Last reviewed: November 2017
Last updated: August  2017

Important updates

Cholera outbreak in Yemen

  • Yemen is experiencing what the World Health Organization and UNICEF have described as the ‘worst cholera outbreak in the world’.

  • From April to August 2017, over 500,000 cases have been reported.

See Diagnosis: approach

Original source of update

US recommends cholera vaccine for adult travelers

  • In 2016, a single-dose, live attenuated oral cholera vaccine was approved by the US Food and Drug Administration.

  • The US Centers for Disease Control and Prevention has now published recommendations and guidance for vaccination providers and travelers about the use of the cholera vaccine.

See Diagnosis: approach

Original source of update



History and exam

Key diagnostic factors

  • copious watery diarrhea
  • evidence of volume depletion

Other diagnostic factors

  • age <5 years
  • ingestion of shellfish
  • FHx of recent, severe, cholera-like illness
  • vomiting
  • fever
  • abdominal pain
  • lethargy or coma

Risk factors

  • ingestion of contaminated water
  • ingestion of contaminated food
  • inadequate sanitation
  • recent heavy rains and flooding
  • decreased gastric acid secretion
  • blood group O
  • malnutrition
  • HIV infection

Diagnostic investigations

1st investigations to order

  • CBC
  • serum electrolytes
  • serum BUN and creatinine
  • serum lactate
  • ABG
  • ECG
  • darkfield/phase-contrast microscopy of stool
  • rapid dipstick testing of stool
Full details

Investigations to consider

  • Gram stain of stool
  • stool culture of liquid stool, fecal suspension, or rectal swab
  • serogroup confirmation using antisera
  • antibiogram (sensitivities)
  • CXR and abdominal x-ray
Full details

Emerging tests

  • ELISA assay of stool
  • PCR assays of stool
  • loop-mediated isothermal amplification (LAMP) assay of stool
Full details

Treatment algorithm


Authors VIEW ALL

Consultant in Infectious Diseases and Clinical Microbiology

Public Health England Molecular Laboratories in Sierra Leone


Sierra Leone


ME declares that he has no competing interests.

Specialist registrar

Infection Department

Imperial College NHS Trust



RL declares that she has no competing interests.

Dr Marcus Eder and Dr Rekha Lopez would like to gratefully acknowledge Dr Justin Green, a previous contributor to this topic. JG is employed by, and holds stock in, GlaxoSmithKline (GSK). GSK has had no involvement in the preparation of this document, and the views expressed are those of the author.

Peer reviewers VIEW ALL


Department of International Health

Johns Hopkins Bloomberg School of Public Health




DS is an author of some studies referenced in this monograph.


Clinical Sciences Division

International Centre for Diarrhoeal Disease Research




NHA is co-author of a study referenced in this monograph.


Department of Pediatrics

University College of Medical Sciences

New Delhi



JSK declares that he has no competing interests.

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