p.347.&lt;/ref&gt;

Cholera become first reportable disease for United States. John Snow for England in 1854 first show say contaminated water be the source of transmission.&lt;ref name=&quot;Lancet2004&quot; /&gt; Today cholera no be big threat for Europe and North America again because of clean water systems like filtration and chlorination, but e still affect developing countries.

Before, ships dey fly yellow quarantine flag if cholera dey onboard. Anybody for ship no go land until about 30–40 days.&lt;ref&gt;{{cite journal | vauthors = Sehdev PS | title = The origin of quarantine | journal = Clinical Infectious Diseases | volume = 35 | issue = 9 | pages = 1071–2 | date = November 2002 | pmid = 12398064 | doi = 10.1086/344062  }}&lt;/ref&gt;

People for old times believe plenty traditional cures. Some think say bad air (miasma theory) dey cause am. Some also believe cold body fit make person more vulnerable, so dem use flannel and cholera belts.&lt;ref&gt;{{cite journal | vauthors = Renbourn ET | title = The history of the flannel binder and cholera belt | journal = Medical History | volume = 1 | issue = 3 | pages = 211–25 | date = July 1957 | pmid = 13440256 | pmc = 1034286 | doi = 10.1017/S0025727300021281 }}&lt;/ref&gt; For Naples outbreak (1854–1855), people use homeopathic camphor.&lt;ref&gt;[http://www.legatum.sk/en:ahr:bayes-cholera-as-treated-by-dr-rubini-158-10355 legatum]&lt;/ref&gt;

Mother's Remedies book talk say tomato syrup dey help. Elecampane also dey used for UK.&lt;ref name=&quot;oldtimeremedies&quot;&gt;{{cite web |title=Cholera Infantum, Tomatoes Will Relieve |url=http://www.oldtimeremedies.co.uk/labels/cholera.html |date=13 October 2008 |access-date=18 February 2013}}&lt;/ref&gt; First vaccine come in 1885, and first antibiotic come in 1948.{{Citation needed|date=May 2026}}

Cholera cases reduce for developed countries because of better sanitation and treatment.&lt;ref&gt;&quot;Cholera&quot;, World Health Organization.&lt;/ref&gt; But in 19th century America, cholera still serious problem. E spread through rivers like Erie Canal and Mississippi system.&lt;ref&gt;{{cite journal | vauthors = Pyle GF | title = The diffusion of cholera in the United States in the nineteenth century | journal = Geographical Analysis | volume = 1 | pages = 59–75 | year = 2010 | pmid = 11614509 | doi = 10.1111/j.1538-4632.1969.tb00605.x  }}&lt;/ref&gt; New York City also suffer because water system no strong enough then.&lt;ref name=&quot;pmid7620035&quot;&gt;{{cite journal | vauthors = Lacey SW | title = Cholera: calamitous past, ominous future | url = https://archive.org/details/sim_clinical-infectious-diseases_1995-05_20_5/page/1409 | journal = Clinical Infectious Diseases | volume = 20 | issue = 5 | pages = 1409–19 | date = May 1995 | pmid = 7620035 | doi = 10.1093/clinids/20.5.1409 | s2cid = 45016958 }}&lt;/ref&gt;

Cholera morbus be old term wey people use for gastroenteritis, not actual cholera disease.&lt;ref name=&quot;rosenberg&quot;&gt;{{cite book|author1=Charles E. Rosenberg|title=The Cholera Years the United States in 1832, 1849, and 1866.|date=2009|publisher=University of Chicago Press|location=Chicago|isbn=978-0-226-72676-2|page=74}}&lt;/ref&gt;

&lt;gallery&gt;
File:Cholera.jpg|Drawing of Death bringing cholera, Le Petit Journal (1912)
File:Pedro II of Brazil and ministers of state.JPG|Emperor Pedro II of Brazil visiting cholera patients in 1855
File:Cholera 395.1.jpg|New York City Board of Health hand bill, 1832 — old advice show say people no understand disease well
&lt;/gallery&gt;

=== Research ===

One big breakthrough for cholera fight come from doctor John Snow (1813–1858), wey in 1854 link cholera to contaminated water.&lt;ref name=&quot;Rosenberg&quot;&gt;{{cite book |author=Rosenberg, Charles E. |title=The cholera years: the United States in 1832, 1849 and 1866 |url=https://archive.org/details/cholerayearsunit0000rose |publisher=University of Chicago Press |location=Chicago |year=1987 |isbn=978-0-226-72677-9}}&lt;/ref&gt; He also propose microbial cause in 1849 and prove say sewage contamination be main source for outbreaks in London in 1854.&lt;ref&gt;John Snow, ''The mode of communication of cholera'', 1855.&lt;/ref&gt; Today people call am Father of Epidemiology.

Bacterium wey cause cholera isolate in 1854 by Filippo Pacini,&lt;ref&gt;{{cite journal |first1=Fillipo |last1=Pacini |year=1854 |url=https://books.google.com/books?id=xdtQAAAAcAAJ&amp;pg=PA397 |title=Osservazioni microscopiche e deduzioni patologiche sul cholera asiatico |journal=Gazzetta Medica Italiana |volume=4 |issue=50 |pages=397–401; 405–412 }}&lt;/ref&gt; but people no really recognize am that time. Others like Joaquim Balcells i Pascual also report am same year.&lt;ref name=&quot;Real Academia de la Historia 2018&quot; /&gt;

Between 1850s and 1900s, developed countries invest heavily for clean water and sewage systems, and that reduce cholera outbreaks. In 1883, Robert Koch identify Vibrio cholerae as bacteria cause of cholera.&lt;ref&gt;{{cite book |last1=Aberth |first1=John |title=Plagues in World History |url=https://archive.org/details/plaguesinworldhi0000aber |date=2011 |publisher=Rowman &amp; Littlefield Publishers |isbn=978-1-4422-0796-7 |page=101 }}&lt;/ref&gt;

Hemendra Nath Chatterjee, Bengali scientist, first show oral rehydration therapy (ORS) work for cholera diarrhea. In 1953, he publish paper for The Lancet.&lt;ref&gt;{{cite journal | vauthors = Ruxin JN | title = Magic bullet: the history of oral rehydration therapy | journal = Medical History | volume = 38 | issue = 4 | pages = 363–97 | date = October 1994 | pmid = 7808099 | pmc = 1036912 | doi = 10.1017/s0025727300036905 }}&lt;/ref&gt;&lt;ref&gt;{{cite journal | vauthors = Chatterjee HN | title = Control of vomiting in cholera and oral replacement of fluid | journal = Lancet | volume = 265 | issue = 6795 | page = 1063 | date = November 1953 | pmid = 13110052 | doi = 10.1016/s0140-6736(53)90668-0 }}&lt;/ref&gt;

Indian scientist Sambhu Nath De discover cholera toxin and prove how bacteria dey transmit disease.&lt;ref&gt;{{Cite web|url=https://inmemoryglobal.com/remembrance/sambhu-nath-de/|title=Sambhu Nath De}}&lt;/ref&gt;

Robert Allan Phillips also develop rehydration protocol during research in Southeast Asia and win Lasker award in 1967.&lt;ref&gt;{{cite web |url= http://www.laskerfoundation.org/awards/show/treatment-of-cholera/ |title=Albert Lasker Clinical Medical Research Award |publisher= Lasker Foundation }}&lt;/ref&gt;

More recent research for 2002 show say Vibrio cholerae change inside human body and become more infectious before e comot through stool, helping am survive for environment.&lt;ref name=&quot;Merrell2002&quot;&gt;{{cite journal | vauthors = Merrell DS, Butler SM, Qadri F, Dolganov NA, Alam A, Cohen MB, Calderwood SB, Schoolnik GK, Camilli A | title = Host-induced epidemic spread of the cholera bacterium | journal = Nature | volume = 417 | issue = 6889 | pages = 642–5 | date = June 2002 | pmid = 12050664 | pmc = 2776822 | doi = 10.1038/nature00778 }}&lt;/ref&gt;

=== Global Strategy ===

For 2017, WHO start global plan called “Ending Cholera: a global roadmap to 2030” wey aim reduce cholera deaths by 90% by 2030.&lt;ref name=&quot;who_fact&quot;&gt;{{Cite web|url=https://www.who.int/news-room/fact-sheets/detail/cholera|title = Cholera}}&lt;/ref&gt; Global Task Force on Cholera Control dey lead am and dey support countries with plans and monitoring.&lt;ref&gt;{{Cite web|url=https://www.gtfcc.org/|title=Global Task Force on Cholera Control}}&lt;/ref&gt;

The plan get 3 main goals: early detection and response, stopping transmission through sanitation and vaccines, and global coordination through GTFCC.&lt;ref name=&quot;who_fact&quot; /&gt;

WHO no believe say cholera fit totally disappear worldwide because bacteria fit survive for environment even without human.&lt;ref&gt;{{Cite report |title=Ending Cholera a Global Roadmap to 2030|publisher=Global Task Force on Cholera Control |date=2017}}&lt;/ref&gt; But human-to-human transmission fit still be eliminated in some places.

Haiti example show say local elimination fit work, even though outbreak happen there before. Some countries still dey target full elimination certification.&lt;ref&gt;{{cite book |title=National Plan for the Elimination of Cholera in Haiti 2013-2022 |date=February 2013 }}&lt;/ref&gt;

GTFCC dey focus on 47 countries, and 13 of them don already start vaccination campaigns.&lt;ref name=&quot;who_report2020&quot;&gt;{{cite book |title=International Coordinating Group (ICG) on Vaccine Provision for Cholera, Meningitis, and Yellow Fever |date=September 2020 |publisher=World Health Organization |isbn=978-92-4-002916-3 }}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==
{{sister project links||d=Q12090|c=Category:Cholera|n=no|q=no|b=no|v=no|voy=no|m=no|mw=no|s=Category:Cholera|wikt=Cholera|species=no}}
* [https://web.archive.org/web/20130622144054/http://www.who.int/cholera/technical/prevention/control/en/ Prevention and control of cholera outbreaks: WHO policy and recommendations]
* [https://web.archive.org/web/20060324155246/http://www.who.int/cholera/ Cholera]{{snd}}World Health Organization
* [https://www.cdc.gov/cholera/index.html Cholera – ''Vibrio cholerae'' infection]{{snd}}Centers for Disease Control and Prevention
{{Authority control}}

[[Category:Cholera| ]]
[[Category:Diarrhea]]
[[Category:Foodborne illnesses]]
[[Category:Gastrointestinal tract disorders]]
[[Category:Intestinal infectious diseases]]
[[Category:Tropical diseases]]
[[Category:Epidemics]]
[[Category:Pandemics]]
[[Category:Sanitation]]
[[Category:Waterborne diseases]]
[[Category:Vaccine-preventable diseases]]
[[Category:Translated from MDWiki]]
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    <title>Muscular dystrophy</title>
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'''Muscular dystrophy''' ('''MD''') be a genetically den clinically heterogeneous group of rare neuromuscular diseases wey cause progressive weakness den breakdown of skeletal muscles over time.&lt;ref name=&quot;NIH20162&quot;&gt;{{cite web |date=March 4, 2016 |title=NINDS Muscular Dystrophy Information Page |url=http://www.ninds.nih.gov/disorders/md/md.htm |url-status=dead |archive-url=https://web.archive.org/web/20160730004520/http://www.ninds.nih.gov/disorders/md/md.htm |archive-date=30 July 2016 |access-date=12 September 2016 |website=NINDS}}&lt;/ref&gt; De disorders dey differ as to wich muscles be primarily affected, de degree of weakness, how fast dem dey worsen, den wen symptoms begin.&lt;ref name=&quot;NIH20162&quot; /&gt; Sam types sanso be associated plus problems insyd oda organs.&lt;ref name=&quot;NIH2016Re&quot;&gt;{{cite web |date=March 4, 2016 |title=Muscular Dystrophy: Hope Through Research |url=http://www.ninds.nih.gov/disorders/md/detail_md.htm#180483171 |url-status=dead |archive-url=https://web.archive.org/web/20160930165657/http://www.ninds.nih.gov/disorders/md/detail_md.htm#180483171 |archive-date=30 September 2016 |access-date=12 September 2016 |website=NINDS}}&lt;/ref&gt;&lt;!-- Other symptoms include...  lung weakness, and cardiomyopathy --&gt;

Over 30 different disorders be classified as muscular dystrophies.&lt;ref name=&quot;NIH20162&quot; /&gt;&lt;ref name=NIH2016Re/&gt; Of those, Duchenne muscular dystrophy (DMD) dey account give approximately 50% of cases den dey affect males beginning around de age of four.&lt;ref name=&quot;NIH20162&quot; /&gt; Oda relatively common muscular dystrophies dey include Becker muscular dystrophy, facioscapulohumeral muscular dystrophy, den myotonic dystrophy,&lt;ref name=&quot;NIH20162&quot; /&gt; whereas limb–girdle muscular dystrophy den congenital muscular dystrophy demselves be groups of several – usually extremely rare – genetic disorders.

