Cholera

Suspected case:

In areas where a cholera outbreak has not been declared: any person aged 2 years and older presenting with acute watery diarrhea and severe dehydration or dying from acute watery diarrhea.

Once a cholera outbreak has been confirmed: any person presenting with or dying from acute watery diarrhea.

Confirmed case:

A suspected case with Vibrio cholerae O1 or O139 infection confirmed by culture or polymerase chain reaction, and in countries where cholera is not present or has been eliminated, the V cholerae O1 or O139 strain is demonstrated to be toxigenic.

A cholera alert (suspected cholera outbreak) is defined by the detection of at least one of the following:

Two or more people aged 2 years or older with acute watery diarrhea and severe dehydration, or dying from acute watery diarrhea, from the same area, within 1 week of one another.
One death from severe acute watery diarrhea in a person aged 5 years or older; and/or
One case of acute watery diarrhea testing positive for cholera by rapid diagnostic test in an area that has not yet detected a confirmed case of cholera (including areas at risk for extension from a current outbreak).

Mild (<5% volume depletion): alert but tachycardic, dry mucous membranes, small postural blood pressure (BP) drop (<20 mmHg), able to drink fluids; in young children, anterior fontanelle palpable but not sunken.
Moderate (5% to 10% volume depletion): irritability, sunken eyes, dry mouth, significant (>20 mmHg) postural drop in BP, mildly decreased skin turgor, thirst.
Severe (>10% volume depletion): lethargy or coma, circulatory collapse (e.g., thready pulse, systolic BP <80 mmHg), sunken eyes, absent tears, dry mucous membranes, poor (>2 seconds) capillary return, decreased skin turgor, biochemical evidence of prerenal failure (e.g., elevated blood urea nitrogen disproportionately higher than creatinine in a ratio of >20:1).

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Criteria