Cholera outbreak: what to do to protect your family

Cholera is a bacterial infection that causes sudden, severe watery diarrhoea and vomiting. It can kill a healthy adult in hours through dehydration. It spreads through water and food contaminated with the bacteria — often when human waste gets into a water supply.

Ethiopia has had recurring cholera outbreaks — especially in Somali Region, Afar, Amhara, and Tigray during and after flooding, drought, or displacement.

The good news: cholera is preventable and treatable. Nearly every cholera death is preventable if the person gets to treatment quickly.

On this page

• Signs of cholera
• What to do the moment it starts
• How to make ORS at home
• When to go to a treatment centre
• How to protect your family during an outbreak
• The cholera vaccine
• After the outbreak ends

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Signs of cholera

Cholera hits fast — usually 12 hours to 5 days after exposure.

• Sudden, painless, watery diarrhoea — often described as “rice water” (cloudy, whitish, no smell of usual faeces)
• Vomiting
• Rapid loss of fluid — the person can lose more than a litre per hour in severe cases
• Signs of dehydration in hours — sunken eyes, dry mouth, weakness, rapid pulse, low blood pressure
• Muscle cramps from salt loss
• No fever — that’s often what distinguishes cholera from other diarrhoeal illnesses

Mild cases look like a regular stomach upset. Severe cases can move from healthy to collapsed in 6-12 hours. Do not wait to see which kind you have — start treatment immediately.

What to do the moment it starts

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Do — right now

• Start ORS immediately — do NOT wait to reach a health facility. The first hour matters.
• Give small sips continuously — as much as the person will drink
• Keep giving ORS even if the person vomits — some absorbs
• Get to a cholera treatment centre or health facility with the person, carrying ORS to keep drinking on the way
• Tell the health post you suspect cholera — outbreak surveillance depends on it
• Isolate the person’s diarrhoea — do not let others use the same bucket/latrine without disinfection
• Wash hands thoroughly after handling anyone with cholera symptoms — bacteria are in the stool
• Keep breastfeeding any infant with symptoms — breastmilk protects and hydrates :::

How to make ORS at home

You should always try to get ORS sachets from the health post — they are precisely measured, free, and made for this. During an outbreak, sachets are distributed widely.

If you cannot get sachets quickly, make it at home:

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Home ORS recipe (use only until you can get sachets)

• 1 litre of the cleanest water you can find (boil for 1 minute and cool if possible)
• 6 level teaspoons of sugar
• Half a level teaspoon of salt

Stir until fully dissolved. Taste — should be no saltier than tears. If too salty, throw it out and remake (too much salt is dangerous).

Use within 24 hours. Make fresh each day. :::

How much to drink:

• Under 2 years: 50-100 ml (a quarter to half a cup) after each loose stool
• 2-9 years: 100-200 ml (half to one cup) after each loose stool
• Older children and adults: as much as they will drink — at least 200 ml (one cup) after each loose stool

Continue for 24 hours after diarrhoea stops.

When to go to a treatment centre

::: urgentAdvice severity=“emergency”

Emergency — go to a cholera treatment centre or hospital NOW if:

• The person cannot drink or is vomiting everything
• Very sleepy, unconscious, or unresponsive
• Skin stays tented when pinched, sunken eyes, dry tongue
• No urine for 6 hours (or dry nappy in an infant)
• Weak or absent pulse
• Rapid, deep breathing
• Very fast heart rate
• Feet and legs cold; grey or blueish colour around lips
• Muscle cramps

At the treatment centre they will give IV fluids rapidly, sometimes several litres in the first hour. This saves lives. :::

How to protect your family during an outbreak

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Water

• Drink ONLY treated water:
  • Boil for 1 minute (longer at high altitude — 3 minutes in the highlands)
  • OR use water purification tablets (Aquatabs, WaterGuard) — one tablet per litre or as instructed
  • OR use chlorine drops — 2 drops per litre, wait 30 minutes
• Store treated water in a clean, covered container. Pour with a ladle, don’t dip cups.
• Wash food and utensils only with treated water :::

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Food

• Eat food that is hot and freshly cooked — “cook it, peel it, or leave it”
• Wash fruits and vegetables in treated water; peel where possible
• Avoid raw fish, raw shellfish, raw milk, and street food
• Never eat food from someone with diarrhoea, even if they wash their hands
• Cover food to keep flies off :::

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Sanitation

• Wash hands with soap — before eating, before preparing food, after using the latrine, after changing nappies, after caring for anyone sick
• Use a latrine, not open defecation — cholera spreads through open faeces
• If the latrine is far, use a bucket and dispose of contents safely (deep pit, well away from water sources)
• Bury faeces at least 30 metres from any water source
• Do not bathe or wash clothes in a water source used for drinking :::

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Don’t

• Do not drink water from surface sources (rivers, lakes, unprotected wells) during an outbreak
• Do not eat street food, salads with raw vegetables, or unpeeled fruits from stalls
• Do not share food or utensils with someone who has diarrhoea
• Do not visit or handle bodies at funerals of cholera victims without protection — the bacteria survive for hours after death
• Do not stop ORS just because the person feels better — continue for 24 hours after diarrhoea stops
• Do not give anti-diarrhoeal medicines (loperamide) — they trap bacteria inside
• Do not skip the vaccine if it’s offered :::

The cholera vaccine

The oral cholera vaccine (Shanchol, Euvichol) is:

• Given as 2 doses, 2 weeks apart
• 60-85% effective for 3-5 years
• Deployed by MoH and WHO during outbreaks in affected woredas
• Free during outbreak response campaigns
• Safe for pregnant women, children over 1 year, and people with HIV

The vaccine is not a substitute for clean water and handwashing — it’s a bridge until sanitation catches up. If it’s offered in your area, take it.

After the outbreak ends

• The area is declared cholera-free after 28 days with no new cases
• Keep treating drinking water for at least a month after — the bacteria can persist in water sources
• Report any new suspected case to the health post immediately — early detection stops recurrence
• If you had cholera and recovered, you have some immunity for a few years — but not lifelong

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa

Sources: WHO Cholera fact sheet 2024; Ethiopian MoH+EPHI National Cholera Preparedness and Response Plan 2023; Global Task Force on Cholera Control Roadmap 2030.

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Draft notes: ~1200 words · grade 6 · isTimeCritical true · Ethiopian context: real regions with recurring outbreaks, real vaccine brands used in campaigns, altitude-specific boiling times, addresses funeral practices (a documented cholera transmission route in Ethiopia) · Cross-references diarrhoea/ORS article.