Muscular dystrophies be caused by mutations insyd genes, usually those dem involve insyd making muscle proteins.&lt;ref name=&quot;NIH2016Re&quot; /&gt; De muscle protein dystrophin dey insyd most muscle cells den works to strengthen de muscle fibers den protect dem from injury as muscles contract den relax.&lt;ref&gt;{{Cite book |last1=Gao |first1=Q. Q. |title=Comprehensive Physiology |last2=McNally |first2=E. M. |date=2011-01-17 |publisher=Wiley |isbn=978-0-470-65071-4 |editor-last=Terjung |editor-first=Ronald |edition=1 |volume=5 |pages=1223–1239 |language=en |doi=10.1002/cphy.c140048 |pmc=4767260 |pmid=26140716 }}&lt;/ref&gt; E dey link de muscle membrane to de thin muscular filaments within de cell. Dystrophin be an integral part of de muscular structure. An absence of dystrophin fi cause impairments: healthy muscle tissue fi be replaced by fibrous tissue den fat, wey dey cause an inability to generate force.&lt;ref&gt;{{Cite journal |last1=Gao |first1=Quan Q. |last2=McNally |first2=Elizabeth M. |date=2015-06-24 |title=The Dystrophin Complex: Structure, Function, and Implications for Therapy |url=http://dx.doi.org/10.1002/cphy.c140048 |journal=Comprehensive Physiology |volume=5 |issue=3 |pages=1223–1239 |doi=10.1002/cphy.c140048 |isbn=9780470650714 |pmc=4767260 |pmid=26140716}}&lt;/ref&gt; Respiratory den cardiac complications fi occur as well. Dese mutations either be inherited from parents anaa fi occur spontaneously during early development.&lt;ref name=&quot;NIH2016Re&quot; /&gt; Muscular dystrophies fi be X-linked recessive, autosomal recessive, anaa autosomal dominant.&lt;ref name=&quot;NIH2016Re&quot; /&gt; Diagnosis often dey involve blood tests den genetic testing.&lt;ref name=&quot;NIH2016Re&quot; /&gt;

Der be no cure for any disorder from de muscular dystrophy group.&lt;ref name=&quot;NIH20162&quot; /&gt; Several drugs dem design to address de root cause be currently available wey dey include gene therapy (Elevidys), den antisense drugs (Ataluren, Eteplirsen etc.).&lt;ref name=&quot;NIH2016Re&quot; /&gt; Oda medications dem use include glucocorticoids (Deflazacort, Vamorolone); calcium channel blockers (Diltiazem); to slow skeletal den cardiac muscle degeneration, anticonvulsants to control seizures den sam muscle activity, den Histone deacetylase inhibitors (Givinostat) to delay damage to dying muscle cells.&lt;ref name=&quot;NIH20162&quot; /&gt; Physical therapy, braces, den corrective surgery fi help plus sam symptoms&lt;ref name=&quot;NIH20162&quot; /&gt; while assisted ventilation fi be required insyd those plus weakness of breathing muscles.&lt;ref name=&quot;NIH2016Re&quot; /&gt;
== References ==
&lt;references /&gt;

== External links ==
[[Category:Translated from MDWiki]]</text>
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'''Muscular dystrophy''' ('''MD''') be a genetically den clinically heterogeneous group of rare neuromuscular diseases wey cause progressive weakness den breakdown of skeletal muscles over time.&lt;ref name=&quot;NIH20162&quot;&gt;{{cite web |date=March 4, 2016 |title=NINDS Muscular Dystrophy Information Page |url=http://www.ninds.nih.gov/disorders/md/md.htm |url-status=dead |archive-url=https://web.archive.org/web/20160730004520/http://www.ninds.nih.gov/disorders/md/md.htm |archive-date=30 July 2016 |access-date=12 September 2016 |website=NINDS}}&lt;/ref&gt; De disorders dey differ as to wich muscles be primarily affected, de degree of weakness, how fast dem dey worsen, den wen symptoms begin.&lt;ref name=&quot;NIH20162&quot; /&gt; Sam types sanso be associated plus problems insyd oda organs.&lt;ref name=&quot;NIH2016Re&quot;&gt;{{cite web |date=March 4, 2016 |title=Muscular Dystrophy: Hope Through Research |url=http://www.ninds.nih.gov/disorders/md/detail_md.htm#180483171 |url-status=dead |archive-url=https://web.archive.org/web/20160930165657/http://www.ninds.nih.gov/disorders/md/detail_md.htm#180483171 |archive-date=30 September 2016 |access-date=12 September 2016 |website=NINDS}}&lt;/ref&gt;&lt;!-- Other symptoms include...  lung weakness, and cardiomyopathy --&gt;

Over 30 different disorders be classified as muscular dystrophies.&lt;ref name=&quot;NIH20162&quot; /&gt;&lt;ref name=NIH2016Re/&gt; Of those, Duchenne muscular dystrophy (DMD) dey account give approximately 50% of cases den dey affect males beginning around de age of four.&lt;ref name=&quot;NIH20162&quot; /&gt; Oda relatively common muscular dystrophies dey include Becker muscular dystrophy, facioscapulohumeral muscular dystrophy, den myotonic dystrophy,&lt;ref name=&quot;NIH20162&quot; /&gt; whereas limb–girdle muscular dystrophy den congenital muscular dystrophy demselves be groups of several – usually extremely rare – genetic disorders.

Muscular dystrophies be caused by mutations insyd genes, usually those dem involve insyd making muscle proteins.&lt;ref name=&quot;NIH2016Re&quot; /&gt; De muscle protein dystrophin dey insyd most muscle cells den works to strengthen de muscle fibers den protect dem from injury as muscles contract den relax.&lt;ref&gt;{{Cite book |last1=Gao |first1=Q. Q. |title=Comprehensive Physiology |last2=McNally |first2=E. M. |date=2011-01-17 |publisher=Wiley |isbn=978-0-470-65071-4 |editor-last=Terjung |editor-first=Ronald |edition=1 |volume=5 |pages=1223–1239 |language=en |doi=10.1002/cphy.c140048 |pmc=4767260 |pmid=26140716 }}&lt;/ref&gt; E dey link de muscle membrane to de thin muscular filaments within de cell. Dystrophin be an integral part of de muscular structure. An absence of dystrophin fi cause impairments: healthy muscle tissue fi be replaced by fibrous tissue den fat, wey dey cause an inability to generate force.&lt;ref&gt;{{Cite journal |last1=Gao |first1=Quan Q. |last2=McNally |first2=Elizabeth M. |date=2015-06-24 |title=The Dystrophin Complex: Structure, Function, and Implications for Therapy |url=http://dx.doi.org/10.1002/cphy.c140048 |journal=Comprehensive Physiology |volume=5 |issue=3 |pages=1223–1239 |doi=10.1002/cphy.c140048 |isbn=9780470650714 |pmc=4767260 |pmid=26140716}}&lt;/ref&gt; Respiratory den cardiac complications fi occur as well. Dese mutations either be inherited from parents anaa fi occur spontaneously during early development.&lt;ref name=&quot;NIH2016Re&quot; /&gt; Muscular dystrophies fi be X-linked recessive, autosomal recessive, anaa autosomal dominant.&lt;ref name=&quot;NIH2016Re&quot; /&gt; Diagnosis often dey involve blood tests den genetic testing.&lt;ref name=&quot;NIH2016Re&quot; /&gt;

Der be no cure for any disorder from de muscular dystrophy group.&lt;ref name=&quot;NIH20162&quot; /&gt; Several drugs dem design to address de root cause be currently available wey dey include gene therapy (Elevidys), den antisense drugs (Ataluren, Eteplirsen etc.).&lt;ref name=&quot;NIH2016Re&quot; /&gt; Oda medications dem use include glucocorticoids (Deflazacort, Vamorolone); calcium channel blockers (Diltiazem); to slow skeletal den cardiac muscle degeneration, anticonvulsants to control seizures den sam muscle activity, den Histone deacetylase inhibitors (Givinostat) to delay damage to dying muscle cells.&lt;ref name=&quot;NIH20162&quot; /&gt; Physical therapy, braces, den corrective surgery fi help plus sam symptoms&lt;ref name=&quot;NIH20162&quot; /&gt; while assisted ventilation fi be required insyd those plus weakness of breathing muscles.&lt;ref name=&quot;NIH2016Re&quot; /&gt;

Outcomes dey depend on de specific type of disorder.&lt;ref name=&quot;NIH20162&quot; /&gt; Chaw affected people go eventually cam be unable to walk&lt;ref name=NIH2016Re/&gt; wey Duchenne muscular dystrophy in particular be associated plus shortened life expectancy.

Na muscular dystrophy be first described insyd de 1830s by Charles Bell.&lt;ref name=&quot;NIH2016Re&quot; /&gt; De word &quot;dystrophy&quot; dey cam from de Greek ''dys'', wey dey mean &quot;no, un-&quot; den ''troph-'' wey dey mean &quot;nourish&quot;.&lt;ref name=&quot;NIH2016Re&quot; /&gt;
== References ==
&lt;references /&gt;

== External links ==
[[Category:Translated from MDWiki]]</text>
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    <revision>
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      <timestamp>2026-09-14T18:54:30Z</timestamp>
      <contributor>
        <username>DaSupremo</username>
        <id>9</id>
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'''Muscular dystrophy''' ('''MD''') be a genetically den clinically heterogeneous group of rare neuromuscular diseases wey cause progressive weakness den breakdown of skeletal muscles over time.&lt;ref name=&quot;NIH20162&quot;&gt;{{cite web |date=March 4, 2016 |title=NINDS Muscular Dystrophy Information Page |url=http://www.ninds.nih.gov/disorders/md/md.htm |url-status=dead |archive-url=https://web.archive.org/web/20160730004520/http://www.ninds.nih.gov/disorders/md/md.htm |archive-date=30 July 2016 |access-date=12 September 2016 |website=NINDS}}&lt;/ref&gt; De disorders dey differ as to wich muscles be primarily affected, de degree of weakness, how fast dem dey worsen, den wen symptoms begin.&lt;ref name=&quot;NIH20162&quot; /&gt; Sam types sanso be associated plus problems insyd oda organs.&lt;ref name=&quot;NIH2016Re&quot;&gt;{{cite web |date=March 4, 2016 |title=Muscular Dystrophy: Hope Through Research |url=http://www.ninds.nih.gov/disorders/md/detail_md.htm#180483171 |url-status=dead |archive-url=https://web.archive.org/web/20160930165657/http://www.ninds.nih.gov/disorders/md/detail_md.htm#180483171 |archive-date=30 September 2016 |access-date=12 September 2016 |website=NINDS}}&lt;/ref&gt;&lt;!-- Other symptoms include...  lung weakness, and cardiomyopathy --&gt;

Over 30 different disorders be classified as muscular dystrophies.&lt;ref name=&quot;NIH20162&quot; /&gt;&lt;ref name=NIH2016Re/&gt; Of those, Duchenne muscular dystrophy (DMD) dey account give approximately 50% of cases den dey affect males beginning around de age of four.&lt;ref name=&quot;NIH20162&quot; /&gt; Oda relatively common muscular dystrophies dey include Becker muscular dystrophy, facioscapulohumeral muscular dystrophy, den myotonic dystrophy,&lt;ref name=&quot;NIH20162&quot; /&gt; whereas limb–girdle muscular dystrophy den congenital muscular dystrophy demselves be groups of several – usually extremely rare – genetic disorders.

Muscular dystrophies be caused by mutations insyd genes, usually those dem involve insyd making muscle proteins.&lt;ref name=&quot;NIH2016Re&quot; /&gt; De muscle protein dystrophin dey insyd most muscle cells den works to strengthen de muscle fibers den protect dem from injury as muscles contract den relax.&lt;ref&gt;{{Cite book |last1=Gao |first1=Q. Q. |title=Comprehensive Physiology |last2=McNally |first2=E. M. |date=2011-01-17 |publisher=Wiley |isbn=978-0-470-65071-4 |editor-last=Terjung |editor-first=Ronald |edition=1 |volume=5 |pages=1223–1239 |language=en |doi=10.1002/cphy.c140048 |pmc=4767260 |pmid=26140716 }}&lt;/ref&gt; E dey link de muscle membrane to de thin muscular filaments within de cell. Dystrophin be an integral part of de muscular structure. An absence of dystrophin fi cause impairments: healthy muscle tissue fi be replaced by fibrous tissue den fat, wey dey cause an inability to generate force.&lt;ref&gt;{{Cite journal |last1=Gao |first1=Quan Q. |last2=McNally |first2=Elizabeth M. |date=2015-06-24 |title=The Dystrophin Complex: Structure, Function, and Implications for Therapy |url=http://dx.doi.org/10.1002/cphy.c140048 |journal=Comprehensive Physiology |volume=5 |issue=3 |pages=1223–1239 |doi=10.1002/cphy.c140048 |isbn=9780470650714 |pmc=4767260 |pmid=26140716}}&lt;/ref&gt; Respiratory den cardiac complications fi occur as well. Dese mutations either be inherited from parents anaa fi occur spontaneously during early development.&lt;ref name=&quot;NIH2016Re&quot; /&gt; Muscular dystrophies fi be X-linked recessive, autosomal recessive, anaa autosomal dominant.&lt;ref name=&quot;NIH2016Re&quot; /&gt; Diagnosis often dey involve blood tests den genetic testing.&lt;ref name=&quot;NIH2016Re&quot; /&gt;

Der be no cure for any disorder from de muscular dystrophy group.&lt;ref name=&quot;NIH20162&quot; /&gt; Several drugs dem design to address de root cause be currently available wey dey include gene therapy (Elevidys), den antisense drugs (Ataluren, Eteplirsen etc.).&lt;ref name=&quot;NIH2016Re&quot; /&gt; Oda medications dem use include glucocorticoids (Deflazacort, Vamorolone); calcium channel blockers (Diltiazem); to slow skeletal den cardiac muscle degeneration, anticonvulsants to control seizures den sam muscle activity, den Histone deacetylase inhibitors (Givinostat) to delay damage to dying muscle cells.&lt;ref name=&quot;NIH20162&quot; /&gt; Physical therapy, braces, den corrective surgery fi help plus sam symptoms&lt;ref name=&quot;NIH20162&quot; /&gt; while assisted ventilation fi be required insyd those plus weakness of breathing muscles.&lt;ref name=&quot;NIH2016Re&quot; /&gt;

Outcomes dey depend on de specific type of disorder.&lt;ref name=&quot;NIH20162&quot; /&gt; Chaw affected people go eventually cam be unable to walk&lt;ref name=NIH2016Re/&gt; wey Duchenne muscular dystrophy in particular be associated plus shortened life expectancy.

