Transmission occurs from man to man via
Fecally Contaminated Water

Fruits & Vegetables
• Uncontrolled water sources such as wells, lakes, ponds, streams and rivers pose a great threat.
• Contaminated Food Drinks: Ingestion of contaminated food and drinks have been associated with outbreaks of cholera. Bottle feeding could be a significant risk factor for infants. Fruits and vegetables washed with contaminated water can be a source of infection. After preparation, cooked food may be contaminated through contaminated hands and/or flies.

Pathogenesis
The main symptom of cholera is diarrhea.

Drinking Water

• Contaminated at its source
• Contaminated during storage
• Ice made from contaminated water

Food

• Contaminated during or after preparation
• Fruits and vegatables, freshened with contaminated water and eaten raw.
• Fruits and vegatables, grown at or near ground level and fertilised with night soil or irrigated with water contaminated with human waste, and with eaten raw.

Infection usually spreads through contaminated water and food.

Large epidemics are often related to faecal contamination of drinking water supplies.