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Biological Warfare (cont.)


Cholera is an acute and potentially severe gastrointestinal disease (stomach and intestines) caused by the bacteria Vibrio cholerae. This agent has been investigated in the past as a biological weapon. Cholera does not spread easily from human to human, so it appears that major drinking water supplies would have to be profusely contaminated for this agent to be effective as a biological weapon.

Cholera normally can infect water or food that becomes contaminated by human bowel waste. The organism can survive for up to 24 hours in sewage and as long as six weeks in certain types of relatively impure water containing organic matter. It can withstand freezing for three to four days, but it is killed readily by dry heat, steam, boiling, short-term exposure to ordinary disinfectants, and chlorination of water.

The toxin causes a person's intestines to create massive amounts of fluid that then produces thin, grayish brown diarrhea.

Signs and Symptoms

Depending on how many organisms a person drinks or eats, the illness could begin within 12-72 hours. The symptoms start suddenly with intestinal cramps and painless (rice-water appearing) diarrhea. Vomiting, feeling ill, and headache often accompany the diarrhea, especially early in the illness.

Fever is rare. If untreated, the disease generally lasts one to seven days. During the illness, the body loses great amounts of fluid, so it is important during recovery to replace fluids and balance electrolytes (such as sodium and potassium).

Children may experience seizures and cardiovascular imbalances severe enough to cause heart problems. The rapid loss of body fluids often leads to more severe illness. If not treated, up to half of children with cholera may die.


Although cholera can be suspected in patients with a large volume of watery diarrhea, physicians make a definitive diagnosis through stool culture on specialized culture media (thiosulfate citrate bile sucrose (TCBS) agar or taurocholate tellurite gelatin agar (TTGA). There are rapid tests that are also available for diagnosis. However, the tests lack specificity and are usually not recommended at this time.


Fluids and electrolytes need to be replaced because the body has lost large amounts of fluids through the vomiting and diarrhea. Doctors may encourage the person to drink, but if someone continues to vomit or has frequent stools, an IV may be used to replace the fluid lost.

Antibiotics such as tetracycline or doxycycline shorten the duration of diarrhea and reduce fluid losses. The antibiotics ciprofloxacin or erythromycin also may be used for a few days.


There are two oral vaccines available; however, the CDC does not recommend their routine use, and in fact, did not use the vaccines during the most recent severe outbreak in Haiti after the 2010 earthquake. The vaccines require two doses, and it may be weeks before the person develops immunity. The CDC does not recommend the vaccines for routine travel prophylaxis.

Medically Reviewed by a Doctor on 11/20/2017

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