CHOLERA: What You Need To Know

Cholera is an acute diarrhoeal disease caused by infection of the intestines with a bacterium called Vibrio cholerae. Both children and adults can be affected.
According to the Centre for Disease Control and Prevention (USA), about 3-5 million cases of cholera are reported globally each year and over 100,000 deaths occur annually around the world. Unsurprisingly, more than 90% of cases occur in Africa except in 2010 when the earthquake in Haiti caused a steep rise in cholera cases there. Thus, temporarily reducing Africa's contribution to the global incidence of
cholera to 50% in 2010.
According to the WHO, Nigeria reported 41,787 cases and 1,716 deaths due to cholera in 2010
alone. In 2014, Nigeria had already recorded 33,229 cases and 635 deaths as at 27th September 2014 with a higher incidence reported between October and December of same year. With the afore-mentioned, it is clear that cholera is a serious threat globally, but more so in the developing world which we are part of. Consequently, we need to give it the attention it deserves and stop this monster from killing our people.

Cholera thrives in places with poor sanitation

Where is Cholera Found?
The bacterium that causes cholera is usually found in water, fruits or food that has been contaminated by faeces of a person who has been infected by vibrio cholerae. Cholera is usually found in places with inadequate water treatment, poor sanitation and poor personal hygiene.
The cholera bacterium may also live in brackish rivers and coastal waters. Shellfish eaten raw have also been a source of cholera in various parts of the world.

How Does a Person Get Cholera?
A person can get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person that contaminates water and/or food. Cholera spreads rapidly in areas with inadequate treatment of sewage and drinking water. However, it is not likely to spread directly from one person to another. Therefore, casual contact with an infected person is not a risk for becoming ill.

What Are The Symptoms of Cholera?
Infection with Vibrio cholerae is often mild or without symptoms, but can sometimes be very severe. According to the WHO, about 20% of those infected develop acute watery diarrhoea. 10-20% of these individuals develop severe watery diarrhoea with vomiting, and leg cramps. In these people, rapid loss of body fluids and salt leads to severe dehydration, shock and death within hours if such persons are not treated immediately. Fatality rates from untreated cases could be as high as 30-50%.

How long after infection do the symptoms appear?
It can take anywhere from a few hours to 5 days for symptoms to appear after infection. Symptoms typically appear in 2-3 days.

What should I do if I think a family member or I have Cholera?
If you think you or a member of your family may have cholera, seek medical attention immediately. Report to the nearest health facility without delay. Dehydration can be rapid so fluid replacement is essential. If you have oral rehydration solution (ORS), the ill person should start taking it now; it can save a life. He or she should continue to drink ORS at home and during travel to get treatment. If you have an infant who has watery diarrhea, continue to breastfeed.

How is Cholera diagnosed?
Doctor diagnose cholera by asking about or getting a history of possible sources of contamination, getting some symptoms and signs (some of which have already been mentioned above), and by sending a stool sample or rectal swab to the laboratory to look for the cholera bacterium.

What is the treatment for cholera?

Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients die.

Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as receiving rehydration. Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical attention promptly.

Should I be worried about getting Cholera from others? 

The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill. 

How can I avoid getting cholera?

When simple precautions are observed, the risk of contracting the illness is very low.

All people (visitors or residents) in areas where cholera is occurring or has occurred should observe the following recommendations:

• Drink only boiled, chemically treated or bottled water and bottled or canned carbonated beverages. When using bottled drinks, make sure that the seal has not been broken.
  • To disinfect your own water: boil for 1 minute or filter the water and add 2 drops of household bleach or ½ an iodine tablet per liter of water.
  • Avoid tap water, fountain drinks, and ice cubes.
• Wash your hands often with soap and clean water.
• If no water and soap are available, use an alcohol-based hand cleaner (with at least 60% alcohol).
  • Clean your hands especially before you eat or prepare food and after using the bathroom.
• Use bottled, boiled, or chemically treated water to wash dishes, brush your teeth, wash and prepare food, or make ice.
• Eat foods that are packaged or that are freshly cooked and served hot.
  • Do not eat raw and undercooked meats and seafood or unpeeled fruits and vegetables.
• Dispose of feces in a sanitary manner to prevent contamination of water and food sources

Is there a vaccine to prevent cholera?

Currently, two oral cholera vaccines are available: Dukoral® and ShanChol®, which are World Health Organization (WHO) prequalified. However, Cholera vaccines are not yet available in many parts of the world, including Nigeria and should not replace standard prevention and control measures.

Stay healthy!

The Story of Cholera (3gp)- You can download this wonderful animation.

References

1. Centre For Disease Control And Prevention. Choera- Vibrio cholerae Infection. http://www.cdc.gov/cholera/general/index.html Accessed February 20, 2015.

2. World Health Organisation Global Task force on Cholera Control. Cholera Outbreak: Assessing The Outbreak Response and Improving Preparedness. 2004.

3. World Health Organisation Global Task force on Cholera Control. Cholera Country Profile: Nigeria. 2011.

4. Adeola Akinremi. In 2014, Nigeria Faced Up To Ebola But Cholera Persists in Thisday Live. http://www.thisdaylive.com/articles/in-2014-nigeria-faced-up-to-ebola-but-cholera-persists/197584/. Accessed February 23, 2015.