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December 7, 2010
  • Cholera risk for travelers "likely very low"
  • Cholera in the DR
  • Travel to the DR
  • CDC on cholera
  • Third World traveler
Cholera risk for travelers "likely very low"
In its 1 December travel notice to US travelers, the Center for Disease Control and Prevention (CDC) says that it has not issued any travel warning for visitors to the Dominican Republic because "the risk of cholera for travelers to the DR "is likely very low if appropriate precautions are taken".
It has been reported that between November 16th and December 3rd, Dominican Republic health officials confirmed 13 cases of cholera in the country, following the outbreak of the disease in Haiti and its spread due to the lack of sanitation facilities.
Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the Vibrio cholerae bacterium. It has a short incubation period, from two hours to five days, and produces an enterotoxin that causes a painless, watery diarrhea. Hydration treatment needs to be administered promptly because the danger is not from the diarrhea, but instead from the dehydration it causes. Children and the elderly are especially at risk.
Protesters in Haiti have blamed Nepalese peacekeeping troops for bringing cholera to the country.
The CDC calls for caution to travelers and advises these to follow five simple steps to prevent cholera:
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 safelyoin the kitchen and in places where the family bathes and washes clothes.
www.cdc.gov/travel/content/id/2492.aspx
Cholera in the DR
In the Dominican Republic, close sanitary monitoring and educational awareness programs are aimed at preventing the spread of cholera from Haiti to the Dominican Republic. These proved effective in detecting and isolating the first case in a Haitian migrant worker returning from visiting friends and relatives in Haiti to his work in a construction project in the east. The case was confirmed on 16 November. Public Health Minister Bautista Rojas Gomez said that 13 suspected cases had been confirmed as of 3 December, most involving Haitian migrants. Cases affecting locals have occurred in Santo Domingo Province in the east and north municipalities. In Santiago there have been cases in Navarrete and Janico municipalities. For recent bulletins, see
www.sespasdigepi.gob.do
Travel to the DR
One of the major concerns for locals is the effect that a cholera outbreak could have on travel to the Dominican Republic. Like the CDC, major travel advisories recommend awareness and preventive measures. Here are some recommendations to keep in mind:
How to avoid getting cholera: The risk of cholera is very low. When simple precautions are observed, contracting the disease is unlikely even when traveling to an area where there have been cases of cholera. All travelers to areas where cholera has occurred should observe the following recommendations:
- Drink only treated water or safe beverages that include tea and coffee made with boiled water and carbonated drinks. Ice also needs to be treated.
- Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.
- Avoid undercooked or raw fish or shellfish, including ceviche.
- Make sure all vegetables are cooked and avoid salads.
- Avoid foods and beverages from street vendors.
- A simple rule of thumb is "Boil it, cook it, peel it, or forget it."
The Mayo Clinic's advice on cholera is that the overall risk of cholera for travelers is extremely low as the disease is transmitted for drinking untreated water or eating poorly cooked seafood in endemic areas. For the majority of travelers advice on food and water hygiene precautions is the most appropriate prevention strategy.
Cholera is transmitted via the fecal-oral route, most commonly by consumption of contaminated water and, to a lesser degree, food; direct person-to-person transmission is rare. A high infecting dose (as many as 1011 organisms) is necessary to cause illness in healthy individuals. Cholera is easily treated. Death results from severe dehydration that can be prevented with a simple and inexpensive rehydration solution. Cholera can be prevented by good hygiene preventive measures.
www.mayoclinic.com/health/cholera/DS00579
CDC on cholera
The Center for Disease Control, the leading US government health prevention center publishes the following on the cholera risk for travelers:
Travelers who follow usual tourist itineraries and who observe food safety recommendations while in countries reporting cholera have virtually no risk. The risk is increased for those who drink untreated water or eat poorly cooked or raw seafood in disease-endemic areas.
From 1996 through 2006, only 40 confirmed cases of cholera in the United States were acquired abroad. Two reports of cholera have been associated with food served on board international flights, most recently in 1992, in the midst of the Latin American epidemic, on a flight from Argentina to Los Angeles. CDC consequently advised the International Air Transport Association that oral rehydration solutions should be carried on international flights and that certain food items prepared in cities with cholera epidemics should not be served. Airline flights have not been implicated in any subsequent cases of cholera.
wwwnc.cdc.gov/travel/yellowbook/2010/chapter-5/cholera.aspx
Third World traveler
Very few Western travelers ever get seriously ill from cholera, according to thirdworldtraveler.com
The website explains that for a person to become ill large amounts of bacteria from heavily contaminated water would have to be consumed. It explains that the risk of infection in travelers is very low, especially for travelers who follow the usual tourist itineraries and stay in standard accommodation. It adds that cholera is reported in only 1 of 500,000 returning US travelers. The illness in healthy tourists is usually very mild because they rarely ingest the heavily polluted water needed to trigger the disease.
www.thirdworldtraveler.com/Disease/cholera.html
The cholera bacteria may be present in contaminated food, water or shellfish. Shellfish contain cholera for the same reason that they contain hepatitis A virus: because both cholera and hepatitis A virus are found in water, and because shellfish filter hundreds of quarts of water each day in their search for food, shellfish actually catch and concentrate cholera and hepatitis A virus.
Travelers are generally at no risk of cholera if they stay "on the beaten track", use standard tourist accommodations, eat only cooked shellfish and cooked food, and drink bottled water.
www.chop.edu/service/vaccine-education-center/a-look-at-each-vaccine/cholera-vaccine.html

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