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Risk factors
By Mayo Clinic staffEveryone is susceptible to cholera, with the exception of infants who derive immunity from nursing mothers who have previously had cholera. Still, certain factors can make you more vulnerable to the disease or more likely to experience severe signs and symptoms. Risk factors for cholera include:
- Malnutrition. Malnutrition and cholera are interconnected. People who are malnourished are more likely to become infected with cholera, and cholera is more likely to flourish in places where malnutrition is common, such as refugee camps, impoverished countries, and areas devastated by famine, war or natural disasters.
- Reduced or nonexistent stomach acid (hypochlorhydria or achlorhydria). Cholera bacteria can't survive in an acidic environment, and ordinary stomach acid often serves as a first-line defense against infection. But people with low levels of stomach acid lack this protection, so they're more likely to develop cholera and to have severe signs and symptoms of the disease. Children and older adults, especially, tend to have lower than normal stomach acid levels. So do people who have had gastric surgery, who have untreated Helicobacter pylori infection, or who are taking antacids, H-2 blockers or proton pump inhibitors for ulcers. Antacids help neutralize stomach acid, and H-2 blockers and proton pump inhibitors reduce the amount of acid your stomach produces.
- Household exposure. You're at significantly increased risk of cholera if you live with someone who has the disease.
- Compromised immunity. If your immune system is compromised for any reason, you're more susceptible to cholera infection.
- Type O blood. For reasons that aren't entirely clear, people with type O blood are twice as likely to develop cholera as are people with other blood types.
- Raw or undercooked shellfish. Although large-scale cholera outbreaks no longer occur in industrialized nations, eating raw shellfish — particularly oysters — from waters known to harbor the bacteria or shellfish transported by travelers from countries where cholera is endemic greatly increases your risk.
References
- Cholera. World Health Organization. http://www.who.int/mediacentre/factsheets/fs107/en/. Accessed Feb. 19, 2009.
- Cholera. Centers for Disease Control and Prevention. http://www.cdc.gov/nczved/dfbmd/disease_listing/cholera_gi.html. Accessed Feb. 19, 2009.
- Cholera. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec14/ch173/ch173e.html. Accessed Feb. 19, 2009.
- Butterton JR. Approach to the patient with Vibrio cholerae infection. http://www.uptodate.com/home/index.html. Accessed Feb. 19, 2009.
- Menon MP, et al. Vibrio cholerae (Cholera). In: Long SS, et al., eds. Long: Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2008:844.
- Seas C, et al. Vibrio cholerae. In: Mandell GL, et al. Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2005:2536.
