Cholera

Definition: Cholera, caused by V. Cholerae (Vibrio cholera), is a severe infection or acute diarrhoeal disease. Cholera is caused by infection with Vibrio cholera, a bacterium that can be spread by fecal matter, food, or water. Most individuals who get the disease consume the species through V. Cholerae-contaminated food or soft drink or water sources.

According to Fricker, cholera is responsible for about 5-10 percent of all acute. diarrhea cases in non-epidemic areas. In adults as well as adolescents, it is more frequent. Cholera is a disease that is both epidemic and endemic. Epidemic cholera is a widespread outbreak of infectious disease at a specific time in a population. As it spreads rapidly and causes mortality, the outbreak of cholera generates an immediate public health crisis.

Epidemiology

• Agent: V.Cholerae.
• Host: Male, Female, Adult, Children.
• Environment: Vegetables, Contaminated water, Street food.

Agent/Factor

• The cholera causative organism is V. Cholerae.
• In fecal matter and vomiting cases and carriers, the causative organism is present.
• The communicability period depends on the treatment and type of carrier.

 Host Factor

• Cholera affects both males and females.
• Cholera involves all ages, but mostly involves children.
• It is more common among those who have reduced gastric acidity.

Environmental Factors

• Poor environmental cleaning.
• Infected water or infected drinks.
• Infected meal (vegetables).
• Lack of education.
• Not good quality of life.

 Incubation Period

2 hours to 5 days.

Mode of Transmission

• Convalescent Carrier: The convalescent carrier is a person who has clinically healed of an infectious disease but is still capable of transmitting the infectious agent to others.

• Chronic Carrier: It is recognized as an asymptomatic carrier as well. A human or other organism that has been infected with a pathogen is an asymptomatic carrier but shows no symptoms. While unaffected by the pathogen itself, it can be transmitted to others by carriers.

Symptoms of Cholera Disease

The symptoms of cholera show within few hours. Few symptoms are given below:

• Dehydration Vomiting
• Loss of skin elasticity
• Nausea
• Muscle cramp
• Hypotension
• Cardiovascular shock
• Concentrated urine

Laboratory Diagnosis

Stool Examination: Stool is collected from patient by two methods:

1. Rubber catheter
2. Rectal swab.

1. Rubber catheter: Rubber catheter or Robinson catheter is used to insert into 8 patient’s bladders to drain urine.

2. Rectal swab: A cotton swab is placed into the rectum. The swab is rotated gently and removed. Water checking is done for V. Cholerae by taking water samples.

Prevention and Control of Cholera

1. Early diagnosis of cases of cholera: In the case of cholera, it should be diagnosed as early as possible, even on intuition. For diagnosis of cholera, V. cholera should be identified in so on the identification of cholera, stool culture of all cases and carrier is required to confirm the diagnosis.

2. Notification: On identification of cholera cases, it should be notified locally and nationally. For this disease, health care workers should be trained enough.

3. Medical care:

• Medical checkups of cholera should be started instantly without delay.
• For Providing check-up or medical checkups, there is a necessity to create treatment facilities that are approachable to people.
• Treatment of cholera depends on the seriousness of the health problem.
• Cholera causes loss of fluid due to diarrhea, which causes dehydration. Dehydration may be a mild form or of severe form.

(A) Mild Dehydration: Dehydration is the loss or removal of water from something or reduction in the amount of water in the body. Symptoms and signs of dehydration include; increased thirst, dry mouth, weakness, lightheadedness, and a decrease in urination. Mild dehydration cases should be treated at home with ORS solution, which is available at health centers and can also be prepared at home.

Solution of Oral Rehydration: 3.5 gm Sodium Chloride + 2.5 gm Sodium Bicarbonate + 1.5 gm potassium Chloride + 20 gm Glucose + 1000 ml Water.

Warning or Instruction:

1. This prepared ORS should be used within 24 hours.
2. These ORS packets are available at health centers Le., sub-centers, primary health centers free of cost.
3. The ORS is given in case of mild dehydration which one can come to know by judgment.

If the following signs are seen in a patient having cholera, then it is considered that he is having mild dehydration. These signs are;

• Weight loss will be only 4-5% with an estimated fluid deficit of 40-50 ml/kg.
• No change in urine output le, it will be normal.
• The patient will be alert, restless, and thirsty.
• The tongue will be slightly wet and skin will retract immediately if pinched.
• Radial pulse will be normal in rate and volume. Even blood pressure will be normal.

(B) Severe Dehydration: Severe dehydration is assessed by observing the following sign among patients. These are:

• Blood pressure is less than or equal to 80 mm of Hg.
• The pulse will be weak.
• Skin elasticity is decreased and on pinching, the skin retracts very slowly.
• The tongue is very dry.

Severely dehydrated patients require IV. fluids so should be admitted to hospital. IV. infusion is required for severely dehydrated patients. The solution used is Ringer’s lactate solution. It provides sodium, potassium, and lactate for the correction of acidosis. 

(C) Antibiotics: Along with rehydration therapy, after 3-4 hours, antibiotics should be started. The antibiotics used are:

• Tetracycline 500 mg
• Trimethoprim and Sulfa Methoxazole 160 mg
• Doxycycline 300 mg
• Furazolidone 100 mg

(D) Drinking safe and clean water: Water supplied should be safe general public. system.

(E) Eating Hygienic food: The food eaten by the public should be Hygienic.

(F) Proper disposal of excreta: It should be disposed of properly by an effective excreta disposal system.

(G) Hand washing: The habit of Handwashing should be inculcated.

(H) Disinfection: The areas or personal items contaminated with stool, vomit, etc. should be disinfected.

(I) Chemoprophylaxis: The individuals who come in contact with a cholera patient can develop clinical illness. To prevent cholera, chemoprophylaxis is advised.

(1) Tetracycline: 500 mg B.D. x 3 days for adults.

125 mg B.D. x 3 days for children of 4-13 years of age.

50 mg of B.D. x 3 days for children of 3 years or below.

(2) Doxycycline: 300 mg for adults.

6mg/kg for children under 15 years of age.

(J) Immunization: Immunization is the process by which the immune system of a person. becomes strong. The vaccine against cholera is given in two doses. If no 2-dose. immunization has been completed, a single dose equivalent to double the 1″ dose is given. The booster dose is given every 6 months after administration. (Table.1)

Table.1: Cholera Vaccine Requirement

Age	Quantity of dose	Route
1-2 years 2-10 years Above 10 years	1st dose 0.5 ml 0.3 ml 0.2 ml	2nd dose 0.5 ml (Parenteral) 0.3 ml (Subcutaneously) 0.2 ml

Note: The interval between two doses should be between 4 to 6 weeks.

(K) Health Education: Health education plays a very important role in the prevention and control of cholera. Health education about the causes, signs, symptoms, prevention, and control of cholera will help to decrease the number of cholera cases.

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