CHOLERA

• Acute diarrhoeal disease caused by vibrio cholerae 01 and 0139

• Characterised by sudden onset of profuse, effortless, watery diarrhoea
followed by vomiting, rapid dehydration, muscular cramps and
suppression of urine.
• Case fatality rate-30-40%
Problem burden
 EPIDEMIOLOGICAL FEATURES
AGENT FACTORS
 AGENT: V. Cholerae 01 and 0139
RESISTANCE : Killed within 30mts by heating

TOXIN PRODUCTION: Produces an exotoxin.

RESERVOIR OF INFECTION: Huan being is the known reservoir. Case/carrier
INFECTIVE MATERIAL: Stool and vomitus of cases and carriers
INFECTIVE DOSE: 10
Carriers in cholera

 Pre-clinical or incubatory: short duration, potential patients

Convalescent carriers: patients who have recovered from cholera
Healthy carrier: due to subclinical infection, less duration
Chronic carrier: infrequent, happens for more than 10years
• HOST FACTORS
Age and sex: affects all ages and both sexes, highest in children
Gastric acidity: effective barrier, destroyed by a PH of 5 or less
Population mobility: easily transmits
Economic status: highest in lower socio-economic groups, poor hygiene
Immunity: gains immunity with infection, duration not known
• Environmental factors
Poor environmental sanitation
Low education status
Poor quality of life
Poor personal hygiene
• Mode of transmission: from man to man through,
1. Faecally contaminated water
2. Contaminated foods and drinks
3. Direct contact
 Incubation period: few hours to 5 days
• Clinical features : 3 stages
stage of evacuation: abrupt onset with profuse , painless watery diarrhoea f/b vomiting. Rice water
appearance
Stage of collapse: dehydration occurs. sunken eyes, absent pulse, washerman’s hands and feet,
unrecordable BP,shallow, quick respirations, diminished urine outputincreased thirst, restlessness, and
death may occur
Stage of recovery: shows signs of clinical improvement
Laboratory diagnosis

• By collectin of rectal swab, rectal cathter, vomitus, contaminated water, food samples
• Samples are transported in VR media
• Culture shows scintillating type of appearance in hanging drop preparations
Control of cholera
1.verification of diagnosis
2.Notification: locally and nationally, notifiable to Who within 24 hrs.
3.Early case findings
4.Establishment of treatment centers: mild cases-home treatment with oral rehydration therapy. Severe: IV
fluids in a nearby hospital. Long-distance transport is not desirable
5.Rehydration therapy; ORT
6.Adjuncts to thearpy: antibiotics as soon as vomiting stopped. tetracycline, fluroquinolones, septran,
azithromycin
7.Epidemiological investigations: general sanitation mesures ensured,
8.Sanitation measures : water control, excreta disposal, food sanitation, disinfection (coal tar disinfectant)

9. ;
9. chemoprophylaxis: tetracycline is the drug of choice
10. vaccination: 2 types of oral cholra vaccine available. Dukoral and Morvax
11.Health education
National diarrhoeal diseases control programme