Cholera is making the headlines as it ravages the earthquake and hurricane-devastated country of Haiti. While Haiti is suffering a cholera epidemic because of the natural disasters that have damaged its water and sanitation infrastructure, this is not the first time cholera has caused loss of lives on a large scale. There have been even more severe cholera outbreaks in the past such as:
– The 1854 epidemics in the USA, England, Spain, Venezuela and Brazil which caused more than 250000 deaths. (1) (2)
– The pandemic between 1899-1923 which caused over 1 million deaths across Russia, the United States, Turkey, Saudi Arabia, the Philippines, and India. (1) (2)
– Outbreaks which occurred in Peru (1991) killing about 10000 people and in Rwandan refugee camps in the Democratic Republic of Congo (1994) killing tens of thousands. (2)
Cholera is an infection of the small intestines caused by the bacteriumVibrio cholerae. Its main symptoms are vomiting and diarrhea with the characteristic rice-water stools (watery stools which contain flecks of mucus, intestinal epithelium and bacteria). These cause loss of body water leading to dehydration, weakness, thirst and hypotension. There is also loss of electrolytes (sodium, potassium, calcium, etc). (3) Severe dehydration and electrolyte loss lead to shock, acidosis, kidney failure and ultimately death.
Cholera is transmitted through contaminated water and food. Its outbreaks are devastating and it is best to prevent them from occurring. The ways to handle cholera include Prevention and Control of outbreaks.
Prevention of Cholera Outbreaks
Access to Clean Water and Proper Personal Hygiene: This is most important for preventing infection with cholera. Contaminated water is the main mode of transmission of cholera. Water contamination should be avoided by purifying water before any form of use (drinking, cooking, washing or bathing). Water purification can be carried out by boiling, chlorination, filtration, etc. Proper hygiene includes regular hand-washing after using the toilet and before handling food. (1) (4)
Proper Sanitation and Sewage Disposal/Treatment: These prevent water sources and food from becoming contaminated. (4)
Health Education: This involves educating people on the measures they can take to prevent themselves from getting infected. (4)
Control of Cholera Outbreaks
Treatment of Cholera: The treatment of cholera is by immediate rehydration to replace the fluid and electrolyte losses due to diarrhea and vomiting. This is frequently done using oral rehydration salt (ORS) sachets dissolved in an amount of clean water (about 600mls). For severe cases, ORS is inadequate and intravenous fluids are used. Antibiotics such as Tetracycline and Ciprofloxacin are also given in severe cases. (2) (5)
Immediate and proper treatment of the infected prevents cholera from spreading.
Vaccines: There is an oral cholera vaccine (OCV) which is usually administered in 2 doses 10-15 days apart. It is recommended for people traveling to areas susceptible to cholera epidemics. This vaccine may also be used in mass vaccination campaigns. However, the WHO recommends that OCV should not be used when cholera outbreaks have already begun because of the number of days required between the 2 doses. (6)
Prevention of Nosocomial Infections: A nosocomial infection is one which is acquired or spread in a hospital. Cholera can rapidly spread in hospitals where infected patients are managed and can be very disastrous. This is usually due to poor sanitation and improper disposal of fecal matter from infected patients. (7)
To achieve proper control, all the methods for prevention must also be carried out during an outbreak to prevent cholera from spreading to the uninfected.
Fortunately, these days cholera is rare in the developed nations such as in North America and Europe because of standard and modernized sanitation and sewage disposal systems but isolated incidences do occur. In the developing world however, outbreaks occur from time to time such as recently in Zimbabwe (2008) and in Nigeria and Haiti (2010).
1. Cholera: Wikipedia
2. Cholera’s Seven Pandemics: CBC News Health
3. Symptoms of Cholera: WrongDiagnosis.com
4. Prevention of Cholera Outbreaks: WHO Policy and Recommendations
5. Case Management: WHO Policy and Recommendations
6. Cholera Vaccines: WHO Policy and Recommendations
7. Control of Cholera Outbreaks: WHO Policy and Recommendations