Cholera is spread by the fecal-oral route and may occur as a sporadic or epidemic disorder. The presence of certain risk factors can enhance its spread.
Risk factors for spread of cholera:
(1) warm weather
(2) fecal contamination of food and water associated with a breakdown in sanitation
(3) poor level of personal hygiene
(4) presence of a large group of people that overwhelms local sewage and water systems
(5) breakdown in hygiene following a natural disaster
Conditions associated with a lower infectious dose:
(1) reduced gastric acid
(1a) hypochlorhydria
(1b) drugs that reduce acid production
(1c) food
(1d) buffers
(2) group O blood type
(3) exposure to wild strains (doses in natural exposure are much lower than clinical studies, perhaps because the cultivated strains are less pathogenic)
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