By

Dr. ANUGOM Emeka.

CHOLERA

1. WHAT IS CHOLERA?

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• An acute diarrhoeal disease that can kill within hours if untreated in both children and adults.

• There are 3-5 million cases every year, with 100,000 to 120, 000 deaths from cholera every year. Common in Asia and Africa

• Incubation period is from 6 hours to 5 days.

• It’s caused by bacteria Vibrio cholerae, with two serotypes O1 (mainly) and O139 having the potential of causing outbreaks

2. HOW IS CHOLERA SPREAD?

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• Poor Sanitation

• Drinking Contaminated Water

• Eating Contaminated Food

• COMMON SOURCES

• - Raw or poorly cooked seafood

• - Raw fruit and Vegetables

• - Other foods contaminated during preparation and storage.

• Main source is bacteria in faeces of infected person.

• Poor sewage and water treatment.

• Over populated areas have highest risk.

3. THE SITUATION IN NIGERIA

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• Nigeria reported Cholera epidemics in 2010 and 2011, with an estimated 2000 deaths during this period.

• This was mainly due to poor sanitation and over population, scarcity of clean drinking water

• It is usually prevalent in the rainy seasons between April to October.

• Currently in 2013, there have been over 1600 reported cases, with an estimated 86 deaths from cholera.

• Zamfara and Nasarawa states in Nigeria are the worst hit states.

• However cases have also been reported in Kebbi, Sokoto, Plateau, Lagos, Ogun and Oyo state

4. THE SITUATION IN NIGERIA

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5. SYMPTOMS OF CHOLERA

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• Mostly mild diarrhoea or no symptoms at all.

• However in 5-10% of patients, very severe watery diarrhoea (rice-water stool) and vomiting may occur

• If untreated, this leads to:

• Severe dehydration from fluid loss and

• Death within hours.

6. PREVENTION OF CHOLERA

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• Simple Rule:

• Boil it – Cook it – Peel it OR Forget it.

• 1. Drink only properly treated water

• N:B Beverages (tea/coffee), Wine, Beer, Carbonated water and Soft drinks, Bottled/packaged fruit juices are usually safe to drink.

• 2. Avoid Ice unless you’re sure it’s from safe water source.

• 3. Eat food that has been well cooked and served still hot.

• (food at room temperature for several hours and served without reheating is a source of infection)

7. PREVENTION OF CHOLERA

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• 4. Avoid raw seafood and other raw foods. (Fruits and Vegetables properly peeled and shelled by you is an exception)

• 5. Boil unpasteurized milk before drinking it.

• 6. If in doubt of reliability of source of ice cream, avoid it .

• 7. Ensure meals bought from street vendors are thoroughly cooked in your presence and do not contain uncooked foods.

• 8. Proper hand washing , especially before food preparation, during meals, work and after use of sanitary facilities

8. TREATMENT FOR CHOLERA

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• 1. SEEK MEDICAL HELP URGENTLY

• 2. REHYDRATION:

• MOST important, especially for diarrhoea and vomiting, to replace water and salt lost early.

• A. Use oral rehydration salts, if unavailable take water and other non-sweetened fluids e.g. soup.

• B. Give intravenous fluid infusion in the severely dehydrated.

9. TREATMENT OPTIONS FOR CHOLERA

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• 3. ANTIBIOTICS:

• May be used in some cases to shorten illness duration.

• However not recommended for MASS treatment as it doesn’t limit the spread

• ANTIDIAARHOEAL DRUGS:

• Loperamide (Imodium) use is NOT recommended and should NOT be given.

10. IMMUNIZATION FOR CHOLERA

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• VACCINATION:

• INJECTABLE CHOLERA VACCINE:

• Formerly used and gives incomplete, unreliable protection for short period. With adverse effects and thus no longer recommended.

• ORAL CHOLERA VACCINE:

• There are two types that give good protection for up to 3years.

• But doesn’t give 100% protection. Hygiene and sanitary precautions should also be applied.

• Given in 2 doses for those above 6yrs old and 3 doses for those 2-6yrs old, 7days to 6 weeks apart.

11. IMMUNIZATION FOR CHOLERA

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• They are both whole-cell killed vaccines, licensed for use in over 60 countries by WHO.

• No meal should be taken 1 hour before and after taking it to ensure gut absorption.

• No country requires proof of this vaccination.

• SHANCHOL

• This is gives long-term protection against V cholerae O1 and O139 in children under 5years.

• DUKORAL

• This has recombinant B-sub unit, with short term protection 85-90% against V. cholerae O1 in all age groups 4-6mths of immunization

• Given in 150ml of water

• Also useful in diarrhoea caused by Enterotoxigenic E.Coli (ETEC)

12. REFERENCES

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• http://www.who.int/mediacentre/factsheets/fs107/en/

• http://www.who.int/topics/cholera/faq/en/

• http://www.patient.co.uk/health/cholera-immunisation

• https://www.internationalsos.com/en/country-guides.htm

• https://www.internationalsos.com/demo/CountryGuides/DiseasesPrevention.cfm?Img=Dp&Pg=Diseases%20Prevention

• http://www.niaid.nih.gov/topics/cholera/Documents/CholeraFactSheet.pdf

• http://news.yahoo.com/cholera-kills-nine-100-hospitalised-nigeria-195406146.html

• http://www.npr.org/blogs/health/2010/10/29/130923065/tracking-the-origins-of-haiti-s-cholera-strain

• http://liveshots.blogs.foxnews.com/2011/01/10/haiti-one-year-later-the-cholera-crisis/

• http://www.cdc.gov/cholera/

• http://minustahphoto.blogspot.com/2010/11/cholera.html

• http://intrd187-f11-grosovsky.wikispaces.umb.edu/Cholera

• http://www.bbc.co.uk/news/world-africa-11093831

• http://telegraphng.com/2013/10/cholera-outbreak-kills-47-zamfara/

• http://evatese.wordpress.com/

• http://www.bbc.co.uk/blogs/africahaveyoursay/2010/08/what-do-you-know-about-cholera-1.shtml

• http://edition.cnn.com/2010/WORLD/africa/10/26/nigeria.cholera/

• http://scannewsnigeria.com/breaking-news/cholera-kills-50-in-northern-nigeria/

• http://www.nigeriahealthwatch.com/2010/09/nigeria-at-50-cholera-outbreak-and.html

• http://www.un.org/apps/news/story.asp?NewsID=39145&Cr=cholera&Cr1

• http://www.rayur.com/cholera-causes-symptoms-and-treatment.html

• http://www.msf.org.au/from-the-field/field-news/field-news/article/cameroon-chad-niger-nigeria-medecins-sans-frontieres-intervenes-in-several-cholera-outbreaks.html

• http://newshopper.sulekha.com/nigeria-cholera_photo_1502991.htm

• http://www.haiti.mphise.info/health-education?page=1

QUESTIONS

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