Cholera

Cholera
❖Cholera is an acute intestinal infection. In severe conditions, it becomes
rapidly fatal. Within an hour of the onset of symptoms in a healthy
individual, the blood pressure drops down to hypotensive levels, and the
individual may die if not treated medically within three hours.

Causative Agent
The causative agent of cholera is a gram-negative bacterium, Vibrio cholerae,
which produces an enterotoxin (cholera toxin). This enterotoxin acts on the
mucosal epithelium lining of the small intestine, and causes exhaustive
diarrhoea (the most salient feature of this disease).

Other causes of cholera include:

✓ Exposure to poor hygienic conditions
✓ Eating raw or undercooked food
✓ Deficiency or lack of hydrochloric acid makes an individual prone to
cholera.
Where is cholera found?
The cholera bacterium is usually found in water or in foods that have been
contaminated by feces (poop) from a person infected with cholera bacteria.
Cholera is most likely to occur and spread in places with inadequate water
treatment, poor sanitation, and inadequate hygiene.
Causative Agent of Cholera
Mode of Transmission
Mode of Transmission…
• The most common contamination source is the faeces of an infected person,
which contaminates the water and food. The disease spreads rapidly in areas
where proper treatment of sewage and drinking water is not carried out.
• Cholera does not spread from one person to another; thus, a healthy person
cannot become ill through a casual contact with an infected person.
 Symptoms
• Symptoms appearing 1-3 days after infection range from mild,
uncomplicated diarrhoea to severe, and potentially fatal disease.
• Mostly, the infection is mild or asymptomatic (i.e., without symptoms), but
sometimes it can be severe. Symptoms of cholera include:

1. Abdominal and leg cramps,

11) Vomiting
2. Dehydration,
12) Unusual sleepiness
3. Diarrhoea with a fishy odour,
4. Dry mouth and skin
5) Excessive thirst,
6) Low urine output
7) Reduced blood pressure
8) Nausea
9) Rapid heart rate
10) Tiredness
Treatment
1. Oral or intravenous hydration is the primary treatment for cholera.
2. Doxycycline is recommended as first-line treatment for adults (including
pregnant women) and children. If resistance to doxycycline is
documented, Azithromycin and Ciprofloxacin are alternative options.
3. Intravenous fluids. Most people with cholera can be helped by oral
rehydration alone, but severely dehydrated people might also need
intravenous fluids.
4. Zinc is an important adjunctive therapy for children under 5, which also
reduces the duration of diarrhoea and may prevent future episodes of
other causes of acute watery diarrhoea.

5. Oral cholera vaccines:-

• There types of vaccines are available:-
1. Dukoral (WC-rBS)
2. Sanchol
3. Euvichol
 INSTRUCTIONS FOR USE:

1. To prepare the buffer solution, dissolve the effervescent granules in a glass of cool
water (approx. 150 ml) by gently stirring. Do not use any other liquid. For
children of 2 to below 6 years: pour away half of the buffer solution.
2. Shake the Dukoral® suspension vial (1 vial = 1 dose).
3. Pour the content of the Dukoral® suspension vial into the glass of buffer solution
(see 1). Mix by gently stirring.
4. Drink the entire mixture within 2 hours. Avoid food and drink starting 1 hour
before until 1 hour after drinking the mixture.
 Prevention and Control of Cholera
1. If you think your water may not be safe- treat it with a chlorine product,
boil it, treat with bleach, or filter it.
• Treat with Chlorine Product
• Treat your water with one of the locally available chlorine treatment products
and follow the label instructions.
• Or Boil it
• If a chlorine treatment product is not available, boiling is an effective way to
make water safe. Bring your water to a rolling boil for 1 minute. Note: Boiled
water is at risk for re-contamination if not stored and used safely.
• Or Treat with Bleach
• If you cannot boil water, treat water with household bleach. Add 8 drops of
household bleach for every 1 gallon of water (or 2 drops of household bleach
for every 1 liter of water) and wait 30 minutes before drinking.
• Or Filter It
• If filtering, use a device with a pore size less than or equal to 0.3 microns and
treat the water with a disinfectant such as chlorine, chlorine dioxide, or iodine.
• Always store your treated water in a clean, covered container.
 2. Wash your hands often with soap and safe water.
1. Before, during, and after preparing food.
2. Before and after eating food or feeding your children.
3. After using the toilet.
4. After cleaning your child’s bottom.
5. After taking care of someone who is sick with diarrhea.
6. If you don’t have access to soap and water, use an alcohol-based hand
rub with at least 60% alcohol.
 3. Use toilets
• Use toilets to get rid of feces. This includes disposal of children’s poop.
• Wash hands with soap and safe water after going to the bathroom.

4. Boil it, cook it, peel it, or leave it.

1. Cook food well, keep it covered, eat it hot, and peel fruits and vegetables.
2. Eat foods that have been thoroughly cooked and are still hot and steaming.
3. Be sure to cook seafood, especially shellfish, until it is very hot all the
way through.
4. Avoid raw vegetables and fruits that cannot be peeled.
 5. Clean up safely.

1. Clean food preparation areas and kitchenware with soap and treated
water and let dry completely before reuse.
2. Bathe and wash clothes or diapers 30 meters (100 feet) away from
drinking water sources.
3. Clean and disinfect toilets and surfaces contaminated with poop: clean
the surface with a soap solution to remove solids; then disinfect using a
solution of 1 part household bleach to 9 parts water.
4. When finished cleaning, safely dispose of soapy water and dirty rags.
Wash hands again with soap and safe water after cleaning and
disinfecting.
 How Family Members Can Prevent Infection
• Drink and use safe water.
• Cook food thoroughly.
• Wash hands with soap and safe water after caring for the patients, and
especially after handling poop.
• Remove and wash any bedding or clothing that may have had contact with
diarrhea, preferably in a washing machine using warm or hot water. Usual
machine detergents are sufficient; bleach is not necessary.
• Use a flush toilet or approved septic system; double bag soiled materials
(items contaminated with poop) when throwing them away.
• Use any household disinfectant or a bleach solution made up of 1 part
bleach to 9 parts water to clean any area that may have contact with poop,
including the patient’s bathroom, bedpan, as soon as possible after being
soiled.
• When possible, use rubber gloves when cleaning any room or surface that
may have had contact with the patient’s poop.
• If another household member starts having diarrhea, give them oral
rehydration solution (ORS) and go to a healthcare provider immediately.
• While caring for persons who are sick with cholera, do not serve food or
drink to anyone outside of the household.