Travel Health Advisory Released: November 1, 2004 The Public Health Agency of Canada (PHAC) continuously monitors worldwide reports of cholera outbreaks. Cholera is found in many tropical countries around the world and outbreaks are a recurring hazard during the rainy season in much of West Africa. The WHO has confirmed with the PHAC, that a cholera outbreak has been verified in Dakar. No official number of reported cases has been published by the WHO at this time. PHAC will continue to monitor the situation closely and will update the advisory as information becomes available. Based on information obtained by unverified media reports, as at October 29, 199 cases of the disease resulting in two deaths have been reported. The cases are being reported from areas in Dakar where sanitation, waste management and stagnant water are commonly problematic. Senegal's bordering countries have all, with the exception of Guinea Bissau and Sierra Leone, reported cholera cases in 2003. Dakar's last cholera outbreak occurred 8 years ago in 1996. Source: WHO communication with PHAC As a reminder, the Public Health Agency of Canada strongly recommends that Canadian travellers to Africa seek an individual risk assessment consultation with their personal physician or a travel clinic prior to departure. Cholera is an acute intestinal infection caused by the bacterium Vibrio cholerae. The bacterium produces a toxin, which causes an infected person to dehydrate through vomiting and profuse watery diarrhea. Cholera is acquired directly through drinking or eating contaminated water or food, or indirectly from exposure to the feces or vomit of an infected person. Person-to-person exposure is unlikely when good hygiene practices (e.g., hand washing) are in place. Undercooked or raw shellfish, such as crabs, fish, shrimp, mussels and oysters, and unpeeled fruits and vegetables have been associated with infection. Cholera outbreaks are usually caused by contaminated water, where sewage and drinking water supplies not been adequately treated. Recommendations Because cholera is spread through contaminated food and water, the Public Health Agency of Canada strongly recommends that travellers to areas experiencing an outbreak of cholera exercise general food and water precautions to minimize their risk of exposure. The key principles to remember are: boil it, cook it, peel it or leave it! Eat only food that has been well-cooked and is still hot when served. Drink only purified water that has been boiled or disinfected with chlorine or iodine, or commercially bottled water in sealed containers. Drinking carbonated drinks without ice, including beer, is usually safe. Avoid ice, unless it has been made with purified water. Boil unpasteurized milk. Avoid unpasteurized dairy products and ice cream. Avoid uncooked foods -- especially shellfish -- and salads. Fruit and vegetables that can be peeled are usually safe. Avoid food from street vendors. Wash hands before eating or drinking. The Public Health Agency of Canada recommends as well, that travellers who become sick or feel unwell on their return to Canada should seek a medical assessment with their personal physician. Travellers should inform their physician, without being asked, that they have been travelling or living outside of Canada , and where they have been. For additional information, please visit the Travel Medicine Program's Disease Information Backgrounder on cholera.
