Key facts from WHO website
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Cholera is an acute
diarrhoeal disease that can
kill within hours if left
untreated.
Researchers have estimated
that each year there are 1.3
to 4.0 million cases of
cholera, and 21 000 to 143
000 deaths worldwide due
to cholera.
Most of those infected will
have no or mild symptoms,
and can be successfully
treated with oral rehydration
solution.
Severe cases will need rapid
treatment with intravenous
fluids and antibiotics.
Provision of safe water and
sanitation is critical
to contro the transmission
of cholera and other
waterborne diseases.
Oral cholera vaccines are an
additional way to control
cholera, but should not
replace conventional control
measures.
Safe oral cholera vaccines
should be used in
conjunction with
improvements in water and
sanitation to control cholera
outbreaks and for prevention
in areas known to be high
risk for cholera.
cholera have mild symptoms but they
contribute to the spread of the disease.
The most common symptom is a
profuse watery diarrhea that appears
like a clear fluid with white flecks
which we call rice water diarrhoea. I
liked the description of one researcher
from KEMRI on TV: this rice water
appearance is caused by the toxin,
which makes the intestinal lining
peel off. The white flecks in essence
are specs of the mucosal lining of the
intestines.
About one in 20 people infected have
64 MAL 19/17 ISSUE
severe watery diarrhea accompanied
by vomiting, which can quickly lead
to dehydration. Signs and symptoms
of dehydration include: Rapid pulse or
heart rate; Loss of skin elasticity (the
ability to return to original position
quickly if pinched); Dry mucous
membranes, including the inside of
the mouth, throat, nose, and eyelids;
Low blood pressure; Thirst; and
Muscle cramps.
Left untreated, dehydration can lead to
shock and death in a matter of hours.
How do we treat cholera?
Most diseases are treated either
definitively (aimed at eradicating the
cause of the disease) or supportively
(aimed at controlling symptoms).
For cholera the mainstay of treatment
is supportive i.e. controlling or
preventing dehydration. This is done via
the use of oral rehydration salts (ORS)
and in severe dehydration intravenous
supplementation with fluids. The fluid
replacement has to be very aggressive
and replacement of more than 7L of
fluids is possible in very severe cases.
This is because patients can lose more
than the same amount and with the
lining gone even the oral rehydration
may not be effective.
Fluid loss will also lead to an
electrolyte imbalance, renal failure and
multi-organ failure if not managed
well with subsequent death as can be
seen in recent events.
Definitive treatment
Definitive treatment involves the use
of antibiotics, which kill the bacteria,
are not part of emergency treatment
for mild cases. But they can reduce the
duration of diarrhea by half and also
reduce the excretion of the bacteria,
thus helping to prevent the spread of
the disease.
The most commonly used is a single
dose of doxycycline. This drug
is contraindicated in pregnancy.
‘ A multi-sectorial
and coordinated
approach is
paramount to
efficiently control
a cholera outbreak.
Key sectors to
be involved are
health, water and
sanitation, fishery
and agriculture, and
education.’’
Azithromycin is recommended as
first-line treatment for children
and pregnant women (the only
professional advice I’m giving as a
gynae in this article). Erythromycin
is a safe alternative to doxycycline but
azithromycin has proved to be more
effective.
Prevention (CDC)
The risk for cholera is very low for
people visiting areas with cholera
epidemic. When simple precautions
are observed, contracting the disease is
unlikely.
All people (visitors or residents) in
areas where cholera is occurring or has
occurred should observe the following
recommendations:
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Drink only bottled, boiled, or
chemically treated water and
bottled or canned carbonated
beverages. When using bottled
drinks, make sure that the seal
has not been broken. To disinfect
your own water: boil for 1 minute
or filter the water and add 2 drops
of household bleach or ½ an
iodine tablet per liter of water.
Avoid tap water, fountain drinks,
and ice cubes.