Na muscular dystrophy be first described insyd de 1830s by Charles Bell.&lt;ref name=&quot;NIH2016Re&quot; /&gt; De word &quot;dystrophy&quot; dey cam from de Greek ''dys'', wey dey mean &quot;no, un-&quot; den ''troph-'' wey dey mean &quot;nourish&quot;.&lt;ref name=&quot;NIH2016Re&quot; /&gt;
==Signs den symptoms==
[[File:Gould Pyle 216.jpg|thumb|Severe limb deformities den contractures indicative of muscular dystrophy]]
De signs den symptoms consistent plus muscular dystrophy are:&lt;ref&gt;{{EMedicine|article|1259041|Muscular Dystrophy Clinical Presentation}}&lt;/ref&gt;{{columns-list|colwidth=22em|
* Progressive muscular wasting
* Poor balance
* Scoliosis (abnormal curvature of de spine anaa de back)&lt;ref name=&quot;Elsobky2024&quot;&gt;{{cite journal |last1=El-Sobky |first1=Tamer A. |last2=Abdulhady |first2=Hala |last3=Mahmoud |first3=Shady |last4=Amen |first4=John |date=31 January 2024 |title=Orthopedic manifestations of congenital muscular dystrophy subtypes in children: Emerging signatures need consolidation: a scoping review |journal=Journal of Musculoskeletal Surgery and Research |volume=8 |pages=11–23 |article-number=11 |doi=10.25259/JMSR_229_2023 |doi-access=free}}&lt;/ref&gt;
* Muscle contracture dey lead to limited range of movement of joints.&lt;ref name=Elsobky2024/&gt;
* Muscle spasms
* Progressive inability to walk
* Waddling gait
* Gowers' sign as insyd Duchenne muscular dystrophy.
* Calf deformation as insyd Duchenne muscular dystrophy.
* Respiratory difficulty &lt;ref&gt;{{cite journal |last1=Birnkrant |first1=DJ |last2=Bushby |first2=K |last3=Bann |first3=CM |last4=Alman |first4=BA |last5=Apkon |first5=SD |last6=Blackwell |first6=A |last7=Case |first7=LE |last8=Cripe |first8=L |last9=Hadjiyannakis |first9=S |last10=Olson |first10=AK |last11=Sheehan |first11=DW |last12=Bolen |first12=J |last13=Weber |first13=DR |last14=Ward |first14=LM |date=April 2018 |title=Diagnosis and management of Duchenne muscular dystrophy, part 2: respiratory, cardiac, bone health, and orthopaedic management. |journal=The Lancet. Neurology |volume=17 |issue=4 |pages=347–361 |doi=10.1016/S1474-4422(18)30025-5 |pmc=5889091 |pmid=29395990}}&lt;/ref&gt;
* Cardiomyopathy&lt;ref&gt;{{cite journal |last1=Bădilă |first1=E |last2=Lungu |first2=II |last3=Grumezescu |first3=AM |last4=Scafa Udriște |first4=A |last5=Rosenthal |first5=David |last6=Duboc |first6=Denis |last7=Melacini |first7=Paola |date=12 May 2021 |title=Diagnosis of Cardiac Abnormalities in Muscular Dystrophies. |journal=Medicina (Kaunas, Lithuania) |volume=57 |issue=5 |page=488 |doi=10.3390/medicina57050488 |pmc=8151418 |pmid=34066119 |doi-access=free}}&lt;/ref&gt;

}}
== References ==
&lt;references /&gt;
== External links ==
[[Category:Translated from MDWiki]]</text>
      <sha1>7zp60d3fbu5193mexapd8upjlc5l61q</sha1>
    </revision>
    <revision>
      <id>111912</id>
      <parentid>111911</parentid>
      <timestamp>2026-09-14T19:00:11Z</timestamp>
      <contributor>
        <username>DaSupremo</username>
        <id>9</id>
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      <comment>Improve article</comment>
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'''Muscular dystrophy''' ('''MD''') be a genetically den clinically heterogeneous group of rare neuromuscular diseases wey cause progressive weakness den breakdown of skeletal muscles over time.&lt;ref name=&quot;NIH20162&quot;&gt;{{cite web |date=March 4, 2016 |title=NINDS Muscular Dystrophy Information Page |url=http://www.ninds.nih.gov/disorders/md/md.htm |url-status=dead |archive-url=https://web.archive.org/web/20160730004520/http://www.ninds.nih.gov/disorders/md/md.htm |archive-date=30 July 2016 |access-date=12 September 2016 |website=NINDS}}&lt;/ref&gt; De disorders dey differ as to wich muscles be primarily affected, de degree of weakness, how fast dem dey worsen, den wen symptoms begin.&lt;ref name=&quot;NIH20162&quot; /&gt; Sam types sanso be associated plus problems insyd oda organs.&lt;ref name=&quot;NIH2016Re&quot;&gt;{{cite web |date=March 4, 2016 |title=Muscular Dystrophy: Hope Through Research |url=http://www.ninds.nih.gov/disorders/md/detail_md.htm#180483171 |url-status=dead |archive-url=https://web.archive.org/web/20160930165657/http://www.ninds.nih.gov/disorders/md/detail_md.htm#180483171 |archive-date=30 September 2016 |access-date=12 September 2016 |website=NINDS}}&lt;/ref&gt;&lt;!-- Other symptoms include...  lung weakness, and cardiomyopathy --&gt;

Over 30 different disorders be classified as muscular dystrophies.&lt;ref name=&quot;NIH20162&quot; /&gt;&lt;ref name=NIH2016Re/&gt; Of those, Duchenne muscular dystrophy (DMD) dey account give approximately 50% of cases den dey affect males beginning around de age of four.&lt;ref name=&quot;NIH20162&quot; /&gt; Oda relatively common muscular dystrophies dey include Becker muscular dystrophy, facioscapulohumeral muscular dystrophy, den myotonic dystrophy,&lt;ref name=&quot;NIH20162&quot; /&gt; whereas limb–girdle muscular dystrophy den congenital muscular dystrophy demselves be groups of several – usually extremely rare – genetic disorders.

Muscular dystrophies be caused by mutations insyd genes, usually those dem involve insyd making muscle proteins.&lt;ref name=&quot;NIH2016Re&quot; /&gt; De muscle protein dystrophin dey insyd most muscle cells den works to strengthen de muscle fibers den protect dem from injury as muscles contract den relax.&lt;ref&gt;{{Cite book |last1=Gao |first1=Q. Q. |title=Comprehensive Physiology |last2=McNally |first2=E. M. |date=2011-01-17 |publisher=Wiley |isbn=978-0-470-65071-4 |editor-last=Terjung |editor-first=Ronald |edition=1 |volume=5 |pages=1223–1239 |language=en |doi=10.1002/cphy.c140048 |pmc=4767260 |pmid=26140716 }}&lt;/ref&gt; E dey link de muscle membrane to de thin muscular filaments within de cell. Dystrophin be an integral part of de muscular structure. An absence of dystrophin fi cause impairments: healthy muscle tissue fi be replaced by fibrous tissue den fat, wey dey cause an inability to generate force.&lt;ref&gt;{{Cite journal |last1=Gao |first1=Quan Q. |last2=McNally |first2=Elizabeth M. |date=2015-06-24 |title=The Dystrophin Complex: Structure, Function, and Implications for Therapy |url=http://dx.doi.org/10.1002/cphy.c140048 |journal=Comprehensive Physiology |volume=5 |issue=3 |pages=1223–1239 |doi=10.1002/cphy.c140048 |isbn=9780470650714 |pmc=4767260 |pmid=26140716}}&lt;/ref&gt; Respiratory den cardiac complications fi occur as well. Dese mutations either be inherited from parents anaa fi occur spontaneously during early development.&lt;ref name=&quot;NIH2016Re&quot; /&gt; Muscular dystrophies fi be X-linked recessive, autosomal recessive, anaa autosomal dominant.&lt;ref name=&quot;NIH2016Re&quot; /&gt; Diagnosis often dey involve blood tests den genetic testing.&lt;ref name=&quot;NIH2016Re&quot; /&gt;

Der be no cure for any disorder from de muscular dystrophy group.&lt;ref name=&quot;NIH20162&quot; /&gt; Several drugs dem design to address de root cause be currently available wey dey include gene therapy (Elevidys), den antisense drugs (Ataluren, Eteplirsen etc.).&lt;ref name=&quot;NIH2016Re&quot; /&gt; Oda medications dem use include glucocorticoids (Deflazacort, Vamorolone); calcium channel blockers (Diltiazem); to slow skeletal den cardiac muscle degeneration, anticonvulsants to control seizures den sam muscle activity, den Histone deacetylase inhibitors (Givinostat) to delay damage to dying muscle cells.&lt;ref name=&quot;NIH20162&quot; /&gt; Physical therapy, braces, den corrective surgery fi help plus sam symptoms&lt;ref name=&quot;NIH20162&quot; /&gt; while assisted ventilation fi be required insyd those plus weakness of breathing muscles.&lt;ref name=&quot;NIH2016Re&quot; /&gt;

Outcomes dey depend on de specific type of disorder.&lt;ref name=&quot;NIH20162&quot; /&gt; Chaw affected people go eventually cam be unable to walk&lt;ref name=NIH2016Re/&gt; wey Duchenne muscular dystrophy in particular be associated plus shortened life expectancy.

Na muscular dystrophy be first described insyd de 1830s by Charles Bell.&lt;ref name=&quot;NIH2016Re&quot; /&gt; De word &quot;dystrophy&quot; dey cam from de Greek ''dys'', wey dey mean &quot;no, un-&quot; den ''troph-'' wey dey mean &quot;nourish&quot;.&lt;ref name=&quot;NIH2016Re&quot; /&gt;
==Signs den symptoms==
[[File:Gould Pyle 216.jpg|thumb|Severe limb deformities den contractures indicative of muscular dystrophy]]
De signs den symptoms consistent plus muscular dystrophy are:&lt;ref&gt;{{EMedicine|article|1259041|Muscular Dystrophy Clinical Presentation}}&lt;/ref&gt;{{columns-list|colwidth=22em|
* Progressive muscular wasting
* Poor balance
* Scoliosis (abnormal curvature of de spine anaa de back)&lt;ref name=&quot;Elsobky2024&quot;&gt;{{cite journal |last1=El-Sobky |first1=Tamer A. |last2=Abdulhady |first2=Hala |last3=Mahmoud |first3=Shady |last4=Amen |first4=John |date=31 January 2024 |title=Orthopedic manifestations of congenital muscular dystrophy subtypes in children: Emerging signatures need consolidation: a scoping review |journal=Journal of Musculoskeletal Surgery and Research |volume=8 |pages=11–23 |article-number=11 |doi=10.25259/JMSR_229_2023 |doi-access=free}}&lt;/ref&gt;
* Muscle contracture dey lead to limited range of movement of joints.&lt;ref name=Elsobky2024/&gt;
* Muscle spasms
* Progressive inability to walk
* Waddling gait
* Gowers' sign as insyd Duchenne muscular dystrophy.
* Calf deformation as insyd Duchenne muscular dystrophy.
* Respiratory difficulty &lt;ref&gt;{{cite journal |last1=Birnkrant |first1=DJ |last2=Bushby |first2=K |last3=Bann |first3=CM |last4=Alman |first4=BA |last5=Apkon |first5=SD |last6=Blackwell |first6=A |last7=Case |first7=LE |last8=Cripe |first8=L |last9=Hadjiyannakis |first9=S |last10=Olson |first10=AK |last11=Sheehan |first11=DW |last12=Bolen |first12=J |last13=Weber |first13=DR |last14=Ward |first14=LM |date=April 2018 |title=Diagnosis and management of Duchenne muscular dystrophy, part 2: respiratory, cardiac, bone health, and orthopaedic management. |journal=The Lancet. Neurology |volume=17 |issue=4 |pages=347–361 |doi=10.1016/S1474-4422(18)30025-5 |pmc=5889091 |pmid=29395990}}&lt;/ref&gt;
* Cardiomyopathy&lt;ref&gt;{{cite journal |last1=Bădilă |first1=E |last2=Lungu |first2=II |last3=Grumezescu |first3=AM |last4=Scafa Udriște |first4=A |last5=Rosenthal |first5=David |last6=Duboc |first6=Denis |last7=Melacini |first7=Paola |date=12 May 2021 |title=Diagnosis of Cardiac Abnormalities in Muscular Dystrophies. |journal=Medicina (Kaunas, Lithuania) |volume=57 |issue=5 |page=488 |doi=10.3390/medicina57050488 |pmc=8151418 |pmid=34066119 |doi-access=free}}&lt;/ref&gt;

