Chapter I

Cholera is contracted by consuming food or water contaminated with the fecal bacteria
Vibrio cholerae. Dehydration from rapid loss of body fluids is the reason the disease can be so deadly
within hours if the patient is not treated. The disease's short incubation period of two hours to five
days increases the likelihood of outbreaks.80% of cholera cases can be treated and resolved with oral
hydration salts. Cholera is rare in industrialized nations. People who live in areas with poor or
inadequate water treatment, sanitation and hygiene practices are more likely to get the disease.

Outbreaks continued to affect several countries. Cholera remains a major public health
problem and affects primarily developing world populations with no proper access to adequate
water and sanitation resources. The Philippine Department of Health is also encouraging
communities to chlorinate water or boil water for over three minutes when they are unsure of the
water quality. A common cause of cholera outbreaks in the Philippines are contaminated water
sources. In the Philippines diarrhea was one of the top ten causes of death in 2011. Measures for
the prevention of cholera mostly consist of providing clean water and proper sanitation to
populations who do not yet have access to basic services. Health education and good food hygiene
are equally important. Communities should be reminded of basic hygienic behaviours, including the
necessity of systematic hand-washing with soap after defecation and before handling food or
eating, as well as safe preparation and conservation of food. Appropriate media, such as radio,
television or newspapers should be involved in disseminating health education messages.
Community and religious leaders should also be associated to social mobilization campaigns.

The WHO is currently supporting the training of health professionals at the sub-national level to
enhance the Philippine Integrated Disease and Surveillance System Response in order to rapidly detect
and respond to these kinds of outbreaks. Together with other health partners, the WHO continues to
support the Philippine Department of Health as they work to ensure that infected patients are
receiving proper treatment and communities are given the information needed to prevent the spread
of this disease.
 Chapter II
PATHOLOGY AND ETHIOLOGY
Cholera is an intestinal infection caused by Vibrio cholerae (see the images below). The
hallmark of the disease is profuse secretory diarrhea. Cholera can be endemic, epidemic, or pandemic.
Despite all the major advances in research, the condition still remains a challenge to the modern
medical world. Although the disease may be asymptomatic or mild, severe cholera can cause
dehydration and death within hours of onset.

Scanning electron microscope image of Vibrio cholerae bacteria, which infect the digestive system.

Electron microscopic image of Vibrio cholerae.

Transmission occurs from man to man via

Fecally Contaminated Water

Cholera is transmitted by the fecal-oral route. Uncontrolled water sources such as wells, lakes,
ponds, streams and rivers pose a great threat.Contaminated Food Drinks: Ingestion of contaminated
food and drinks have been associated with outbreaks of cholera. Bottle feeding could be a significant
risk factor for infants. Fruits and vegetables washed with contaminated water can be a source of
infection. After preparation, cooked food may be contaminated through contaminated hands and/or
flies.

Drinking Water
Contaminated at its source,during storage and ice made from contaminated water

Food
Contaminated during or after preparation.Fruits and vegatables, freshened with contaminated
water and eaten raw.Fruits and vegatables, grown at or near ground level and fertilised with night soil
or irrigated with water contaminated with human waste, and with eaten raw.Infection usually spreads
through contaminated water and food
Large epidemics are often related to faecal contamination of drinking water supplies.
 Chapter III

CHOLERA SYMPTOMS
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 diarrhea 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:

Objectives:

 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

Subjective:

 Rapid heart rate

 Thirst
 Muscle cramps

If not treated, dehydration can lead to shock and death in a matter of hours.

Acute Symptoms of Cholera

Typically, cholera is more common in countries without modern water treatment and with poor
sanitation. However, most vacationers or business travelers who ingest only a few bacteria from food
and drinks do not become ill. Be aware that symptoms may not appear right away, though.

You may also experience these signs of cholera, which can cause life-threatening dehydration:

Objectives:

 Watery diarrhea
 Dry mouth

Subjective:

 Painful stomach cramps,

 Nausea and vomiting
 Excessive thirst.
Exposure to cholera bacteria, for instance, is much less likely to make you sick than exposure to
the norovirus that often sickens cruise ship passengers. In those who do become infected with cholera,
about 80 percent have a mild or moderate infection, according to the World Health Organization, not
the severe disease marked by profuse diarrhea, vomiting and leg cramps. If it’s the severe form, death
can occur within hours without treatment; dehydration can occur within three hours of symptoms.
 Chapter IV

TREATMENT

 The primary goal of therapy is to replenish fluid losses caused by diarrhea & vomiting.
 Fluid therapy is accomplished in 2 phases: rehydration and maintenance.
 Rehydration should be completed in 4 hours & maintenance fluids should replace ongoing
losses & provide daily requirement.

MEDICATION

FLUID THERAPY

 Ringer lactate solution is preferred over normal saline because it corrects the associated
metabolic acidosis.
 IV fluids should be restricted to patients who purge >10 ml/kg/h & for those with severe
dehydration.
 The oral route is preferred for maintenance & the use of ORS at a rate of 500-1000 ml/h is
recommended.

DRUG THERAPY

 The goals of drug therapy are to eradicate infection, reduce morbidity and prevent
complications.
 The drugs used for adults include tetracycline, doxycycline, cotrimoxazole & ciprofloxacin.
 For children erythromycin, cotrimoxazole and furazolidone are the drugs of choice.
 Chapter V

Medical Management and Intervention

The aim for cholera outbreak for case fatality ratioof 1% or less. 80-90% of patients can be
treated with ORS (Oral Rehydration Salts). These outbreak must be initiate the treatment promptly.
Give the patient an intravenous therapy (Ringers/Hartmann’s) only for severely dehydrated.

Rehydration is the first priority in the treatment of cholera. Rehydration is accomplished

in 2 phases: rehydration and maintenance.The goal of the rehydration phase is to restore
normal hydration status, which should take no more than 4 hours. Set the rate of intravenous
infusion in severely dehydrated patients at 50-100 mL/kg/hr. Lactated Ringer solution is
preferred over isotonic sodium chloride solution because saline does not correct metabolic
acidosis
The goal of the maintenance phase is to maintain normal hydration status by replacing
ongoing losses. The oral route is preferred, and the use of oral rehydration solution (ORS) at a
rate of 500-1000 mL/hr is recommended.

Intervention of cholera outbreak in Caribbean region example Haiti.With the recent and
devastating return of cholera to the Caribbean region, there has been a tremendous interest in
the effectiveness of interventions since the Haitian outbreak. Vaccination appears to be the
predominant response, with a call for health authorities to incorporate it into existing
intervention methods to reduce infection rates and minimize future epidemics. With an
increasing disease burden in endemic regions and high fatality rates in newly affected regions,
there is a need to examine the efficacy of existing strategies and to explore the use of
predictive technology to implement proactive intervention measures.

Time is a critical element for reducing cholera transmission. An early warning system
based on a spatially explicit cholera prediction model can potentially provide critical lead-time
to deploy human and material resources and establish preventive measures in vulnerable
areas ahead of impending outbreaks. By combining prediction and prevention, we can reduce
the cholera burden.
Report in DRRR
(Cholera)

Submitted by:

Curtom, Elizabeth Iris → Reporter I

Colorge, Egan → Reporter II & IV

Magbanua, Jolina Kisha → Reporter III

Mecer, Junard → Reporter V

12-StemB

Submitted to:

Mrs. Lorline Agregado