CHOLERA

Infectious gastroenteritis caused by enterotoxin-producing

strains of the bacterium Vibrio cholerae

• Causative agent:
Vibrio cholerae serogroup O1 includes two biotypes: Classical and
El Tor.
A serogroup of Vibrio cholerae 0139 was found to be responsible for
the large-scale epidemic that occurred in India and Bangladesh in
late 1992.

• Reservoir of infection:
Human either cases or carriers
The organism found exit through stool and vomitus of cases

• Modes of infection
Food borne through ingestion of food or water contaminated directly
or indirectly with faeces or vomitus of infected persons.
• Incubation period: From few hours to 5 days, usually 2-
3 days

• Period of communicability: For the duration of stool

positive stage usually only few days after recovery

• Severe typical cases usually suffer from:

- Sudden profuse painless watery diarrhea and vomiting,
no fever
- In untreated cases, rapid dehydration occurred due to
loss of fluids and electrolytes.

• Asymptomatic infection is much more frequent than

clinical illness, especially with organism of the El Tor
biotype
 Prevention
• General measures:
Environmental sanitation including safe water supply, fly control and
food sanitation Health education of the public for proper clean habits

• Specific measures: Active immunization:

with the parenteral whole cell vaccine is of little practical value in
epidemic control or management of contacts of cases. These
vaccines give only 50% protection that last for short duration (3-6
months).

It is not now recommended by WHO and not officially required by

any country. (CDC, 2000).

Immunization with the new oral vaccines is recommended for

individuals from industrialized countries traveling to endemic areas.
 Control
Case:
• Notification to local health authorities
• Isolation at hospitals is only indicated in severe cases.
• Specific treatment: Fluid therapy in case of dehydration and
tetracycline
• Concurrent and terminal disinfection of feaces and vomitus and of
linens and articles used by patients by heat, carbolic acid or other
disinfectants.

Contacts
• Surveillance of persons who shared food and drink with a cholera
patient for 5 days from last exposure.
• Chemoprophylaxis : Tetracycline 500 mg 4 times daily for adults or
50mg/kg/day in 4 divided doses for children.
• Investigate the contacts and source of infection: investigate
possibilities of infection from polluted drinking water and
contaminated food.