}}
== References ==
&lt;references /&gt;
==Read further==
* {{cite journal |last1=De Los Angeles Beytía |first1=Maria |last2=Vry |first2=Julia |last3=Kirschner |first3=Janbernd |date=2012 |title=Drug treatment of Duchenne musculardystrophy: available evidence and perspectives |journal=Acta Myologica |volume=31 |issue=1 |pages=4–8 |pmc=3440798 |pmid=22655510}}
* {{cite journal |last1=Bertini |first1=Enrico |last2=D'Amico |first2=Adele |last3=Gualandi |first3=Francesca |last4=Petrini |first4=Stefania |date=December 2011 |title=Congenital Muscular Dystrophies: A Brief Review |journal=Seminars in Pediatric Neurology |volume=18 |issue=4 |pages=277–288 |doi=10.1016/j.spen.2011.10.010 |pmc=3332154 |pmid=22172424}}

== External links ==
{{Commons}}


{{Authority control}}

{{DEFAULTSORT:Muscular Dystrophy}}
[[Category:Muscular dystrophy| ]]
[[Category:Myoneural junction den neuromuscular diseases]]
[[Category:Translated from MDWiki]]</text>
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  <page>
    <title>LaKeysia Beene</title>
    <ns>0</ns>
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    <revision>
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      <timestamp>2026-09-14T23:46:31Z</timestamp>
      <contributor>
        <username>DaSupremo</username>
        <id>9</id>
      </contributor>
      <comment>Improve article</comment>
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'''LaKeysia Rene Beene''' (born March 9, 1978) be an American former soccer goalkeeper wey play give de United States women's national soccer team den de San Jose CyberRays of Women's United Soccer Association (WUSA).

== Playing career ==

=== College ===
Beene attend den play college soccer as goalkeeper for de University of Notre Dame.  She graduate insyd 1999 having majored insyd environmental geoscience.  Plus de Fighting Irish, na Beene be a two-time All-American wey she backstop de team to a runners-up finish insyd de 1999 NCAA Division I Women's Soccer Championship.

=== Club ===
Insyd 2000, Beene cam be one of de 24 founding players of de Women's United Soccer Association, (WUSA), de first official professional women's soccer league insyd de United States.  From 2001 to 2003, she play give de San Jose CyberRays. Insyd 2001, na dem name Beene WUSA goalkeeper of de year, as de CyberRays win de championship game, beating Atlanta Beat on a penalty shootout.&lt;ref&gt;{{cite news|title=Milbrett Tops List of WUSA Post-Season Honorees|url=http://www.ussoccer.com/News/Articles/2001/08/Milbrett-Tops-List-Of-WUSA-Post-Season-Honorees.aspx?print=true|publisher=[[United States Soccer Federation]]|date=August 23, 2001|accessdate=December 20, 2013|url-status=dead|archiveurl=https://web.archive.org/web/20131221022308/http://www.ussoccer.com/News/Articles/2001/08/Milbrett-Tops-List-Of-WUSA-Post-Season-Honorees.aspx?print=true|archivedate=December 21, 2013}}&lt;/ref&gt;

Beene previously play give pro–am Women's Premier Soccer League (WPSL) team California Storm. She return to de Storm wen WUSA collapse after de 2003 season.&lt;ref&gt;{{cite news|title=Women keep the ball rolling / Players passing time until WUSA returns|url=http://www.sfgate.com/sports/article/Women-keep-the-ball-rolling-Players-passing-2783514.php|publisher=[[San Francisco Chronicle]]|date=May 4, 2004|accessdate=December 22, 2013|first=Michelle|last=Smith}}&lt;/ref&gt;

=== International ===
Na Beene ein first appearance on de United States women's national soccer team be on January 7, 2000, insyd an 8–1 win over Czech Republic insyd Melbourne, Australia.&lt;ref name=&quot;ST&quot;&gt;{{cite web |date=August 23, 2001 |title=Goalkeeper: Lakeysia Beene |url=http://www.soccertimes.com/usteams/roster/women/beene.htm |url-status=dead |archive-url=https://web.archive.org/web/20160303205601/http://www.soccertimes.com/usteams/roster/women/beene.htm |archive-date=March 3, 2016 |accessdate=December 20, 2013 |publisher=Soccer Times}}&lt;/ref&gt;&lt;ref&gt;{{cite web |last=Litterer |first=Dave |date=June 16, 2011 |title=USA - Women - International Results |url=https://www.rsssf.org/tablesu/usa-wom-intres.html |accessdate=September 23, 2012 |publisher=[[Rec.Sport.Soccer Statistics Foundation]]}}&lt;/ref&gt;  She collect a total of 18 caps over de following three years,&lt;ref&gt;{{cite web |title=U.S. Women's National Team All-Time Player Appearances |url=http://www.ussoccer.com/about/media-services/media-guide.aspx |url-status=dead |archiveurl=https://web.archive.org/web/20131216085455/http://www.ussoccer.com/about/media-services/media-guide.aspx |archivedate=December 16, 2013 |accessdate=December 20, 2013 |publisher=[[United States Soccer Federation]]}}&lt;/ref&gt; buh dem no include am insyd de US squads for de 2000 Sydney Olympics, anaa de 2003 FIFA Women's World Cup.

==== International statistics ====
{| class=&quot;wikitable&quot; style=&quot;text-align:center&quot;
! colspan=&quot;3&quot; |{{fbw|USA}}
|-
!Year
!Apps
!Goals
|-
|2000
|3
|0
|-
|2001
|1
|0
|-
|2002
|9
|0
|-
|2003
|5
|0
|-
!Total
!18
!0
|}

== Personal life ==

Na Beene be a teenage Tang Soo Do champion.&lt;ref name=&quot;ST&quot;&gt;{{cite web |date=August 23, 2001 |title=Goalkeeper: Lakeysia Beene |url=http://www.soccertimes.com/usteams/roster/women/beene.htm |url-status=dead |archive-url=https://web.archive.org/web/20160303205601/http://www.soccertimes.com/usteams/roster/women/beene.htm |archive-date=March 3, 2016 |accessdate=December 20, 2013 |publisher=Soccer Times}}&lt;/ref&gt; She graduate from de University of Notre Dame insyd January 2005 plus a [[Bachelor of Science|B.S.]] insyd environmental geosciences.&lt;ref&gt;{{cite web |title=Our Story |url=https://und.com/ot-60bca-story-html/ |url-status=live |archive-url=https://web.archive.org/web/20201026051017/https://und.com/ot-60bca-story-html/ |archive-date=October 26, 2020 |access-date=February 8, 2023 |publisher=[[Notre Dame Fighting Irish]] |quote=1999 – As the last line of defense, goalkeeper Lakeysia Beene ('05) protects the net as the Irish women's soccer team advances to play in the NCAA title game.}}&lt;/ref&gt;

Na dem admit am to The State Bar of California insyd 2009 wey she currently dey practice environmental law insyd Sacramento.&lt;ref&gt;{{cite web |title=Lakeysia R Beene - #265078 |url=http://members.calbar.ca.gov/fal/Member/Detail/265078 |website=The State Bar of California}}&lt;/ref&gt;

== References ==
&lt;references /&gt;

== External links ==</text>
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      <text bytes="6133" sha1="5ix5zyh00pr2y7cvmbbdgwd2tcg4rxj" xml:space="preserve">{{Databox}}
'''LaKeysia Rene Beene''' (born March 9, 1978) be an American former soccer goalkeeper wey play give de United States women's national soccer team den de San Jose CyberRays of Women's United Soccer Association (WUSA).

== Playing career ==

=== College ===
Beene attend den play college soccer as goalkeeper for de University of Notre Dame.  She graduate insyd 1999 having majored insyd environmental geoscience.  Plus de Fighting Irish, na Beene be a two-time All-American wey she backstop de team to a runners-up finish insyd de 1999 NCAA Division I Women's Soccer Championship.

=== Club ===
Insyd 2000, Beene cam be one of de 24 founding players of de Women's United Soccer Association, (WUSA), de first official professional women's soccer league insyd de United States.  From 2001 to 2003, she play give de San Jose CyberRays. Insyd 2001, na dem name Beene WUSA goalkeeper of de year, as de CyberRays win de championship game, beating Atlanta Beat on a penalty shootout.&lt;ref&gt;{{cite news|title=Milbrett Tops List of WUSA Post-Season Honorees|url=http://www.ussoccer.com/News/Articles/2001/08/Milbrett-Tops-List-Of-WUSA-Post-Season-Honorees.aspx?print=true|publisher=[[United States Soccer Federation]]|date=August 23, 2001|accessdate=December 20, 2013|url-status=dead|archiveurl=https://web.archive.org/web/20131221022308/http://www.ussoccer.com/News/Articles/2001/08/Milbrett-Tops-List-Of-WUSA-Post-Season-Honorees.aspx?print=true|archivedate=December 21, 2013}}&lt;/ref&gt;

Beene previously play give pro–am Women's Premier Soccer League (WPSL) team California Storm. She return to de Storm wen WUSA collapse after de 2003 season.&lt;ref&gt;{{cite news|title=Women keep the ball rolling / Players passing time until WUSA returns|url=http://www.sfgate.com/sports/article/Women-keep-the-ball-rolling-Players-passing-2783514.php|publisher=[[San Francisco Chronicle]]|date=May 4, 2004|accessdate=December 22, 2013|first=Michelle|last=Smith}}&lt;/ref&gt;

=== International ===
Na Beene ein first appearance on de United States women's national soccer team be on January 7, 2000, insyd an 8–1 win over Czech Republic insyd Melbourne, Australia.&lt;ref name=&quot;ST&quot;&gt;{{cite web |date=August 23, 2001 |title=Goalkeeper: Lakeysia Beene |url=http://www.soccertimes.com/usteams/roster/women/beene.htm |url-status=dead |archive-url=https://web.archive.org/web/20160303205601/http://www.soccertimes.com/usteams/roster/women/beene.htm |archive-date=March 3, 2016 |accessdate=December 20, 2013 |publisher=Soccer Times}}&lt;/ref&gt;&lt;ref&gt;{{cite web |last=Litterer |first=Dave |date=June 16, 2011 |title=USA - Women - International Results |url=https://www.rsssf.org/tablesu/usa-wom-intres.html |accessdate=September 23, 2012 |publisher=[[Rec.Sport.Soccer Statistics Foundation]]}}&lt;/ref&gt;  She collect a total of 18 caps over de following three years,&lt;ref&gt;{{cite web |title=U.S. Women's National Team All-Time Player Appearances |url=http://www.ussoccer.com/about/media-services/media-guide.aspx |url-status=dead |archiveurl=https://web.archive.org/web/20131216085455/http://www.ussoccer.com/about/media-services/media-guide.aspx |archivedate=December 16, 2013 |accessdate=December 20, 2013 |publisher=[[United States Soccer Federation]]}}&lt;/ref&gt; buh dem no include am insyd de US squads for de 2000 Sydney Olympics, anaa de 2003 FIFA Women's World Cup.

