an acute infection of the small intestine resulting in a profuse, watery diarrhea, vomiting, and dehydration. Infection always occurs by ingesting food or water that has been contaminated with the bacterium Vibrio cholerae. Anywhere from a few hours to five days after exposure to the bacterium, the vomiting and diarrhea begin. The bacterium produces a toxin that speeds the passage of fluid from the bloodstream into the intestines. More than a pint of fluid can be lost every hour. If the fluid is not replaced quickly, the patient may die within a few hours. The usual treatment is replacement of the fluids and minerals by mouth or by intravenous infusion. Antibiotics can lessen the diarrhea and reduce the spread of infection. Improved sanitation and food handling as well as water purification can prevent epidemics, such as those common to northeast India. Since the 1960s, a pandemic (worldwide epidemic) has spread from Indonesia to Asia, Africa, the Mediterranean, the Gulf Coast of North America, and South America. A vaccine can provide short-lived protection, usually for about six months, to travelers in areas with poor sanitation. Boiling all drinking water or drinking only bottled drinks is another precaution against the disease. In 1994 a severe outbreak of cholera that killed more than 23,000 people in Rwanda and the Rwandan-refugee camps of Zaire made news headlines |