PRESENTATION ON CHOLERA

PRESENTED BY JYOTI PRAKASH

DEFINITION Cholera is an acute diarrhoeal disease caused by VIBRIO

CHOLERAE(bacteria),According to WHO.

MEANING

The word Cholera is derived from a Greek term “KHOLE” that means “flow of bile” and Latin ward “CHOLERA” which means “bilious diarrhoea”.

PROBLEMS STATEMENT IN INDIA

• From 1997 to 2006, there are 37,783 case of cholera occurred in India and 84 deaths are occurred, according to WHO.

• Onwards of 2006, there is no measure outbreaks of cholera happened in India

PROBLEM STATEMENT IN ODISHA

• The most affected area are the KBK districts.

• The deaths are occurred in a large number but there is no government report.

• The no. of death is 28 from 2000 to 2011 according to ZEE news.

EPIDEMIOLOLOGICAL DETERMINANAT

Cholera is both epidemic and endemic disease .

Epidemics of cholera are characteristically abrupt and often create an acute public health problem. They have a high potential to spread fast and causes death.

In areas where cholera is endemic , it does not show a stable endemicity. It under goes seasonal fluctuations. The seasonal variation differs between countries and even between regions of the same country.

DETERMINANTS are 1. AGENT FACTOR

2. HOST FACTOR

3. ENVIRONMENTAL FACTOR

AGENT FACTORa) Agent

b) Resistance

c) Toxin Production

d) Reservoir of Infection

e) Infective Material

f) Infective Dose

g) Period of communicability

HOST FACTORa) Age and sex

b) Gastric acidity

c) Population mobility

d) Economic status

e) Immunity

ENVIRONMENTAL FACTOR

• Transmission is readily possible in a community with a poor environmental sanitation.

• Transmission is possible due to contaminated water food in the community.

CARRIERS IN CHOLERA• THERE ARE SOME CARRIERS FOR CHOLERA

Preclinical or, Incubatory carrier

Convalescent carrier

Contact or, healthy carrier

Chronic carrier

MODE OF TRANSMISSIONTransmission occurs in this way

Fecally contaminated water

Contaminated food water

Direct contact

INCUBATION PERIOD The duration of incubation period is form few hours up to 5 days ,but it is commonly 1 -2 days.

CLINICAL FEATURES The severity of Cholera is dependent on the rapidity and duration of fluid loss. The infected person has several symptoms which can be characterized by:- Dehydration

• Dry Mouth

• Abdominal Cramps

• Dry skin

Excessive Thirst

• LEG CRAMPS

• LOW URINE OUT PUT• LOW BLOOD PRESSURE

• NAUSEA

• VOMITING• RAPID HEART RATE• SUNKEN EYES

• TIREDNESS

• UNUSUAL SLEEPINESS

• WATERY DIARRHOEA

LABORATORY DIAGNOSIS OF CHOLERA IT UNDERGOES SOME STAPES.THESE ARE :- (1) COLLECTION OF STOOLS (2) COLLECTION OF VOMITUS (3) COLLECTION OF CONTA MINATED WATER (4) COLLECTION OF FOOD SAMPELS (5) MAINTAIN GOOD TRANSPORT OF THESE SAMPLES (6) DIRECT EXAMINATION (7) CULTURE METHODS (8)CHARACTERISATION (9) BIOCHEMICAL TEST (10) FURTHER CHARACTERISATION

TREATMENT ANDCONTROL OF CHOLERA

A. Verification of the diagnosisB. NotificationC. Early case findingD. Establishment of treatment centresE. Rehydration therapyF. Adjuncts to therapyG. Sanitation measures H. VaccinationI. Home treatment

• Verification of the diagnosis All case of diarrhoea should be investigated even on the slightest

suspicion.

• Notification Cholera is a notifiable disease,locally,nationally and internationally.

Health workers at all levels should be trained to identify and notify case immediately to initiate prompt treatment.

• Early case finding An aggressive search for cases should be made in the community to

be able to imitate prompt treatment.

• Establishment of treatment centres A health care team should made their camp in the cholera affected

area to provide rapid care

• Rehydration therapy It is two types (1)Oral rehydration (2)Intravenous rehydration

• Adjuncts to therapy Some antibiotics are added to the therapy. for example :-Doxycycline once a day Tetracycline 4 times per day for 3 days Furazolidone 4 times per day for 3 days

• Sanitation measures It works under 4 steps. These are :- (1) water control (2)excreta disposal (3)food sanitation (4)disinfection

• Vaccination It is two types:- (a) parenteral vaccine(b) oral vaccine (a) parenteral vaccine Preliminary immunization consists of two equal doses injected

subcutaneously at an interval of 4 to 6 weeks .

The vaccine is a saline suspension of approximately 6000 million each of classical Ogawa and Inaba serotype of V.cholerae O1 per ml.

Age group 1st dose 2nd dose

Over 10 years 0.5 ml 0.5 ml

2-10 years 0.3 ml 0.3 ml

1-2 years 0.2 ml 0.2 ml

• (b) oral vaccine Two type of Vaccines are available

• . A vaccine consisting of killed whole – cell V. Cholerae O1 in combination with a recombinant B-sub unit of cholera toxin is available since early 1990s. Work out is 50 – 60% for 3 years .

• Since 1994, Another oral vaccine is the live, attenuated CVD 130-HgR vaccine containing the genetically manipulated classical V.cholerae strain CVD 103 – HgR. Work out 80%.

Home treatment

• Use of Guava Root Bark: Thirty grams of the root bark should be used in half a litre of water to make the decoction. The water should be boiled down to reduce it by one-third. This decoction can be taken twice daily.

Home treatment

• Use of Onion: Onions are another valuable remedy for cholera. About thirty grams of onion and seven black peppers should be pounded finely in a pestle and given to the patient in two or three doses during the day.

Home treatment• Use of Bitter Gourd: The fresh juice of bitter gourd is an

effective medicine in the early stages of cholera. Two teaspoons of this juice, mixed with an equal quantity of white onion juice and a teaspoon of lime juice, should be given twice daily.

Home treatment

• Use of Cucumber: A glass of fresh juice of cucumber leaves with an equal quantity of tender coconut water, given in doses of 30-60 ml, forms a valuable remedy for excessive thirst during cholera.

Home treatment

• Use of Clove: Cloves are useful in cholera. About four grams of cloves should be boiled in three litres of water until half of the water has evaporated. The decoction thus prepared should be given to the patient several times during the day.

ROLE OF NURSE

• A nurse plays an important role in the field of health education at a community.

• Teach them how to escape from the infection of cholera. Some methods are:-• Drink only boiled water or water that has been

treated with chlorine or iodine. • Eat only thoroughly cooked food and are still hot, or

fruit that you have peeled yourself. • Avoid undercooked or raw fish.

ROLE OF NURSE

• Make sure all vegetables are cooked properly, avoid salads.

• Avoid foods and beverages from street vendors. • Do not bring perishable seafood. • Check for proper sanitation and water purification

systems.• Give liquid bland foods, lemon, onions and mint to

the patient.• Vegetables and fruits must be washed with solution

of potassium permanganate.

A SHORT STORY OF CHOLERA

• Park.K. Park’s text book of preventive and social medicine.18th edition. 2005.Jabalpur:M/s Banarasidas Bhanot;1970.Page no – 175 to 183.

• www.thehindu.com• www.google.com• www.en.wikipedia.org• www.whereincity.com• www.youko.com/suko