Cholera: how to rehydrate quickly and recognise severe forms?

How is cholera caught?

The bacterium is passed on through drinking water or food contaminated by stools. The first symptoms appear between 12 hours and five days after infection. Most infected people have no symptoms, but they can shed the bacterium in their stools for one to ten days and pass it on without knowing.

Outbreaks mainly occur where access to clean water and sanitation is inadequate: overcrowded neighbourhoods, camps for displaced people, areas affected by floods or conflict. According to the World Health Organization, 47 countries reported more than 450,000 cases to it in 2025, and the real number of cases is probably higher.

What signs should raise concern?

Watery diarrhoea

Most patients have mild or moderate symptoms. The typical sign is liquid, heavy diarrhoea without much pain, sometimes with vomiting. In an area where cholera is circulating, any acute watery diarrhoea must be taken seriously.

Signs of severe dehydration

A minority of patients lose very large amounts of water and salts in a short time. The emergency signs are:

• sunken eyes and a very dry mouth;
• skin that stays wrinkled when pinched;
• severe weakness, drowsiness or loss of consciousness;
• a weak or undetectable pulse, cold hands and feet;
• no urine;
• being unable to drink.

Without treatment, a severe form can cause death within hours. Do not wait before getting to a health centre.

The most vulnerable people

Young children, older people, pregnant women and people who are undernourished or have a chronic disease tolerate dehydration less well. They need to be seen particularly quickly.

What to do from the first stools?

Start oral rehydration at home

Oral rehydration solution, or ORS, sold in sachets, is prepared with safe water following the instructions on the packet. It should be drunk in small, regular sips, even if there is vomiting. It replaces the water and salts lost. Water alone, soft drinks or juices are not enough.

Keep breastfeeding and eating

A baby should continue to be breastfed. A person who has the strength can go on eating normally as soon as they feel like it.

Get to a health centre

Go to a health centre without stopping the rehydration solution during the journey. During an outbreak, health authorities often open dedicated treatment centres or rehydration points.

How is cholera treated?

Rehydration, the basis of treatment

Rehydration is the essential treatment. Most patients recover with oral rehydration solution alone. In severe forms, health staff give fluids through an intravenous drip, then switch to the oral solution as soon as the patient can drink.

When rehydration is quick and sufficient, the risk of death becomes very low: the World Health Organization sets a target of less than 1% mortality in treatment centres.

Antibiotics, as a complement

In severe forms, an antibiotic chosen by the doctor can shorten the illness and reduce fluid loss. It is added to rehydration and never replaces it. Taking antibiotics as a preventive measure, in a family or a community, is not recommended: it has shown no benefit and encourages resistance.

How is the diagnosis confirmed?

Treatment must not wait for results. Rapid diagnostic tests help to identify a likely outbreak. Confirmation relies on laboratory analysis of stools, by culture or PCR.

How to protect yourself?

Water and hygiene

• Drink safe water: sealed bottled water, boiled or treated water.
• Wash your hands with soap after using the toilet, after cleaning a patient and before preparing meals or eating.
• Eat food that is well cooked and served hot, and peel fruit yourself.
• Use toilets or latrines, and clean soiled surfaces following the instructions of health teams.

Oral vaccination

Oral vaccines against cholera exist. They are mainly used in organised campaigns in affected or at-risk areas, and they can be given during pregnancy. They protect but do not replace safe water or hygiene.

Frequently asked questions