==== International statistics ====
{| class=&quot;wikitable&quot; style=&quot;text-align:center&quot;
! colspan=&quot;3&quot; |{{fbw|USA}}
|-
!Year
!Apps
!Goals
|-
|2000
|3
|0
|-
|2001
|1
|0
|-
|2002
|9
|0
|-
|2003
|5
|0
|-
!Total
!18
!0
|}

== Personal life ==

Na Beene be a teenage Tang Soo Do champion.&lt;ref name=&quot;ST&quot;&gt;{{cite web |date=August 23, 2001 |title=Goalkeeper: Lakeysia Beene |url=http://www.soccertimes.com/usteams/roster/women/beene.htm |url-status=dead |archive-url=https://web.archive.org/web/20160303205601/http://www.soccertimes.com/usteams/roster/women/beene.htm |archive-date=March 3, 2016 |accessdate=December 20, 2013 |publisher=Soccer Times}}&lt;/ref&gt; She graduate from de University of Notre Dame insyd January 2005 plus a [[Bachelor of Science|B.S.]] insyd environmental geosciences.&lt;ref&gt;{{cite web |title=Our Story |url=https://und.com/ot-60bca-story-html/ |url-status=live |archive-url=https://web.archive.org/web/20201026051017/https://und.com/ot-60bca-story-html/ |archive-date=October 26, 2020 |access-date=February 8, 2023 |publisher=[[Notre Dame Fighting Irish]] |quote=1999 – As the last line of defense, goalkeeper Lakeysia Beene ('05) protects the net as the Irish women's soccer team advances to play in the NCAA title game.}}&lt;/ref&gt;

Na dem admit am to The State Bar of California insyd 2009 wey she currently dey practice environmental law insyd Sacramento.&lt;ref&gt;{{cite web |title=Lakeysia R Beene - #265078 |url=http://members.calbar.ca.gov/fal/Member/Detail/265078 |website=The State Bar of California}}&lt;/ref&gt;

== References ==
&lt;references /&gt;

==External links==
* [https://web.archive.org/web/20031004010014/http://www.wusa.com/players_coaches/players/lakeysia_beene/ Profile] at [[Women's United Soccer Association]]
* [https://web.archive.org/web/20000226021521/http://www.fansonly.com/schools/nd/sports/w-soccer/mtt/nd-w-soccer-beene.html Notre Dame player profile]

{{DEFAULTSORT:Beene, LaKeysia}}
[[Category:Human]]
[[Category:1978 births]]
[[Category:American women's soccer players]]
[[Category:Notre Dame Fighting Irish women's soccer players]]
[[Category:United States women's international soccer players]]
[[Category:Women's United Soccer Association players]]
[[Category:Soccer players wey komot California]]
[[Category:San Jose CyberRays players]]
[[Category:Women's association football goalkeepers]]
[[Category:California Storm players]]
[[Category:Women's Premier Soccer League players]]
[[Category:California lawyers]]
[[Category:African-American soccer players]]
[[Category:21st-century African-American sportswomen]]
[[Category:21st-century American sportswomen]]
[[Category:20th-century African-American sportswomen]]
[[Category:20th-century American sportswomen]]
[[Category:Sportspeople wey komot Sumter, South Carolina]]
[[Category:Soccer players wey komot South Carolina]]</text>
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    <title>Elena Rybakina</title>
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      <text bytes="5820" sha1="hco9t40a12pnjz3px9n36gjypquja5h" xml:space="preserve">'''Elena Andreyevna Rybakina''' (born 17 June 1999) be a Russian-born Kazakhstani professional tennis player. She currently be ranked world No. 1 insyd singles by de Women's Tennis Association (WTA). Rybakina win 14 WTA Tour-level singles titles, wey dey include three major titles den de 2025 WTA Finals. She be de first Kazakhstani player to win a major, den to be ranked world No. 1 den insyd de world's top 10.

A former junior world No. 3, Rybakina start ein career competing give Russia before switching federations to Kazakhstan insyd 2018. She break thru insyd 2020 wen she play insyd five tour finals, de most of any player dat year. Rybakina win ein first major title at de 2022 Wimbledon Championships, before reaching de 2023 Australian Open final. At de end of 2025, she win de WTA Finals, wey Australian Open follow den US Open titles insyd 2026, wich se am cam be de world No. 1 player for de first time insyd ein career.

Rybakina be noted for ein excellent serve den ability to generate high-powered groundstrokes, den dey play primarily from de baseline. She be known for ein calm demeanour on court, wey she often be referred to plus de nickname &quot;Ice Queen&quot;.&lt;ref&gt;{{Cite web |date=2025-12-31 |title=Rybakina: 'Entendo por que me chamam de Rainha de Gelo' |url=https://www.tenisnews.com.br/rybakina-entendo-por-que-me-chamam-de-rainha-de-gelo/ |access-date=2026-04-11 |language=pt-BR}}&lt;/ref&gt;

== Early life den background ==
Na dem born Elena Rybakina on 17 June 1999 insyd Moscow to Andrey Rybakin den Ekaterina. Ein poppie originally be from Almaty insyd Kazakhstan wey he work as a producer give de television channel NTV Plus.&lt;ref name=&quot;Father Kazakhstan&quot;&gt;{{cite web |date=10 July 2022 |title=Победа Рыбакиной – победа Казахстана. Кто такие натурализованные спортсмены |url=https://informburo.kz/stati/pobeda-rybakinoi-pobeda-kazaxstana-kto-takie-naturalizovannye-sportsmeny |website=informburo.kz |language=Russian}}&lt;/ref&gt; She start dey play sports give ein older sisto, Anna, from a very young age, originally focusing on gymnastics den ice skating.&lt;ref name=&quot;get-to-know&quot;&gt;{{cite web |last1=Nguyen |first1=Courtney |date=22 January 2020 |title=Getting to Know: Elena Rybakina's rocket rise |url=https://www.wtatennis.com/news/1584000/getting-to-know-elena-rybakina-s-rocket-rise |url-status=dead |archive-url=https://web.archive.org/web/20200222173244/https://www.wtatennis.com/news/1584000/getting-to-know-elena-rybakina-s-rocket-rise |archive-date=22 February 2020 |access-date=26 September 2020 |website=WTA Tennis}}&lt;/ref&gt;&lt;ref&gt;{{cite web |date=14 February 2020 |title=Elena Rybakina: I felt confident after winning the first set |url=http://lt.formulatx.com/en/blog/2020/02/14/elena-rybakina-uverennost-poyavilas-s-vyigryshem-pervogo-seta/ |url-status=dead |archive-url=https://web.archive.org/web/20220625040000/https://lt.formulatx.com/en/blog/2020/02/14/elena-rybakina-uverennost-poyavilas-s-vyigryshem-pervogo-seta/ |archive-date=25 June 2022 |access-date=27 September 2020 |website=Formula TX St. Petersburg Ladies' Trophy}}&lt;/ref&gt; Upon dem tell am say na she be too tall to become a professional insyd either of those sports, na ein poppie suggest she switch to tennis instead secof ein interest insyd de sport.&lt;ref&gt;{{Cite web |last=Rabiner |first=Igor |date=18 August 2022 |title=&quot;Just six months ago, Lena wanted to quit tennis.&quot; An interview with the father of Wimbledon champion Elena Rybakina. |url=https://www.sport-express.ru/tennis/wta/reviews/tennis-andrey-rybakin-otec-chempionki-uimbldona-eleny-rybakinoy-o-vystuplenii-za-kazahstan-i-rossii-kontrakte-ftr-i-ssha-1962750/ |access-date=2 January 2026 |website=Sport Express Russia}}&lt;/ref&gt; Rybakina begin dey play tennis at de age of six.&lt;ref name=&quot;get-to-know&quot; /&gt;

Rybakina move from de Dynamo Sports Club to de Spartak Tennis Club, wer na she get several accomplished coaches. She train plus former top-10 player [[Andrey Chesnokov]] den former top-100 player [[Evgenia Kulikovskaya]]. Na one of ei  fitness coaches be [[Irina Kiseleva]], a World Championship gold medallist insyd de modern pentathlon.&lt;ref name=&quot;ubi&quot;&gt;{{cite web |date=11 March 2020 |title=Elena Rybakina Is Really Special |url=https://www.ubitennis.net/2020/03/elena-rybakina-really-special/ |access-date=27 September 2020 |website=Ubi Tennis}}&lt;/ref&gt;&lt;ref&gt;{{cite web |date=19 October 2017 |title=Поколение Next. Елена Рыбакина |trans-title=Next Generation: Elena Rybakina |url=http://tennis-stars.ru/worldnews/pokolenie-next-elena-rybakina/ |url-status=dead |archive-url=https://web.archive.org/web/20220712172830/http://tennis-stars.ru/worldnews/pokolenie-next-elena-rybakina/ |archive-date=12 July 2022 |access-date=27 September 2020 |website=Tennis Stars |language=ru}}&lt;/ref&gt;&lt;ref name=&quot;spartak&quot;&gt;{{cite web |last1=Fagan |first1=Kate |date=9 January 2013 |title=From Russia, With Topspin |url=https://www.espn.com/espnw/news-commentary/story/_/id/8827683/espnw-russia-topspin |access-date=27 September 2020 |website=ESPN}}&lt;/ref&gt;

Na Rybakina no get individual training as a junior, instead practicing insyd a group of about eight players up til age 15 den a group of four players thru age 18. She sanso only play tennis about two hours per day wey she train insyd fitness for three hours a day. N ein time give tennis be limited in part secof she attend a regular high school wey no specialized for athletes wey she need to balance tennis plus schoolwork.&lt;ref name=&quot;school&quot;&gt;{{cite web |last1=Cox |first1=David |date=22 January 2020 |title=Elena Rybakina: Getting to know the 'anonymous' yet in-form No.29 seed |url=https://ausopen.com/articles/features/elena-rybakina-getting-know-anonymous-yet-form-no29-seed |access-date=27 September 2020 |website=Australian Open}}&lt;/ref&gt;</text>
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      <text bytes="8957" sha1="ae6t3xejb2izz00fldm6k3a0o14hrz1" xml:space="preserve">'''Elena Andreyevna Rybakina''' (born 17 June 1999) be a Russian-born Kazakhstani professional tennis player. She currently be ranked world No. 1 insyd singles by de Women's Tennis Association (WTA). Rybakina win 14 WTA Tour-level singles titles, wey dey include three major titles den de 2025 WTA Finals. She be de first Kazakhstani player to win a major, den to be ranked world No. 1 den insyd de world's top 10.

A former junior world No. 3, Rybakina start ein career competing give Russia before switching federations to Kazakhstan insyd 2018. She break thru insyd 2020 wen she play insyd five tour finals, de most of any player dat year. Rybakina win ein first major title at de 2022 Wimbledon Championships, before reaching de 2023 Australian Open final. At de end of 2025, she win de WTA Finals, wey Australian Open follow den US Open titles insyd 2026, wich se am cam be de world No. 1 player for de first time insyd ein career.

Rybakina be noted for ein excellent serve den ability to generate high-powered groundstrokes, den dey play primarily from de baseline. She be known for ein calm demeanour on court, wey she often be referred to plus de nickname &quot;Ice Queen&quot;.&lt;ref&gt;{{Cite web |date=2025-12-31 |title=Rybakina: 'Entendo por que me chamam de Rainha de Gelo' |url=https://www.tenisnews.com.br/rybakina-entendo-por-que-me-chamam-de-rainha-de-gelo/ |access-date=2026-04-11 |language=pt-BR}}&lt;/ref&gt;

== Early life den background ==
Na dem born Elena Rybakina on 17 June 1999 insyd Moscow to Andrey Rybakin den Ekaterina. Ein poppie originally be from Almaty insyd Kazakhstan wey he work as a producer give de television channel NTV Plus.&lt;ref name=&quot;Father Kazakhstan&quot;&gt;{{cite web |date=10 July 2022 |title=Победа Рыбакиной – победа Казахстана. Кто такие натурализованные спортсмены |url=https://informburo.kz/stati/pobeda-rybakinoi-pobeda-kazaxstana-kto-takie-naturalizovannye-sportsmeny |website=informburo.kz |language=Russian}}&lt;/ref&gt; She start dey play sports give ein older sisto, Anna, from a very young age, originally focusing on gymnastics den ice skating.&lt;ref name=&quot;get-to-know&quot;&gt;{{cite web |last1=Nguyen |first1=Courtney |date=22 January 2020 |title=Getting to Know: Elena Rybakina's rocket rise |url=https://www.wtatennis.com/news/1584000/getting-to-know-elena-rybakina-s-rocket-rise |url-status=dead |archive-url=https://web.archive.org/web/20200222173244/https://www.wtatennis.com/news/1584000/getting-to-know-elena-rybakina-s-rocket-rise |archive-date=22 February 2020 |access-date=26 September 2020 |website=WTA Tennis}}&lt;/ref&gt;&lt;ref&gt;{{cite web |date=14 February 2020 |title=Elena Rybakina: I felt confident after winning the first set |url=http://lt.formulatx.com/en/blog/2020/02/14/elena-rybakina-uverennost-poyavilas-s-vyigryshem-pervogo-seta/ |url-status=dead |archive-url=https://web.archive.org/web/20220625040000/https://lt.formulatx.com/en/blog/2020/02/14/elena-rybakina-uverennost-poyavilas-s-vyigryshem-pervogo-seta/ |archive-date=25 June 2022 |access-date=27 September 2020 |website=Formula TX St. Petersburg Ladies' Trophy}}&lt;/ref&gt; Upon dem tell am say na she be too tall to become a professional insyd either of those sports, na ein poppie suggest she switch to tennis instead secof ein interest insyd de sport.&lt;ref&gt;{{Cite web |last=Rabiner |first=Igor |date=18 August 2022 |title=&quot;Just six months ago, Lena wanted to quit tennis.&quot; An interview with the father of Wimbledon champion Elena Rybakina. |url=https://www.sport-express.ru/tennis/wta/reviews/tennis-andrey-rybakin-otec-chempionki-uimbldona-eleny-rybakinoy-o-vystuplenii-za-kazahstan-i-rossii-kontrakte-ftr-i-ssha-1962750/ |access-date=2 January 2026 |website=Sport Express Russia}}&lt;/ref&gt; Rybakina begin dey play tennis at de age of six.&lt;ref name=&quot;get-to-know&quot; /&gt;

