CHOLERA
Frequently Asked Questions?
What is cholera?
Cholera is a diarrheal illness caused by the bacterium Vibrio Cholera. Over 190 serotypes exist but only types O1 and O139 cause an epidemic in humans. The disease is endemic in Asia and Africa, but it has caused an epidemic in Central and South America. Cholera is associated with poor sanitation and water treatment. The incubation period varies from 5 hours to 5 days but is typically 24 to 48hours.
What are the symptoms?
Most cases of cholera only result in mild diarrhea or no symptom at all. Only 7% of the persons affected need treatment at a health center.
The symptoms include nausea, vomiting and watery diarrhea. Diarrhea is typically profuse, it has a straw color with a slight fishy smell; the liquid stools (poop) do not have the typical fecal consistency.
What is the source of the cholera in Haiti?
According to the Center of Disease Control (CDC), the Haitian cholera outbreak is not related to the earthquake as the disease was not pre-existent there. The exact source is still a subject of debate.
How does Cholera kill?
Only about 5% of cases are severe. The cholera patient can lose up to 2 liters of fluids an hour. In severe cases so much fluid may be lost that after just a few hours, the patient becomes lethargic, unable to even sit up. If enough volume is lost, shock ensues with possible renal failure, cardiac arrhythmia, confusion and death. Low blood glucose is a sign of poor prognosis.
Mortality is worse in children (10 times that of adults) and pregnant women.
Mortality in Haiti is reported between 1.5 to 4% in those seeking medical care.
How does the practitioner identify an emergent case?
Skin loses its normal turgor, meaning when it’s pulled it takes long time go back into position. The eyes are sunken. The thinking process is slow and dull though patient can be conscious. In extreme cases, the patient becomes unconscious and even dies.
What is the principle of treatment?
The main goal of treatment is to replace water and salts lost. If this is done quickly, survival is guaranteed and patient recovers quickly. Antibiotic therapy is not essential in the management of cholera; it only helps shorten the course of the disease.
Are antibiotics needed?
Antibiotics are not essential in the management of cholera, they only help shorten the course of the disease. Doxycycline, tetracycline, azythromycin, fluoroquinolones can be used. In Haiti, antibiotic resistance has been confirmed to trimethroprim-sulfamethoxazole, furazolidone, nalidixic acid, and streptomycin.
What is oral rehydration?
Oral serum is a mix of water, salts (potassium, sodium), sugar and bicarbonate. In the proper setting, it is as effective as intravenous treatment yet much less expensive, safer and can be administered at home. The proportion of the components is designed to replace the fluids and electrolytes lost.
How is cholera transmitted?
Cholera is transmitted by the fecal-oral route, meaning infection results from ingestion of contaminated fluids or food products. The disease is not transmitted from person to person; health care workers in cholera centers very rarely catch the disease from their patients.
What is a cholera cot?
This is a special bed with a hole in the center that offers a convenient way to collect liquid stools into a container placed underneath the bed.
How is the patient managed?
In severe dehydration, one or two large bore (18 gauge) needles are needed. Lactate Ringer’s is the best choice for intravenous fluid, if not available normal saline (NS), or half normal saline with 5% glucose (D5 1/2NS) can be used.
How can I avoid Cholera if travelling to an area that is affected?
The risk of contracting the disease is very low if standard precautions are followed.
One should drink only bottled, boiled or chemically treated water.
To disinfect water, you can boil it for one minute and add two drops of household bleach or half of an iodine tablet per liter of water.
Avoid tap water, fountain drinks and ice cubes.
Wash hands frequently with soap and clean water or an alcohol based cleaner.
Used treated water to wash dishes, brush your teeth or prepare food.
Cooked foods are advised and should be consumed hot; if cooked foods need to be preserved they should be reheated.
Dispose of feces in a sanitary manner away from body of waters.
Can I be vaccinated for cholera?
Two oral vaccines exist; they are not routinely recommended because they only offer limited protection and for a short period of time. Preventive measures are the best way to avoid the disease.
Prepared by Dr H. Boucard
Sources:
World Health Organization
Center for Disease Control |
General Assembly