Cholera in Cuba
This information is current as of today, July 27, 2012 at 17:00 EDT
Released: July 27, 2012
What Is the Current Situation?
The Cuban Ministry of Health has confirmed the first cholera outbreak in Cuba in more than a century. One hundred thirty-seven confirmed cases and 3 deaths have been reported in Granma province in the cities of Manzanillo, Bayamo, Yara, and Campechuela Niquero. Currently, cases are limited to Granma Province, mostly in Manzanillo. According to the Cuban Ministry of Public Health, control measures have been implemented including ensuring that water is safe for drinking, implementation of environmental sanitation measures and public awareness campaigns. The Pan American Health Organization (PAHO) (PDF) is also closely monitoring this situation.
Most travelers are not at high risk of getting cholera. However, travelers to an area with a known outbreak should take steps to avoid getting sick. (See below.) The vaccine to prevent cholera is not available in the United States.
What Is Cholera?
Cholera is a bacterial disease that can cause diarrhea and dehydration. Cholera is most often spread through the ingestion of contaminated food or drinking water. Water may be contaminated by the feces of an infected person or by untreated sewage. Food can be contaminated by water containing cholera bacteria or by being handled by a person ill with cholera.
How Can Travelers Protect Themselves?
Travelers can prevent cholera by following these 5 basic steps:
- Drink and use safe water.*
- Bottled water with unbroken seals and canned or bottled carbonated beverages are safe to drink and use.
- Use safe water to brush your teeth, wash and prepare food, and make ice.
- Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse.
*Piped water sources, drinks sold in cups or bags, or ice may not be safe. All drinking water and water used to make ice should be boiled or treated with chlorine.
To be sure water is safe to drink and use:
- Boil it or treat it with water purification tablets, a chlorine product, or household bleach.
- Bring your water to a complete boil for at least 1 minute.
- To treat your water, use water purification tablets—brought with you from the United States or a locally available treatment product—and follow the instructions.
- If a chlorine treatment product is not available, you can treat your water with household bleach. Add 8 drops of household bleach for every 1 gallon of water (or 2 drops of household bleach for every 1 liter of water) and wait 30 minutes before drinking.
- Always store your treated water in a clean, covered container.
- Wash your hands often with soap and safe water.*
- Before you eat or prepare food
- Before feeding your children
- After using the bathroom
- After changing diapers
- After taking care of someone ill with diarrhea
* If no soap is available, use an alcohol-based hand sanitizer (containing at least 60% alcohol).
- Use toilets; do not defecate in any body of water.
- Use toilets, latrines, or other sanitation systems, such as chemical toilets, to dispose of feces.
- Wash hands with soap and safe water after using the bathroom.
- Clean toilets and surfaces contaminated with feces by using a solution of 1 part household bleach to 9 parts water.
- Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables.*
- Boil it, cook it, peel it, or leave it.
- Be sure to cook shellfish (such as crabs and crayfish) until they are very hot all the way through.
- Do not bring perishable seafood back to the United States.
*Avoid raw foods other than fruits and vegetables you have peeled yourself.
- Clean up safely—in the kitchen and in places where the family bathes and washes clothes
- Wash yourself, your children, diapers, and clothes at least 30 meters away from drinking water sources.
Clinicians should obtain a travel history from their patients. Cholera infection is most often asymptomatic or results in mild gastroenteritis. Severe cholera is characterized by acute, profuse watery diarrhea, described as “rice-water stools” and often vomiting leading to volume depletion. Cholera is confirmed through culture of a stool specimen or rectal swab. Cary-Blair medium is ideal for transport, and the selective thiosulfate-citrate-bile salts agar is ideal for isolation and identification. Rehydration is the best treatment. Oral rehydration salts are used and intravenous fluids are used when necessary. For more information, see CDC Health Information for International Travel 2012.
Commentary: It is sad to see that infectious diseases thought to be virtually extinct are reappearing in many parts of the globe. It also makes the job of a travel health physician that much more challenging!