Rybakina move from de Dynamo Sports Club to de Spartak Tennis Club, wer na she get several accomplished coaches. She train plus former top-10 player [[Andrey Chesnokov]] den former top-100 player [[Evgenia Kulikovskaya]]. Na one of ei  fitness coaches be [[Irina Kiseleva]], a World Championship gold medallist insyd de modern pentathlon.&lt;ref name=&quot;ubi&quot;&gt;{{cite web |date=11 March 2020 |title=Elena Rybakina Is Really Special |url=https://www.ubitennis.net/2020/03/elena-rybakina-really-special/ |access-date=27 September 2020 |website=Ubi Tennis}}&lt;/ref&gt;&lt;ref&gt;{{cite web |date=19 October 2017 |title=Поколение Next. Елена Рыбакина |trans-title=Next Generation: Elena Rybakina |url=http://tennis-stars.ru/worldnews/pokolenie-next-elena-rybakina/ |url-status=dead |archive-url=https://web.archive.org/web/20220712172830/http://tennis-stars.ru/worldnews/pokolenie-next-elena-rybakina/ |archive-date=12 July 2022 |access-date=27 September 2020 |website=Tennis Stars |language=ru}}&lt;/ref&gt;&lt;ref name=&quot;spartak&quot;&gt;{{cite web |last1=Fagan |first1=Kate |date=9 January 2013 |title=From Russia, With Topspin |url=https://www.espn.com/espnw/news-commentary/story/_/id/8827683/espnw-russia-topspin |access-date=27 September 2020 |website=ESPN}}&lt;/ref&gt;

Na Rybakina no get individual training as a junior, instead practicing insyd a group of about eight players up til age 15 den a group of four players thru age 18. She sanso only play tennis about two hours per day wey she train insyd fitness for three hours a day. N ein time give tennis be limited in part secof she attend a regular high school wey no specialized for athletes wey she need to balance tennis plus schoolwork.&lt;ref name=&quot;school&quot;&gt;{{cite web |last1=Cox |first1=David |date=22 January 2020 |title=Elena Rybakina: Getting to know the 'anonymous' yet in-form No.29 seed |url=https://ausopen.com/articles/features/elena-rybakina-getting-know-anonymous-yet-form-no29-seed |access-date=27 September 2020 |website=Australian Open}}&lt;/ref&gt;

== Juniors ==
[[File:Osuigwe_and_Rybakina_shake_hands.png|left|thumb|Rybakina (right) den [[Whitney Osuigwe]] at de 2017 ITF Junior Masters]]
Rybakina be a former world No. 3 junior.&lt;ref name=&quot;itf-juniors&quot;&gt;{{cite web |title=Elena Rybakina Junior Singles Overview |url=https://www.itftennis.com/en/players/elena-rybakina/800365863/kaz/jt/s/overview/ |access-date=26 September 2020 |website=ITF Tennis}}&lt;/ref&gt; She begin dey play on de ITF Junior Circuit insyd November 2013 at de age of 14. De following March, she win ein first title at ein second career event, de Grade-3 Almetievsk Cup. She play ein first Grade-2 event insyd June at de Ozerov Cup insyd Moscow, finishing runner-up to compatriot [[Anna Blinkova]]. She begin dey play Grade-1 events from de start of 2015, buh na she no get any success til she reach de final at de Belgian International Junior Championships insyd May, losing to [[Katharina Hobgarski]].

Rybakina make ein junior-major debut later insyd de year at de [[2015 US Open (tennis)|US Open]], wer she reach de third round. Following an opening-round loss at de 2016 Australian Open, she win back-to-back Grade-1 titles. She continue to struggle at de junior Grand Slam den oda Grade-A events insyd singles for de rest of de year.&lt;ref name=&quot;itf-junior-singles&quot;&gt;{{cite web |title=Elena Rybakina Junior Singles Activity |url=https://www.itftennis.com/en/players/elena-rybakina/800365863/kaz/jt/s/activity/ |access-date=26 September 2020 |website=ITF Tennis}}&lt;/ref&gt; Ein best result of 2016 at de Grade A-events cam insyd doubles wen she fini runner-up to [[Olesya Pervushina]] den [[Anastasia Potapova]] at de Trofeo Bonfiglio, alongside [[Amina Anshba]] insyd an all-Russian final.&lt;ref name=&quot;itf-junior-doubles&quot;&gt;{{cite web |title=Elena Rybakina Junior Doubles Activity |url=https://www.itftennis.com/en/players/elena-rybakina/800365863/kaz/jt/d/activity/ |access-date=26 September 2020 |website=ITF Tennis}}&lt;/ref&gt;

Na de 2017 season be Rybakina ein last year on de junior tour. Insyd de middle of de season, she win ein first den only Grade-A title at de Trofeo Bonfiglio, defeating [[Iga Świątek]] insyd de final.&lt;ref name=&quot;:0&quot;&gt;{{cite web |date=28 May 2017 |title=Popyrin e Rybakina vincono il Trofeo Bonfiglio 2017 |trans-title=Popyrin and Rybakina win the Bonfiglio Trophy 2017 |url=https://www.spaziotennis.com/jnr/popyrin-e-rybakina-vincono-il-trofeo-bonfiglio-2017/49314 |access-date=26 September 2020 |website=Spazio Tennis |language=it}}&lt;/ref&gt; She sanso fare better at de Grand Slam events compared to previous years, losing insyd de semifinals of de Australian Open den de French Open to eventual champions [[Marta Kostyuk]] den [[Whitney Osuigwe]], respectively. She fini ein junior career at de first round-robin edition of de ITF Junior Masters, de junior counterpart to de WTA Finals. She win one match insyd ein round-robin group wey she fini insyd seventh place.&lt;ref name=&quot;itf-junior-singles&quot;&gt;{{cite web |title=Elena Rybakina Junior Singles Activity |url=https://www.itftennis.com/en/players/elena-rybakina/800365863/kaz/jt/s/activity/ |access-date=26 September 2020 |website=ITF Tennis}}&lt;/ref&gt;</text>
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  <page>
    <title>Masai Russell</title>
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      <comment>Created by translating the opening section from the page &quot;[[:en:Special:Redirect/revision/1372626317|Masai Russell]]&quot;</comment>
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      <text bytes="379" sha1="pkjnfirt7h2eux390owl3kdxa9tmqtd" xml:space="preserve">de [[2024 Summer Olympics]] insyd de 100&amp;nbsp;m hurdles event. Russell be de world record holder insyd de 100&amp;nbsp;m hurdles, running a time of 12.09 seconds on August 27, 2026.

In addition to ein world record, Russell dey hold personal bests of 7.74 seconds over de 60-meter hurdles, wich she tie for thirteenth-fastest of all time, den 54.66 seconds over de 400-meter hurdles.</text>
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      <comment>Created by translating the section &quot;Career&quot; from the page &quot;[[:en:Special:Redirect/revision/1374822190|Masai Russell]]&quot;</comment>
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      <text bytes="17294" sha1="4mde0bfuaxnqmhjd8mho3hfx4paof6f" xml:space="preserve">de [[2024 Summer Olympics]] insyd de 100&amp;nbsp;m hurdles event. Russell be de world record holder insyd de 100&amp;nbsp;m hurdles, running a time of 12.09 seconds on August 27, 2026.

In addition to ein world record, Russell dey hold personal bests of 7.74 seconds over de 60-meter hurdles, wich she tie for thirteenth-fastest of all time, den 54.66 seconds over de 400-meter hurdles.

== Career ==
Insyd 2021, Russell run ein first sub-13s 100 m hurdles in placing second insyd ein heat at de SEC Championships. She go on to place sixth insyd de final.&lt;ref name=&quot;WAprofile&quot;&gt;{{cite web |title=Masai RUSSELL - Athlete Profile |url=https://worldathletics.org/athletes/united-states/masai-russell-14659011 |access-date=November 9, 2024 |website=[[World Athletics]]}}&lt;/ref&gt; Later dat year, Russell run 12.93s to make de final of de NCAA Division I Championships, wer she fini sixth. She sanso place fourth insyd de 400 meter hurdles plus a time of 56.18s, a personal best at de time.&lt;ref&gt;[https://dt8v5llb2dwhs.cloudfront.net/Outdoor/2021/029-2_compiled.htm &quot;Results: Women 100 M Hurdles (Final)&quot;]. &lt;/ref&gt;&lt;ref&gt;[https://dt8v5llb2dwhs.cloudfront.net/Outdoor/2021/030-2_compiled.htm &quot;Results: Women 400 M Hurdles (Final)&quot;]. &lt;/ref&gt;&lt;ref&gt;{{Cite web |last=Most |first=Jake |date=June 12, 2021 |title=Masai Russell, Faith Ross, Celera Barnes, 4×400 Relay Tally at NCAA Track and Field Championships |url=https://ukathletics.com/news/2021/06/12/womens-track-field-masai-russell-faith-ross-celera-barnes-4x400-relay-tally-at-ncaa-track-and-field-championships/ |access-date=August 28, 2026 |website=UK Athletics |language=en-US}}&lt;/ref&gt;

At de 2022 NCAA Division I Outdoor Championships, Russell place third insyd de 100 m hurdles den fourth insyd de 400 m hurdles.&lt;ref name=&quot;WAprofile&quot;&gt;{{cite web |title=Masai RUSSELL - Athlete Profile |url=https://worldathletics.org/athletes/united-states/masai-russell-14659011 |access-date=November 9, 2024 |website=[[World Athletics]]}}&lt;/ref&gt;

Insyd 2023, Russell break de collegiate record for de 60 m hurdles, running 7.75s to beat [[Grace Stark]] ein time of 7.78s set de year before.&lt;ref&gt;{{cite web |date=January 20, 2023 |title=Masai Russell Breaks Collegiate Record in 60-Meter Hurdles |url=https://ukathletics.com/news/2023/01/20/masai-russell-breaks-collegiate-record-in-60-meter-hurdles/ |access-date=November 9, 2024 |website=Kentucky Athletics}}&lt;/ref&gt;&lt;ref&gt;{{Cite news|date=January 22, 2023|title=Strong start to World Indoor Tour, Russell and Alfred make early season statements|url=https://worldathletics.org/competitions/world-athletics-indoor-tour/news/world-indoor-tour-russell-alfred|url-status=live|archive-url=https://web.archive.org/web/20230130183544/https://worldathletics.org/competitions/world-athletics-indoor-tour/news/world-indoor-tour-russell-alfred|archive-date=January 30, 2023|access-date=January 30, 2023|publisher=World Athletics}}&lt;/ref&gt; Insyd April, she run a collegiate/NCAA record of 12.36s over 100&amp;nbsp;m hurdles at de Texas Relays.&lt;ref&gt;{{cite web |date=April 2, 2023 |title=Russell breaks collegiate 100m hurdles record at Texas Relays |url=https://worldathletics.org/news/report/texas-relays-masai-russell |access-date=November 9, 2024 |website=[[World Athletics]]}}&lt;/ref&gt;&lt;ref&gt;{{cite web |date=April 1, 2023 |title=L'Américaine Masai Russell démarre fort aux Texas Relays |trans-title=American Masai Russell starts strong at Texas Relays |url=https://www.lequipe.fr/Athletisme/Actualites/L-americaine-masai-russell-demarre-fort-aux-texas-relays/1389256 |access-date=July 10, 2023 |work=[[L'Équipe]] |language=fr}}&lt;/ref&gt; Insyd June, she place second insyd both de 100&amp;nbsp;m hurdles den 400&amp;nbsp;m hurdles at de 2023 NCAA Division I Outdoor Championships.&lt;ref&gt;{{cite web |title=Women 100 M Hurdles (Final) |url=https://flashresults.ncaa.com/Outdoor/2023/029-2_compiled.htm |access-date=November 9, 2024 |website=flashresults.ncaa.com}}&lt;/ref&gt;&lt;ref&gt;{{cite web |title=Women 400 M Hurdles (Final) |url=https://flashresults.ncaa.com/Outdoor/2023/030-2_compiled.htm |access-date=November 9, 2024 |website=flashresults.ncaa.org}}&lt;/ref&gt; After de conclusion of de 2023 NCAA season, Russell turn professional.&lt;ref&gt;{{Cite web |date=December 11, 2024 |title=Masai Russell: A look at historic debut that won her USATF's 2024 Breakthrough Performer |url=https://www.pulsesports.co.ke/story/masai-russell-a-look-at-historic-debut-that-won-her-usatfs-2024-breakthrough-performer-2024121011460783286 |access-date=August 27, 2026 |website=Pulse Sports Kenya |language=en}}&lt;/ref&gt; At de 2023 USA Outdoor Championships, Russell fini third qualifying to represent de United States at de World Championships insyd Budapest.&lt;ref&gt;{{cite web |date=July 8, 2023 |title=Masai Russell Qualifies For World Championships, Sydney McLaughlin-Levrone Wins 400m National Championship |url=https://ukathletics.com/news/2023/07/08/masai-russell-qualifies-for-world-championships-sydney-mclaughlin-levrone-wins-400m-national-championship/ |access-date=November 9, 2024 |website=Kentucky Athletics}}&lt;/ref&gt; She make de semi-finals, buh na she no fini der after hitting a hurdle.&lt;ref&gt;{{cite web |last=Chawla |first=Harshita |date=August 24, 2023 |title=US Collegiate Record Holder in 100m Hurdles Faces Upsetting Fate at World Athletics Championship 2023 |url=https://www.essentiallysports.com/us-sports-news-olympics-news-track-and-field-news-us-collegiate-record-holder-in-m-hurdles-faces-upsetting-fate-at-world-athletics-championship-2023/ |access-date=November 9, 2024 |website=Essentially Sports}}&lt;/ref&gt;

