A cholera vaccine is available for those traveling to Africa and the Middle and Far East, but it is no longer recommended because it is only 50 percent effective and protects for only three to six months. The vaccine is no help against controlling epidemics. A new, more effective oral vaccine is being tested, but it is not yet licensed.

The bacteria are killed by chlorine and boiling. Contaminated shellfish must be boiled or steamed for 10 minutes to kill all bacteria. The core temperatures of cooked food should be 158°F. Unless all the bacteria are killed by cooking, they will multiply rapidly at room temperature in cooked shellfish.

Cholera can be controlled by improved sanitation, especially by maintaining untainted water supplies. Travelers to high-risk areas—affected areas in Latin America, Africa, and Asia—must:

• not bring perishable seafood back to the United States

• not eat unboiled or untreated water or ice

• not eat food or beverages from street vendors

• not eat raw or partially cooked fish or shellfish

• not eat raw vegetables or salads

• treat unbottled water with chlorine or iodine tablets

• drink carbonated bottled water or bottled soft drinks (the carbonation destroys the bacteria)

• drink tea and coffee made only with boiled water

• eat only fruits with a peel

• eat only foods that are cooked and hot ciguatera poisoning The most common clinical syndrome caused by eating certain tropical marine reef fish, mostly barracuda, red snapper, amber-jack, surgeon fish, sea bass, and grouper. The fish are toxic at certain times of the year when they ingest a type of dinoflagellate called Gambierdiscus

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