The Sunday News
Lee-Anne Hall
Introduction
CHOLERA is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibro cholera. Researchers have estimated that every year, there are roughly 1,4 to 4,3 million cases, and 28 000 to 142 000 deaths per year worldwide due to cholera.
Cholera remains a global threat to public health and a key indicator of lack of social development.
So what causes cholera?
– Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by faeces from a person with the infection.
Common sources are namely:
– Municipal water supplies
– Ice made from municipal water
– Foods and drinks sold by street vendors
– Vegetables grown with water containing human wastes
– Raw or undercooked fish and seafood caught in waters polluted with sewage
– When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhoea.
– It is not likely you will catch cholera just from casual contact with an infected person.
Symptoms of cholera
Symptoms of cholera can begin as soon as a few hours or as long as five days after infection. Often, symptoms are mild but sometimes they are very serious. About one in 20 people infected have severe watery diarrhoea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection.
Signs and symptoms of dehydration include:
– Rapid heart rate
– Loss of skin elasticity (the ability to return to original position quickly if pinched)
– Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids
– Low blood pressure
– Thirst
– Muscle cramps
If not treated, dehydration can lead to shock and death in a matter of hours.
Risk factors and disease burden
Cholera transmission is closely linked to inadequate environmental management. Typical at-risk areas include semi-urban slums, where basic infrastructure is not available, where minimum requirements of clean water and sanitation are not met.
The consequences of a humanitarian crisis in Zimbabwe such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded areas can unfortunately increase the risk of cholera transmission should the bacteria be present or introduced.
The number of cholera cases reported to WHO continues to be high. During 2013, a total of 129 064 cases were notified from 47 countries, including 2 102 deaths.
Prevention and control
A multi-disciplinary approach is key for reducing cholera outbreaks, controlling cholera in endemic areas and reducing deaths.
Water and sanitation interventions
The long-term solution for cholera control (which benefits all diseases spread by the fecal-oral route) lies in economic development and universal access to safe drinking water and adequate sanitation, which is key in preventing both epidemic and endemic cholera.
Actions targeting environmental conditions include:
– The development of piped water systems with water treatment facilities (chlorination);
– Interventions at the household level (water filtration, water chemical or solar disinfection, safe water storage containers)
– Lastly, the construction of systems for sewage disposal and latrines.
– Most of those interventions require substantial long-term investments and high maintenance costs which are difficult to fund and sustain by the least developed countries, where they are also most needed.
Treatment
Cholera is an easily treatable disease. Up to 80 percent of people can be treated successfully through prompt administration of oral rehydration salts (WHO/Unicef ORS standard sachet).
Very severely dehydrated patients require the administration of intravenous fluids. These patients also need appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the duration of V cholerae excretion.
Mass administration of antibiotics is not recommended, as it has no effect on the spread of cholera and contributes to increasing antimicrobial resistance.
Social mobilisation
Health education campaigns, adapted to local culture and beliefs, should promote the adoption of appropriate hygiene practices such as hand-washing with soap, safe preparation and storage of food and breastfeeding.
Awareness campaigns during outbreaks also encourage people with symptoms to seek immediate health care. The campaigns should use modern communication channels (mobile phones, smartphones, social media, etc) and be adapted to local cultures. The use of qualitative methods of analysis, to help adapt messages to local culture and beliefs, is also encouraged.
Travel and trade
Today, no country requires proof of cholera vaccination as a condition for entry. Past experience shows that quarantine measures and embargoes on the movement of people and goods are unnecessary. Import restrictions on food produced using good manufacturing practices, based on the sole fact that cholera is epidemic or endemic in a country, are not justified.
Countries neighbouring cholera-affected areas are encouraged to strengthen disease surveillance and national preparedness to rapidly detect and respond to outbreaks should cholera spread across borders.
Further, information should be provided to travellers and the community on the potential risks and symptoms of cholera, together with precautions to avoid cholera, and when and where to report cases.
If you would like to know more about cholera please email me at [email protected], visit my blog www.healthpromotionbyleeanne.wordpress.com or read articles posted by the World Health Organisation.
Take care of your busy body, you owe that to your family.
Lee-Anne Hall
BSc Physiotherapy