[[File:Masai_Russell_at_the_2024_United_States_Olympic_trials.jpg|left|thumb|Russell at de 2024 United States Olympic trials]]
Russell fini fourth insyd de 60 m hurdles at de 2024 World Indoor Championships.&lt;ref&gt;{{cite web |last=Rowbottom |first=Mike |date=March 3, 2024 |title=Charlton lowers world 60m hurdles record to 7.65 for global gold in Glasgow |url=https://worldathletics.org/competitions/world-athletics-indoor-championships/world-athletics-indoor-championships-7180312/news/report/glasgow-24-women-60m-hurdles-report |access-date=November 9, 2024 |website=[[World Athletics]]}}&lt;/ref&gt; Insyd April 2024, she sign a sponsorship deal plus Nike after previously na she sign plus Gymshark.&lt;ref&gt;{{Cite web |last=Rout |first=Abhiruchi |date=April 15, 2024 |title=NCAA 100m hurdles record holder Masai Russell signs sponsorship deal with Nike |url=https://www.sportskeeda.com/us/olympics/news-ncaa-100m-hurdles-record-holder-masai-russell-signs-sponsorship-deal-nike |access-date=August 27, 2026 |website=Sportskeeda |language=en-us}}&lt;/ref&gt;&lt;ref&gt;{{Cite web |date=October 12, 2024 |title='Why should I care? - Masai Russell on the challenges of competing without a sponsor |url=https://www.pulsesports.co.ke/story/why-should-i-care-masai-russell-on-the-challenges-of-competing-without-a-sponsor-2024101211513949540 |access-date=August 27, 2026 |website=Pulse Sports Kenya |language=en}}&lt;/ref&gt; She place first at de 2024 U.S. Olympic Trials insyd de 100 m hurdles insyd a personal best time of 12.25 to qualify am for de [[2024 Summer Olympics]] insyd Paris.&lt;ref&gt;{{cite news|url=https://www.mymcmedia.org/potomacs-masai-russell-qualifies-for-olympics-after-breaking-trial-records/|title=Potomac’s Masai Russell Qualifies for Olympics After Breaking Trials Record|website=mymcm|last=Etta|first=Devin|date=July 1, 2024|access-date=November 9, 2024}}&lt;/ref&gt; At de Olympics, Russell win gold plus a time of 12.33s, narrowly beating [[Cyréna Samba-Mayela]].&lt;ref&gt;{{cite web |last=de Villiers |first=Ockert |date=August 10, 2024 |title=Paris 2024 athletics: USA's Masai Russell wins maiden Olympic 100m hurdles gold medal in photo finish |url=https://olympics.com/en/news/masai-russell-wins-maiden-olympic-100m-hurdles-gold-medal-in-photo-finish |access-date=November 9, 2024 |website=olympics.com |publisher=[[International Olympic Committee|IOC]]}}&lt;/ref&gt;&lt;ref&gt;{{cite web |last=Turnbull |first=Simon |date=October 19, 2024 |title=Russell's Olympic title win launches legacy in the making |url=https://worldathletics.org/women-in-athletics/news/masai-russell-usa-100m-hurdles-paris-olympic-games |access-date=November 9, 2024 |website=[[World Athletics]]}}&lt;/ref&gt; Insyd September 2024, na dem announce say Russell sign up for de inaugural season of de Michael Johnson-founded Grand Slam Track.&lt;ref&gt;{{cite web |title=Entire Olympic 100m hurdles podium signs for Grand Slam Track |url=https://athleticsweekly.com/athletics-news/entire-olympic-100m-hurdles-podium-signs-for-grand-slam-track-1039992969/ |accessdate=December 20, 2024 |publisher=Athletics Weekly}}&lt;/ref&gt; She end ein 2024 season by finishing third at de inaugural Athlos meet.&lt;ref&gt;{{cite web |last=Dredge |first=Mark |date=September 27, 2024 |title=ATHLOS 2024: An Incredible Night Of Women’s Track Racing in NYC |url=https://therunningchannel.com/athlos-nyc-2024/ |access-date=November 9, 2024 |website=[[The Running Channel]]}}&lt;/ref&gt;

On May 2, 2025, she run de 100-meter hurdles insyd a time of 12.17 seconds, an American record, at de 2025 Miami Grand Slam meet.&lt;ref&gt;{{Cite web |last=Geoghegan |first=Zack |date=May 4, 2025 |title=Former Kentucky track star Masai Russell has made American history |url=https://www.on3.com/teams/kentucky-wildcats/news/former-kentucky-track-star-masai-russell-has-made-american-history/ |accessdate=May 4, 2025 |website=On3}}&lt;/ref&gt;&lt;ref name=&quot;:2&quot;&gt;{{Cite web |date=May 3, 2025 |title=Russell and Jones jump to No.2 and No.3 all time in historic hurdles clash in Miami |url=https://worldathletics.org/news/report/russell-jones-100m-hurdles-miami-grand-slam-track |access-date=May 3, 2025 |website=[[World Athletics]]}}&lt;/ref&gt; On July 5, she run to fourth place at de 2025 Prefontaine Classic.&lt;ref&gt;{{Cite web |last=Zaccardi |first=Nick |date=July 5, 2025 |title=2025 Prefontaine Classic Results |url=https://www.nbcsports.com/olympics/news/prefontaine-classic-results-2025 |access-date=August 27, 2026 |website=NBC Sports |language=en-US}}&lt;/ref&gt; On August 2, she compete insyd de 2025 USA Outdoor Track and Field Championships wey she win de gold medal plus a time of 12.22 seconds.&lt;ref&gt;{{Cite news|last=Ellis|first=R.R.|date=August 3, 2025|title=Here's What Happened On Day 3 Of The USATF Championships - FloTrack|url=https://www.flotrack.org/articles/14443875-heres-what-happened-on-day-3-of-the-usatf-championships|access-date=August 27, 2026|work=FloTrack|language=en-US}}&lt;/ref&gt;&lt;ref&gt;{{Cite web |date=August 3, 2025 |title=Here Are the Results from the 2025 USATF Championships |url=https://www.runnersworld.com/news/a65564334/usatf-championships-results-2025/ |access-date=August 27, 2026 |website=Runner's World |language=en-US}}&lt;/ref&gt; At de 2025 World Athletics Championships, Russell win both ein heat den semi-final race buh she only fini fourth insyd de final.&lt;ref&gt;{{Cite web |last=Majendie |first=Matt |date=September 15, 2025 |title=Kambundji shocks in Tokyo as Swiss peaks to take 100m hurdles gold |url=https://worldathletics.org/competitions/world-athletics-championships/world-athletics-championships-tokyo-2025-7190593/news/report/world-championships-tokyo-25-report-womens-100m-hurdles |access-date=August 27, 2026 |website=World Athletics}}&lt;/ref&gt;&lt;ref&gt;{{Cite web |last=Kano |first=Shintaro |date=September 15, 2025 |title=World Athletics Championships Tokyo 2025: Surprise, surprise - Ditaji Kambundji comes out of nowhere to win women's 100m hurdles gold |url=https://www.olympics.com/en/news/world-athletics-championships-2025-women-100-hurdles-final-results |access-date=August 27, 2026 |website=Olympics}}&lt;/ref&gt; She end de season with winning de 2025 Athlos meet for de 100&amp;nbsp;m hurdles plus a wind-assisted 12.52 seconds.&lt;ref&gt;{{Cite web |date=October 11, 2025 |title=Brown, Davis-Woodhall and Hodgkinson shine at Athlos |url=https://worldathletics.org/news/report/athlos-nyc-2025-brown-davis-woodhall-hodgkinson |access-date=August 27, 2026 |website=World Athletics}}&lt;/ref&gt;

[[File:Masai_Russell_(USA)_DSC00109.jpg|left|thumb|Russell after breaking de 100 metres hurdles world record at de 2026 Weltklasse Zürich]]
Insyd May 2026, Russell further improve on ein personal best to 12.14 seconds after winning de event at de Xiamen Diamond League.&lt;ref&gt;{{Cite web |date=May 23, 2026 |title=Xiamen Diamond League - 100m Hurdles Women Results |url=https://ath-wdl-archive.azureedge.net/2026/xiamen/ATHW100MHURDDIAMOND---FNL-000100--_C73B1_1.0.PDF |url-status=live |archive-url=https://web.archive.org/web/20260523145832/https://ath-wdl-archive.azureedge.net/2026/xiamen/ATHW100MHURDDIAMOND---FNL-000100--_C73B1_1.0.PDF |archive-date=May 23, 2026 |access-date=May 23, 2026 |website=[[World Athletics]]}}&lt;/ref&gt;&lt;ref&gt;{{Cite web |last=Goulding |first=Grace |last2=Nelsen |first2=Matt |date=July 3, 2026 |title=Exclusive: Paris 2024 hurdles Olympic champion Masai Russell: &quot;It's not a secret that I'm on world-record watch&quot; |url=https://www.olympics.com/en/news/masai-russell-hurdles-world-record-watch-eugene-diamond-league |access-date=August 27, 2026 |website=Olympics}}&lt;/ref&gt; On June 24, 2026, Russell compete insyd de Los Angeles Grand Prix insyd de 100 meter hurdles wey she win plus a time of 12.26 seconds.&lt;ref&gt;{{Cite web |date=May 15, 2026 |title=11 Reigning World and Olympic Champions Headline the LA Grand Prix |url=https://usatf.org/news/2026/11-reigning-world-and-olympic-champions-headline-t |access-date=August 27, 2026 |website=USATF}}&lt;/ref&gt;&lt;ref&gt;{{Cite web |date=June 11, 2026 |title=Olympic champions Rogers and Russell face tough opposition at Los Angeles Grand Prix |url=https://worldathletics.org/competitions/world-athletics-continental-tour/news/rogers-russell-los-angeles-grand-prix-2026 |access-date=August 27, 2026 |website=World Athletics}}&lt;/ref&gt;&lt;ref&gt;{{Cite web |date=June 13, 2026 |title=USATF LA Grand Prix {{!}} Results |url=https://worldathletics.org/competition/calendar-results/results/7233063?eventId=10229522&amp;gender=W |access-date=August 27, 2026 |website=World Athletics}}&lt;/ref&gt; On July 4, she win de same event at de 2026 Prefontaine Classic plus a time of 12.24, equaling a meet record.&lt;ref&gt;{{Cite web |date=July 4, 2026 |title=Records fall as top-class clashes light up Eugene |url=https://worldathletics.org/competitions/diamond-league/news/prefontaine-classic-eugene-2026-britt-russell-hiltz-taylor |access-date=August 27, 2026 |website=World Athletics}}&lt;/ref&gt;

