How to Avoid Cholera

LIKE a bolt out of the blues, the Lagos State Government, during the week issued an alert about an outbreak of cholera in the State. Even before the announcement, fatalities had been recorded out of at least a dozen reported cases.

Earlier in the week, a similar outbreak in the Northern part of the country had elicited concern. In Nigeria, cholera is endemic and outbreaks are not unusual. Although reports of epidemics have not been consistent, the disease is very dynamic. The emergence of cholera in Nigeria was evident in 1970 and in 1991.   During the last two decades, three major epidemics have occurred in Ibadan that was attributed to contaminated potable water sources. Street vended water and not washing of hands with soap before eating food were possible reasons for the 1995-1996 cholera outbreaks in Kano state. The 2010 outbreak of cholera was speculated to be directly related with breaches in sanitation and water supply.

What it is

Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. It is a universal threat to public health and a key indicator of lack of social development. An estimated 3-5 million cases and over 100,000 deaths occur each year around the world. In a cholera endemic area, outbreaks usually occur as a result of bad or absent sanitation and/or sewage services.

How does it infect people?

Why do people come down with cholera? It is usually as a result of poor hygiene. People acquire the infection by consuming contaminated water, seafood, or other foods. Once infected, they excrete the bacteria in stool. Thus, the infection can spread rapidly, particularly in areas where human waste is untreated.  The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill.

In the Lagos outbreak, suspected cases were allegedly contracted from food sources such as the African food salad popularly called ‘Abasha’, contaminated well-water sources, infected foods from food sellers, and other unhygienic habits.    Usually, the source of the contamination is other cholera patients when their untreated diarrhoea discharge is allowed to get into water supplies.

Symptoms

According to the Centers for Disease Control and Prevention Cholera infection is often mild or without symptoms, but can sometimes be severe. Approximately one in 20 infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours. It can take anywhere  from a few hours to five days for symptoms to appear after infection. Symptoms typically appear in 2-3 days.

Characteristics of  Vibrio cholera

About 75 percent of people infected with V. cholera do not develop any symptoms, although the bacteria are present in their faeces for 7-14 days after infection and are shed back into the environment, potentially infecting other people.  Among people who develop symptoms, 80 percent have mild or moderate symptoms, while around 20 percent develop acute watery diarrhoea with severe dehydration.

In severe infections, more than one quart of water and salts is lost per hour. The stool looks gray and has flecks of mucus in it— termed “rice water stools”. Within hours, dehydration can become severe, causing intense thirst, muscle cramps, and weakness. Very little urine is produced and the eyes may become sunken, and the skin on the fingers may become much wrinkled.

If dehydration is not treated, loss of water and salts can lead to kidney failure, shock, coma, and death. In people who survive, symptoms usually subside in three to six days. Most people are free of the bacteria in two weeks. The bacteria remain in a few people indefinitely without causing symptoms. Who is most affected Cholera infection rate, sex and age distribution and seasonality are not constant. Children are often the most affected among all age groups. Cholera exists as a seasonal disease, occurring mostly during rainy seasons. Rainfall is a driver of the seasonal cycle of cholera through its waterborne transmission, its dose-dependent nature of infection, and the decline of cases during the rainy season.

Risk factors

Lack of safe water and poor sanitation are important risk factors. For a cholera outbreak to occur, two conditions have to be met—there must be significant breaches in the water, sanitation, and hygiene infrastructure used by groups of people, permitting large-scale exposure to food or water contaminated with Vibrio cholera organisms; and cholera must be present in the population. The principal mode of transmission is ingestion of contaminated water or food. If you think you may have cholera, seek medical attention immediately.

Dehydration

can be rapid so fluid replacement is essential.

Complications

Infection with cholera can result in a range of responses, from severe and life threatening diarrhoea to mild or unapparent infections. Sanitation and nutrition are particularly important factors and it has become clear that good sanitation and hygienic practices largely prevent the disease. Vibrio cholera infection is known to be more severe in individuals suffering from malnutrition.

Diagnosis

To test for cholera, doctors must take a stool sample or a rectal swab and send it to a laboratory to look for the cholera bacterium. Treatment & management The mainstay of the case management of cholera is treatment of dehydration using Oral Rehydration Therapy (ORS) or IV fluids (Ringer lactate) and electrolytes. In cholera management, antibiotic prophylaxis is usually not part of intervention but essential for disease treatment in severe cases.

However, Vibrio cholera strains from endemic and outbreaks situation within the last decade revealed What you should do to avoid cholera infectioninteresting patterns of antibiotic resistance to commonly used antimicrobial agents. Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as receiving rehydration.

How to avoid infection

There is a clear link to poverty, dirty environment, and lack of social amenities including provision of good water sources. These factors definitely impart much on the frequency and severity of the disease as well as its epidemic potential. The risk for cholera is very low when simple precautions are observed and contracting the disease is unlikely.

Vanguard