- Cholera causes severe diarrhea and dehydration. Left untreated, cholera can be fatal in a matter of hours, even in previously healthy people. Modern sewage and water treatment have virtually eliminated cholera in industrialized countries. The last major outbreak in the United States occurred in 1911.
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Each year, cholera infects 1.3 to 4 million people around the world, killing 21,000 to 143,000 people, according to the World Health Organization (WHO).
- Vibrio cholerae Strains
- Epidemiology, Risk Factors, and Disease Burden
- Prevention and Control
- Water and Sanitation Interventions
- Hygiene Promotion and Social Mobilisation
- Oral Cholera Vaccines
Cholera is an extremely virulent disease that can cause severe acute watery diarrhoea. It takes between 12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water (2). Cholera affects both children and adults and can kill within hours if untreated. Most people infected with V. choleraedo not develop any symptoms, although the bacteria are present in their faeces for 1-10 days after infection and are shed back into the environment, potentially infecting other people. Among people who develop symptoms, the majority have mild or moderate symptoms, while a minority develop acute watery diarrhoea with severe dehydration. This can lead to death if left untreated.
During the 19th century, cholera spread across the world from its original reservoir in the Ganges delta in India. Six subsequent pandemics killed millions of people across all continents. The current (seventh) pandemic started in South Asia in 1961, and reached Africa in 1971 and the Americas in 1991. Cholera is now endemic in many countries.
There are many serogroups of V. cholerae, but only two – O1 and O139 – cause outbreaks. V. cholerae O1 has caused all recent outbreaks. V. choleraeO139 – first identified in Bangladesh in 1992 – caused outbreaks in the past, but recently has only been identified in sporadic cases. It has never been identified outside Asia. There is no difference in the illness caused by the two serogroups.
Cholera can be endemic or epidemic. A cholera-endemic area is an area where confirmed cholera cases were detected during the last 3 years with evidence of local transmission (meaning the cases are not imported from elsewhere). A cholera outbreak/epidemic can occur in both endemic countries and in countries where cholera does not regularly occur. In cholera endemic countries an outbreak can be seasonal or sporadic and represents a greater than expected number of cases. In a country where cholera does not regularly occur, an outbreak is defined by the occurrence of at least 1 confirmed case of cholera with evidence of local transmission in an area where there is not usually cholera. Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities. Typical at-risk areas include peri-urban slums, and camps for internally displaced persons or refugees, where minimum requirements of clean water and sanitation are not been met. The consequences of a huma...
A multifaceted approach is key to control cholera, and to reduce deaths. A combination of surveillance, water, sanitation and hygiene, social mobilisation, treatment, and oral cholera vaccines are used.
Cholera surveillance should be part of an integrated disease surveillance system that includes feedback at the local level and information-sharing at the global level. Cholera cases are detected based on clinical suspicion in patients who present with severe acute watery diarrhoea. The suspicion is then confirmed by identifying V. choleraein stool samples from affected patients. Detection can be facilitated using rapid diagnostic tests (RDTs), where one or more positive samples triggers a cholera alert. The samples are sent to a laboratory for confirmation by culture or PCR. Local capacity to detect (diagnose) and monitor (collect, compile, and analyse data) cholera occurrence, is central to an effective surveillance system and to planning control measures. Countries affected by cholera are encouraged to strengthen disease surveillance and national preparedness to rapidly detect and respond to outbreaks. Under the International Health Regulations, notification of all cases of choler...
The long-term solution for cholera control lies in economic development and universal access to safe drinking water and adequate sanitation. Actions targeting environmental conditions include the iimplementation of adapted long-term sustainable WASH solutions to ensure use of safe water, basic sanitation and good hygiene practices in cholera hotspots. In addition to cholera, such interventions prevent a wide range of other water-borne illnesses, as well as contributing to achieving goals related to poverty, malnutrition, and education. The WASH solutions for cholera are aligned with those of the Sustainable Development Goals (SDG 6).
Cholera is an easily treatable disease. The majority of people can be treated successfully through prompt administration of oral rehydration solution (ORS). The WHO/UNICEF ORS standard sachet is dissolved in 1 litre (L) of clean water. Adult patients may require up to 6 L of ORS to treat moderate dehydration on the first day. Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids. These patients are also given appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of V. choleraeexcretion in their stool. Mass administration of antibiotics is not recommended, as it has no proven effect on the spread of cholera may contribute to antimicrobial resistance. Rapid access to treatment is essential during a cholera outbreak. Oral rehydration should be available in communities, in addition to larger treatment centres that can provide intravenous flu...
Health education campaigns, adapted to local culture and beliefs, should promote the adoption of appropriate hygiene practices such as hand-washing with soap, safe preparation and storage of food and safe disposal of the faeces of children. Funeral practices for individuals who die from cholera must be adapted to prevent infection among attendees. Further, awareness campaigns should be organised during outbreaks, and information should be provided to the community about the potential risks and symptoms of cholera, precautions to take to avoid cholera, when and where to report cases and to seek immediate treatment when symptoms appear. The location of appropriate treatment sites should also be shared. Community engagement is key to long term changes in behaviour and to the control of cholera.
