Clinical features: Cholera is an acute gastrointestinal infection caused by Vibrio cholera organisms El Tor and V. cholera). In Tanzania only the El Tor occurs, in its severe form, clinical features include profuse watery stools (rice water), vomiting severe dehydration and muscular cramps. However, in epidemics there are many subclinical or mild cases. In suspected case notify Medical Officer for Health (MOH) IMMEDIATELY.

For confirmation at the beginning of an outbreak, take rectal swab or stool specimen, handle properly and transport carefully to laboratory. Treat on site without referral wherever possible.

Incubation period: commonly 2-4 days (range 1-7 days)

Management: Rehydration is the most important step; orally in moderate cases, IV (using Ringer lactate) in more severe cases. Start antibiotics (see below) after the patient is rehydrated and vomiting has stopped, usually after 4-6 hours. Although the disease is self-limiting, an effective antibiotic will reduce the volume of diarrhoea and shorten the period during which vibrio cholera is excreted. Antibiotic prophylaxis may be given to all close contacts in the same dosage as for treatment.

Start feeding 3-4 hours after oral rehydration begin. Preferably, give antibiotics (especially doxycycline) with food to minimize vomiting.