On August 27, 2026, Russell win de 100&amp;nbsp;m hurdles insyd de 2026 Zürich Diamond League plus a world record time of 12.09 seconds, one of two world records set at dat meet.&lt;ref&gt;{{Cite web |last=Imbo |first=Will |date=August 27, 2026 |title=Masai Russell breaks women's 100m hurdles world record with 12.09 at 2026 Zurich Diamond League |url=https://www.olympics.com/en/news/masai-russell-100m-hurdles-world-record-zurich |access-date=August 27, 2026 |website=Olympics}}&lt;/ref&gt;&lt;ref&gt;{{Cite web |last=Zaccardi |first=Nick |date=August 27, 2026 |title=Masai Russell breaks 100m hurdles world record in Zurich |url=https://www.nbcsports.com/olympics/news/masai-russell-world-record-100-meter-hurdles |access-date=August 27, 2026 |website=NBC Sports |language=en-US}}&lt;/ref&gt;&lt;ref&gt;{{Cite web |last=Nassuna |first=Margaret |date=August 27, 2026 |title=Masai Russell Sets 100m World Record At Diamond League Zurich |url=https://www.flotrack.org/articles/16147788-masai-russell-sets-100m-world-record-at-diamond-league-zurich |access-date=August 27, 2026 |website=FloTrack |language=en}}&lt;/ref&gt; Dis break de previous record time of 12.12s by [[Tobi Amusan]] back insyd 2022.&lt;ref&gt;{{Cite web |last=Fasetire |first=Sam O'Femi |date=August 28, 2026 |title=Tobi Amusan Takes Consolation From Season's Best Time, After Losing World Record To USA's Masai Russell |url=https://www.sports247.ng/tobi-amusan-takes-consolation-from-seasons-best-time-after-losing-world-record-to-usas-masai-russell/ |access-date=August 28, 2026 |website=Sports247 Nigeria |language=en-US}}&lt;/ref&gt;&lt;ref&gt;{{Cite web |last=Nwoke |first=Chidi Uduma |date=August 28, 2026 |title=Masai Russell Breaks Tobi Amusan’s 100m Hurdles World Record |url=https://von.gov.ng/masai-russell-claims-tobi-amusans-100m-hurdles-world-record/ |access-date=August 28, 2026 |website=Voice of Nigeria |language=en-US}}&lt;/ref&gt; De victory mark ein 11th consecutive win insyd de event. Reflecting on ein performance, Russell suggest say na a stronger tailwind fi push am under de 12-second barrier. &quot;''If we get a 1.9 wind behind my back, that could have been a sub-12 race'',&quot; she note, dey add, &quot;''Everything that I’ve said that I wanted to do has come into fruition, so why not say I think I can be the first one to run sub-12?''&quot;&lt;ref&gt;{{Cite web |last=Goh |first=ZK |date=August 28, 2026 |title=Masai Russell goes from 'taking the Ls' to world record holder and now wants sub-12: &quot;I don't know what is possible at this point&quot; |url=https://www.olympics.com/en/news/masai-russell-world-record-holder-sub-12-sights-100m-hurdles |access-date=August 28, 2026 |website=Olympics}}&lt;/ref&gt;&lt;ref&gt;{{Cite web |last= |date=August 27, 2026 |title=Masai Russell Runs 12.09 World Record as Her Perfect Season Continues in the 100m hurdles |url=https://www.letsrun.com/news/2026/08/masai-russell-runs-12-09-world-record-as-her-perfect-season-continues-in-the-100m-hurdles/ |access-date=August 28, 2026 |website=LetsRun.com |language=en}}&lt;/ref&gt;</text>
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  <page>
    <title>Alison dos Santos</title>
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      <text bytes="686" sha1="fj5lks3uuvd2pmrkugmapsw945iw662" xml:space="preserve">'''Alison Brendom Alves dos Santos''' (born 3 June 2000) be a Brazilian hurdler den sprinter wey dey specialise insyd de 400 metres hurdles. Competing insyd de 400 metres hurdles, he be de 2022 World Champion wey he win de bronze medal at de 2020 den 2024 Summer Olympics. On 27 August 2026, dos Santos break de world record insyd de event plus a time of 45.80 seconds.

In addition to ein world record, dos Santos dey hold de South American under-20 record insyd de 400 metres hurdles den de world best insyd de rarely run 200 metres hurdles. A gold medalist at de Pan American Games den South American Championships insyd 2019, na he sanso be de 2022 den 2024 Diamond League champion.</text>
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      <text bytes="7131" sha1="7xutw992agdhaeb01b7iqrjiead39u2" xml:space="preserve">'''Alison Brendom Alves dos Santos''' (born 3 June 2000) be a Brazilian hurdler den sprinter wey dey specialise insyd de 400 metres hurdles. Competing insyd de 400 metres hurdles, he be de 2022 World Champion wey he win de bronze medal at de 2020 den 2024 Summer Olympics. On 27 August 2026, dos Santos break de world record insyd de event plus a time of 45.80 seconds.

In addition to ein world record, dos Santos dey hold de South American under-20 record insyd de 400 metres hurdles den de world best insyd de rarely run 200 metres hurdles. A gold medalist at de Pan American Games den South American Championships insyd 2019, na he sanso be de 2022 den 2024 Diamond League champion.

== Early life ==
Dem born Dos Santos on 3 June 2000 insyd São Joaquim da Barra, São Paulo, Brazil, to poppie Gerson dem mommie Sueli.&lt;ref&gt;{{Cite web |last=Webrun |first=Redação |date=3 August 2021 |title=Alison dos Santos faz história e conquista o bronze nos Jogos de Tóquio |url=https://www.webrun.com.br/alison-dos-santos-faz-historia-e-conquista-o-bronze-nos-jogos-de-toquio/ |access-date=29 September 2023 |website=Webrun {{!}} Corrida, saúde, qualidade de vida |language=pt-BR}}&lt;/ref&gt;&lt;ref name=&quot;:0&quot;&gt;{{Cite web |date=3 August 2021 |title=Mãe de Alison dos Santos diz que atletismo o ajudou a vencer timidez |url=https://www.uol.com.br/esporte/olimpiadas/ultimas-noticias/2021/08/03/mae-de-alison-dos-santos-diz-que-atletismo-o-ajudou-a-vencer-timidez.htm |access-date=27 September 2023 |website=UOL |language=pt-br}}&lt;/ref&gt; Dos Santos get three sistos dem name Drieli, Andrieli, den Anieli. Ein parents later separate.&lt;ref name=&quot;:5&quot;&gt;{{Cite web |last=Gabriel |first=João |last2=Santos |first2=Bruno |date=4 August 2021 |title=Na infância, Alison dos Santos era 'Teco' e teve de superar timidez para entrar no atletismo |url=https://www1.folha.uol.com.br/esporte/2021/08/na-infancia-alison-dos-santos-era-teco-e-teve-de-superar-timidez-para-entrar-no-atletismo.shtml |access-date=27 September 2023 |website=Folha de S.Paulo |language=pt-BR}}&lt;/ref&gt;

At 10 months old, while spending time at ein grandparents dema home, dos Santos suffer third-degree burns after accidentally tipping over a pan of hot oil, wich ein grandmommie prepare to fry fish; she sanso suffer severe burns wen trying to intervene. Dem rush Dos Santos to hospital by ein grandpoppie, wer he go stay for de next four months. De incident lef am plus visible scars on ein forehead, scalp, face, chest, den left arm.&lt;ref name=&quot;:5&quot;&gt;{{Cite web |last=Gabriel |first=João |last2=Santos |first2=Bruno |date=4 August 2021 |title=Na infância, Alison dos Santos era 'Teco' e teve de superar timidez para entrar no atletismo |url=https://www1.folha.uol.com.br/esporte/2021/08/na-infancia-alison-dos-santos-era-teco-e-teve-de-superar-timidez-para-entrar-no-atletismo.shtml |access-date=27 September 2023 |website=Folha de S.Paulo |language=pt-BR}}&lt;/ref&gt;&lt;ref&gt;{{cite web |last=Pells |first=Eddie |date=16 September 2025 |title=A burn victim as a child, Brazilian hurdler dos Santos explains how track helped save his life |url=https://apnews.com/article/hurdles-dos-santos-track-worlds-brazil-f6781f190183e03c7585aa6487e5e0cd |access-date=27 August 2026 |website=The Associated Press}}&lt;/ref&gt; He dey wear a cap anaa hat on ein head during training to protect de area from de sun.&lt;ref name=&quot;:3&quot;&gt;{{Cite web |last=Mulkeen |first=Jon |date=2 January 2020 |title=Now established among world elite, Dos Santos relishes first season as a senior |url=https://worldathletics.org/competitions/world-athletics-continental-tour/news/alison-dos-santos-brazil-400m-hurdles?competitionGroup=world-athletics-continental-tour&amp;articleUrlSlug=alison-dos-santos-brazil-400m-hurdles |access-date=27 September 2023 |website=World Athletics}}&lt;/ref&gt; 

Na Dos Santos be shy growing up, partly secof ein scars, wey he stay insyd ein room alone til he start to become involved insyd sports.&lt;ref name=&quot;:0&quot;&gt;{{Cite web |date=3 August 2021 |title=Mãe de Alison dos Santos diz que atletismo o ajudou a vencer timidez |url=https://www.uol.com.br/esporte/olimpiadas/ultimas-noticias/2021/08/03/mae-de-alison-dos-santos-diz-que-atletismo-o-ajudou-a-vencer-timidez.htm |access-date=27 September 2023 |website=UOL |language=pt-br}}&lt;/ref&gt;&lt;ref name=&quot;:6&quot;&gt;{{Cite news|last=Watta|first=Evelyn|date=9 March 2022|title=Olympic bronze medallist Alison dos Santos: 'We are not seeing history, we are making history.'|work=Olympics|url=https://olympics.com/en/news/alison-dos-santos-brazil-move-training-400m-hurdles-warholm}}&lt;/ref&gt; As a kiddie, he practise judo from age six to fourteen. Although he love judo, de high cost associated plus each training session cause am to abandon am. A kiddie time paddie soon convince am to switch to athletics.&lt;ref name=&quot;:5&quot;&gt;{{Cite web |last=Gabriel |first=João |last2=Santos |first2=Bruno |date=4 August 2021 |title=Na infância, Alison dos Santos era 'Teco' e teve de superar timidez para entrar no atletismo |url=https://www1.folha.uol.com.br/esporte/2021/08/na-infancia-alison-dos-santos-era-teco-e-teve-de-superar-timidez-para-entrar-no-atletismo.shtml |access-date=27 September 2023 |website=Folha de S.Paulo |language=pt-BR}}&lt;/ref&gt; Dos Santos begin athletics insyd 2013 at Pedro Badran State Technical School (ETEC) wey na he be coached by Ana Fidélis.&lt;ref name=&quot;:3&quot;&gt;{{Cite web |last=Mulkeen |first=Jon |date=2 January 2020 |title=Now established among world elite, Dos Santos relishes first season as a senior |url=https://worldathletics.org/competitions/world-athletics-continental-tour/news/alison-dos-santos-brazil-400m-hurdles?competitionGroup=world-athletics-continental-tour&amp;articleUrlSlug=alison-dos-santos-brazil-400m-hurdles |access-date=27 September 2023 |website=World Athletics}}&lt;/ref&gt;&lt;ref name=&quot;:6&quot; /&gt; Within months, na he no longer do athletics out of a financial need buh secof he truly enjoy am wey he even make paddies thru out de city, states, den country. At de age of 16, na he already dey compete among adults.&lt;ref name=&quot;:4&quot;&gt;{{cite web |last=Ramos |first=Raphael |date=2 August 2021 |title=Conheça Alison dos Santos, vítima de acidente doméstico aos 10 meses, e medalha de bronze em Tóquio |url=https://www.terra.com.br/esportes/jogos-olimpicos/conheca-alison-dos-santos-vitima-de-acidente-domestico-aos-10-meses-e-medalha-de-bronze-em-toquio,e27944ceeb9eda45c9a26e69b7ffc487vht01wlo.html |accessdate=18 May 2022 |website=Terra |language=pt}}&lt;/ref&gt; Dos Santos earn de nickie &quot;Piu&quot; early insyd ein career. Explaining de nickie ein origin, he recount joining a local athletics project one week after de departure of a different athlete. Dis athlete resemble a homeless man dem name Piu known to people insyd São Joaquim da Barra, so teammates jokingly decide to call dos Santos by de same name.&lt;ref&gt;{{cite web |date=9 August 2024 |title=Por que Alison dos Santos, do atletismo, é chamado de 'Piu'? |trans-title=Why is Alison dos Santos, from athletics, called 'Piu'? |url=https://www.espn.com.br/olimpiadas/artigo/_/id/14017451/por-que-alison-dos-santos-do-atletismo-e-chamado-de-piu |access-date=27 August 2026 |website=ESPN |language=pt-BR}}&lt;/ref&gt;</text>
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  <page>
    <title>Category:Muscular dystrophy</title>
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  <page>
    <title>Neurosyphilis</title>
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      <comment>Created by translating the page [[:mdwiki:Special:Redirect/revision/1503643|Neurosyphilis]] to:gpe #mdwikicx</comment>
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[[Category:Translated from MDWiki]]</text>
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      <comment>Improve article</comment>
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      <text bytes="702" sha1="g0yiwbeuww59jd3w7ec0yypb0me382y" xml:space="preserve">{{Databox}}
'''Neurosyphilis''' be de infection of de central nervous system by ''Treponema pallidum'', de bacterium wey dey cause de [[sexually transmitted infection]] [[syphilis]]. Insyd de era of modern antibiotics, de majority of neurosyphilis cases be reported insyd HIV-infected patients.&lt;ref name=&quot;:2&quot;&gt;{{Cite web |last=CDC |date=November 7, 2024 |title=National Overview of STIs in 2023 |url=https://www.cdc.gov/sti-statistics/annual/summary.html#:~:text=As%20in%20past%20years,%20there,Alaska%20Native%20persons%20in%202023. |access-date=January 16, 2025 |website=STI Statistics |language=en-us}}&lt;/ref&gt;

== References ==
[[Category:Translated from MDWiki]]

&lt;references /&gt;

== External links ==</text>
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    <title>Category:Soccer players wey komot South Carolina</title>
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      <comment>Fresh category</comment>
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    <title>Category:Sportspeople wey komot Sumter, South Carolina</title>
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      <comment>Fresh category</comment>
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    <title>Category:California lawyers</title>
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      <timestamp>2026-09-14T23:55:54Z</timestamp>
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    <title>Category:San Jose CyberRays players</title>
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