Currently there are three WHO pre-qualified oral cholera vaccines (OCV): Dukoral®, Shanchol™, and Euvichol-Plus®. All three vaccines require two doses for full protection. Dukoral® is administered with a buffer solution that, for adults, requires 150 ml of clean water. Dukoral can be given to all individuals over the age of 2 years. There must be a minimum of 7 days, and no more than 6 weeks, delay between each dose. Children aged 2 -5 require a third dose. Dukoral® is mainly used for travellers. Two doses of Dukoral® provide protection against cholera for 2 years. Shanchol™ and Euvichol-Plus® are essentially the same vaccine produced by two different manufacturers. They do not require a buffer solution for administration. They are given to all individuals over the age of one year. There must be a minimum of two weeks delay between each dose of these two vaccines. Two doses of Shanchol™ and Euvichol-Plus® provide protection against cholera for three years, while one dose provides sh...
- What is cholera? Cholera is an acute diarrheal infection caused by eating food or drinking water contaminated with a bacteria, V. cholerae. If not treated promptly, the disease can become deadly within hours, even in previously healthy people.
- Is there cholera in the United States? Adding chlorine to drinking water kills cholera bacteria. That's why cholera is very rare in the United States — modern water and sewage treatment systems stop the bacteria from spreading.
- How bad is the cholera outbreak in the Democratic Republic of Congo? The DRC cholera outbreak is by far the world's deadliest. Last year, more than 17,000 cases of cholera were recorded in the DRC.
- How does cholera affect children? Cholera is particularly dangerous for the very young, the very old and the undernourished. Children under age 5 have the highest incidence of cholera and are more likely to die from it.
Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days.
Apr 07, 2020 · The Broad Street cholera outbreak: how bad was it and how was it contained? Try 3 issues of BBC History Magazine or BBC History Revealed for only £5 In 1854, amidst a major cholera pandemic, London physician John Snow made a deduction that would save countless lives – that the disease was not spread by 'bad air', but by germ-ridden water.
Cholera, caused by the bacterium Vibrio cholerae, is very rare in the U.S. Cholera was common domestically in the 1800s but water-related spread has been eliminated by modern water and sewage treatment systems. Nearly all cholera cases reported in U.S. are acquired during international travel.
During the worst period, it is estimated that as many as 3,000 people were dying per day from cholera. A persistent strain of Gulf Coast cholera, 01, has been found in the brackish waters of marshes in Louisiana and Texas in the United States. It could possibly be transmitted by shipments of seafood from those areas to other parts of the country.
- Risk Factors
Cholera is a bacterial disease usually spread through contaminated water. Cholera causes severe diarrhea and dehydration. Left untreated, cholera can be fatal in a matter of hours, even in previously healthy people.Modern sewage and water treatment have virtually eliminated cholera in industrialized countries. The last major outbreak in the United States occurred in 1911. But cholera is still present in Africa, Southeast Asia and Haiti. The risk of cholera epidemic is highest when poverty, wa...
Most people exposed to the cholera bacterium (Vibrio cholerae) don't become ill and never know they've been infected. Yet because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water. Most symptomatic cases of cholera cause mild or moderate diarrhea that's often hard to distinguish from diarrhea caused by other problems.Only about 1 in 10 infected people develops more-serious signs and symptoms of cholera, usually within a few...
A bacterium called Vibrio cholerae causes cholera infection. However, the deadly effects of the disease are the result of a potent toxin called CTX that the bacterium produce in the small intestine. CTX binds to the intestinal walls, where it interferes with the normal flow of sodium and chloride. This causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes).Contaminated water supplies are the main source of cholera infectio...
Everyone is susceptible to cholera, with the exception of infants who derive immunity from nursing mothers who have previously had cholera. Still, certain factors can make you more vulnerable to the disease or more likely to experience severe signs and symptoms. Risk factors for cholera include: 1. Poor sanitary conditions. Cholera is more likely to flourish in situations where a sanitary environment — including a safe water supply — is difficult to maintain. Such conditions are common to ref...
Cholera can quickly become fatal. In the most severe cases, the rapid loss of large amounts of fluids and electrolytes can lead to death within two to three hours. In less extreme situations, people who don't receive treatment may die of dehydration and shock hours to days after cholera symptoms first appear.Although shock and severe dehydration are the most devastating complications of cholera, other problems can occur, such as: 1. Low blood sugar (hypoglycemia). Dangerously low levels of bl...
Cholera is rare in the United States with the few cases related to travel outside the U.S. or to contaminated and improperly cooked seafood from the Gulf Coast waters.If you're traveling to cholera-endemic areas, your risk of contracting the disease is extremely low if you follow these precautions: 1. Wash hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water are...