CHOLERA

Presented by: Iris Balino

Presented to: Dr. Dario V. Sumande
IDENTIFICATION
• The German bacteriologist, Robert Koch (1843-1910), studied the
disease during an epidemic in Egypt. He found a bacterium in the
intestines of those who had died of cholera but could neither isolate
the organism nor infect animals with it.
• Later that year, Koch went to India, where he succeeded in
isolating the bacteria. He discovered that they thrived in damp, dirty
linen and moist earth, and in the stools of patients with the disease.

Medical News Today, 2018

IDENTIFICATION
• Cholera is an acute diarrheal infection caused by ingestion of food or
water contaminated with the bacterium Vibrio cholerae. Cholera
remains a global threat to public health and an indicator of inequity
and lack of social development.

World Health Organization, 2019

Symptoms
Only around 1 in 20 cholera infections are severe, and a high percentage of infected
people show no symptoms.
If symptoms appear, they range from mild or asymptomatic to severe.
They typically include:
• large volumes of explosive watery diarrhea, sometimes called "rice water stools"
because it can look like water that has been used to wash rice
• vomiting
• leg cramps
• A person with cholera can quickly lose fluids, up to 20 liters a day, so severe
dehydration and shock can occur.
Medical News Today, 2018
 Signs of dehydration include:
• loose skin • fast heart beat
• sunken eyes • low blood pressure
• dry mouth • dizziness or lightheadedness
• decreased secretion, for example, • rapid weight loss
less sweating
Shock can lead to collapse of the circulatory system. It is a life-threatening condition
and a medical emergency.
Medical News Today, 2018
INFECTIOUS AGENT
• It is caused by the bacterium Vibrio cholera (V. cholera).
OCCURENCE
• Worldwide, there are an estimated 3–5 million cholera cases and
100,000–120,000 deaths due to cholera every year. In the Philippines,
diarrhea was one of the top ten causes of death in 2011. (WHO-Western
Pacific Region, 2011)
• Researchers have estimated that every year, there are roughly 1.3 to 4.0
million cases, and 21 000 to 143 000 deaths worldwide due to cholera.
(World Health Organization, 2019)
• From 2008 to 2013, 42,071 suspected and confirmed cholera cases were
reported in 87% of provinces and metropolitan areas in the country,
confirming the endemicity of cholera in the Philippines. (Lopez, et al.,
2015)
RESERVOIR
• Marine and freshwater aquatic environments where vibrios can survive for
years. Contaminated water forms the reservoir of vibrios with humans as the
only host. V. cholerae has been shown to survive for up to 14 days in food.
MODE OF TRANSMISSION
• Primary: Ingestion of water or food (e.g. raw or undercooked
shellfish, foods washed in contaminated water) contaminated with the
feces or vomitus of infected persons is the predominant method of
transmission of cholera. Foodborne transmission probably accounts
for about 60% of cases in the developed world.
• Secondary: Person to person transmission is not a major method of
spread but transmission by ready to eat food touched by
contaminated hands is possibly important for onward transmission
within households.
INCUBATION PERIOD
• The incubation period ranges from 12 hours to 5 days after the
exposure.
PERIOD OF COMMUNICABILITY
• Patients are infectious from the onset of symptoms until seven days
after resolution of diarrhea. The carrier state may develop and
persist for a few months, but very rarely.
SUSCEPTIBILITY OF THE DISEASE
Risk factors
Everyone is susceptible to cholera, with the exception of infants who
derive immunity from nursing mothers who have previously had cholera.
Still, certain factors can make you more vulnerable to the disease or more
likely to experience severe signs and symptoms.
Risk factors for cholera include:
• Poor sanitary conditions.
• Reduced or nonexistent stomach acid (hypochlorhydria or
achlorhydria).
• Household exposure.
• Type O blood. For reasons that aren't entirely clear, people with type
O blood are twice as likely to develop cholera compared with people
with other blood types.
• Raw or undercooked shellfish.
METHODS OF CONTROL
• Cholera is generally a disease spread by poor sanitation, resulting in
contaminated water supplies. Controlling the disease goes a long with
application of sanitary principles protecting drinking water and food from
contamination with human feces. At present, the excellent sanitation facilities
in the US are responsible for the near eradication of epidemic cholera.
However underdeveloped areas are still afflicted with epidemic cholera.
PREVENTION
If you're traveling to cholera-endemic areas, your risk of contracting the
disease is extremely low if you follow these precautions:
• Wash hands with soap and water frequently, especially after using the
toilet and before handling food. Rub soapy, wet hands together for at
least 15 seconds before rinsing. If soap and water aren't available, use
an alcohol-based hand sanitizer.
• Drink only safe water, including bottled water or water you've boiled or
disinfected yourself. Use bottled water even to brush your teeth. Hot
beverages are generally safe, as are canned or bottled drinks, but wipe
the outside before you open them. Avoid adding ice to your beverages
unless you made it yourself using safe water.
• Eat food that's completely cooked and hot and avoid street vendor
food, if possible. If you do buy a meal from a street vendor, make sure
it's cooked in your presence and served hot.
• Avoid sushi, as well as raw or improperly cooked fish and seafood of
any kind.
• Stick to fruits and vegetables that you can peel yourself, such as
bananas, oranges and avocados. Stay away from salads and fruits
that can't be peeled, such as grapes and berries.
• Be wary of dairy foods, including ice cream, which is often
contaminated, and unpasteurized milk.
METHODS OF CONTROL
Cholera vaccine
• There are currently three cholera vaccines recommended by the
World Health Organization (WHO). These are Dukoral, Shanchol, and
Euvichol.
All three require two doses to give full protection.

• Dukoral needs to be taken with clean water, and it provides roughly

65 percent protection for 2 years. Shanchol and Euvichol do not need
to be taken with water, and they provide 65 percent protection for 5
years. All the vaccines offer higher protection nearer to the time they
are given.
TREATMENT
Cholera requires immediate treatment because the disease can cause
death within hours.

• Rehydration. The goal is to replace lost fluids and electrolytes using a

simple rehydration solution, oral rehydration salts (ORS). The ORS
solution is available as a powder that can be reconstituted in boiled or
bottled water. Without rehydration, approximately half the people with
cholera die. With treatment, the number of fatalities drops to less than 1
percent.
• Intravenous fluids. During a cholera epidemic, most people can be
helped by oral rehydration alone, but severely dehydrated people may
also need intravenous fluids.
• Zinc supplements. Research has shown that zinc may decrease and
shorten the duration of diarrhea in children with cholera.
• Antibiotics. While antibiotics are not a necessary part of cholera
treatment, some of these drugs may reduce both the amount and
duration of cholera-related diarrhea for people who are severely ill.