The Dominican Republic has been battling a cholera outbreak for two years this month. In 2012 alone, Dominican health officials have reported more than 6,600 cholera cases, including 47 fatalities.
Because of these large numbers, the Centers for Disease Control and Prevention (CDC) issued an outbreak notice for travelers to this part of Hispaniola on Nov. 28.
Neighboring Haiti has seen well over a half million cases since the outbreak began in Oct. 2010.
Cholera is an acute bacterial intestinal disease characterized by sudden onset, profuse watery stools (given the appearance as rice water stools because of flecks of mucus in water) due to a very potent enterotoxin. The enterotoxin leads to an extreme loss of fluid and electrolytes in the production of diarrhea. It has been noted that an untreated patient can lose his bodyweight in fluids in hours resulting in shock and death.
It is caused by the bacterium, Vibrio cholerae. Serogroups O1 and O139 are the types associated with the epidemiological characteristics of cholera (outbreaks).
The bacteria are acquired through ingestion of contaminated water or food through a number of mechanisms. Water is usually contaminated by the feces of infected individuals.
Drinking water can be contaminated at the source, during transport or during storage at home.
Food can be contaminated by soiled hands, during preparation or while eating.
Beverages and ice prepared with contaminated water and fruits and vegetables washed with this water are other examples. Some outbreaks are linked to raw or undercooked seafood.
The incubation for cholera can be from a few hours to 5 days. As long as the stools are positive, the person is infectious. Some patients may become carriers of the organism which can last for months.
Cholera is diagnosed by growing the bacteria in culture. Treatment consists of replacement of fluids lost, intravenous replacement in severe cases. Doxycycline or tetracycline antibiotic therapy can shorten the course of severe disease.
The CDC says, although the risk of contracting cholera in the Dominican Republic is not high, health officials say that travelers to the country take precautions to avoid getting sick.
They recommend seeing your physician or a travel medicine specialist prior to traveling to see if a prescription for antibiotics is in order.
In addition, they recommend a travel health kit.
They recommend the following actions to protect yourself from contracting cholera and other food and water borne pathogens while in the Dominican Republic:
1) Drink and use safe water
2) Wash your hands often with soap and safe water
3) Use toilets; do not defecate in any body of water
4) Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables
5) Clean up safely—in the kitchen and in places where the family bathes and washes clothes
See the CDC travel notice for more details.
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