Cholera

- Cholera is an acute, diarrheal illness caused by infection of the intestine with the
toxigenic gram-negative, comma-shaped bacterium Vibrio cholera
- There exists more than 200 serogroups of V.cholera but only two cause epidemic
disease: serogroup O1 and O139
- Cholera is considered a disease of poverty and is usually associated with poor
sanitation and poor access to clean drinking water
- The infection is often mild or without symptoms, but can sometimes be severe
and life threatening
- Worldwide distribution:

- Transmission pattern:
o It is mainly spread through fecal contamination of food and water
o Toxigenic V. cholera O1 and O139 are free living organisms found in fresh and
brackish water
o Infection is most commonly acquired from drinking water in which V.cholera is
found naturally or which has become contaminated through infected feces
o Contaminated fish and shellfish are also common routes of transmission
o Humans are the only known natural host and direct transmission from person to
person is uncommon
- Risk population:
o Travelers in area of active cholera transmission
o Cholera response workers
o Healthcare personnel treating cholera patients
- Morbidity/Mortality Trends (WHO)
o In 2016, total of 28 countries reported a cumulative total of 132,121 cases
o 2,420 deaths (case fatality rate of 1.8%)

- Symptoms
o Profuse water diarrhea aka “rice-water stools”
o Vomiting
o Rapid heart rate
o Loss of skin elasticity
o Dry mucous membranes
o Low blood pressure
 o Thirst
o Muscle cramps
o Restlessness or irritability
- Diagnosis and Detection
o Gold standard: isolation and identification of Vibrio cholera serogroup O1 or
0139 by culture of a stool specime
o Rapid tests: Crystal-VC dipstick
- Treatment
o Rehydration therapy – prompt restoration of lost fluids and salts through
rehydration therapy is the primary goal of treatment
o Antibiotic treatment – reduces fluid requirements and duration of illness is
indicated for severe cases of cholera
o Zinc treatment – shown to help improve cholera symptoms in children
- Prevention and Control
o Five Basic Cholera Prevention Steps
 Drink and use safe water
 Wash hands often with soap and safe water
 Use latrines or bury your feces; do not defecate in any body of water
 Cook food well (specially sea food); keep it covered, eat it hot, and peel
fruits and vegetables
 Clean up safely – in the kitchen and in places where the family bathes and
washes clothes
o Vaccines
 Vaxchora (lypophilized CVD 103-HgR) – a single dose live oral cholera
vaccine approved for adults 18-64 years old who are travelling to an area
of active cholera transmission
 Dukoral, ShanChol, and Euvichol-Plus/Euvichol – oral inactivated, or non-
live cholera vaccines prequalified by WHO
- Effect of human activities and global warming in the reemergence of the disease
o Large population migration into urban centers in developing countries are
straining existing water and sanitation infrastructure and increasing disease risk
o Simple rehydration treatment saves lives, but logistics of delivery in remote
areas remain difficult during epidemic periods
o Accompanying antibiotic treatment is helpful but may be difficult because of
growing antimicrobial resistance
o Natural reservoirs for the bacterium in warm coastal waters make eradication
very unlikely.