Vibrio cholera is spread via the fecal-oral route, with most people infected by consuming contaminated water or food.
Water supplies should be assumed to be contaminated during an outbreak:
(1) all water should be chlorinated or filtered or boiled
(2) Bottled water can be used if from a reputable source (in some countries people bottle local water and sell it as clean water).
Food should be prepared with care, with attention to hygiene.
(1) Food should be thoroughly cooked if possible and served in clean dishes.
(2) Fresh vegetables should be washed thoroughly with known clean water.
(3) Marketplaces should be inspected and kept at a high level of sanitation.
(4) Food from street vendors and other uncertain sources should be avoided.
Sewage handling
(1) Special precautions should be taken in the handling of human waste.
(2) Patients with cholera shed enormous numbers of bacteria and the feces need to be disposed of carefully.
(3) Recently infected patients may continue to shed vibrios for some time after clinical recovery and should be cautioned to practice careful hygiene.
(4) Everyone should thoroughly wash their hands after toileting.
Antibiotic prophylaxis with doxycyline or other suitable agent should be considered for high risk populations:
(1) household contacts
(2) health care workers with high exposures
Large gatherings and festivals should be postponed until after the epidemic is under control. These can cause a breakdown in sanitation measures.
Surveillance should be coordinated to monitor the outbreak and to identify emerging problems such as antibiotic resistance.
