CHOLERA

1. What are the symptoms?

Very rapid onset of vomiting and diarrhoea
with large volumes of very watery (rice
water type) stools (>3 times a day)
Severe de-hydration, = low pulse,
undetectable blood pressure, sunken eyes,
wrinkled hands and feet
Slow recovery of shape after depression of
skin
No urine output
Laboratory confirmation but count all
suspected cases and treat

2. How is it transmitted?
It is caused by a bacterium (Vibrio cholerae)
which lives naturally in brackish/freshwater
amoeba, and is transmitted through -:
Unsafe water.
Unwashed fruit and vegetables (or washed
in bad water), left over rice not re-heated (3
investigations +Lusaka 2004),
Lack of handwashing (food preparation,
hand shaking, childcare)
Cooked and uncooked sea food vibrio
survives light cooking (2 investigations)

3. Who is most at risk?

Those living near lagoons / low lying
areas with fresh/ brackish water/ fishing
populations
With unsafe water sources
With poor faecal disposal practices
With poor personal hygiene
With poor food hygiene (esp. moist food
of neutral acidity)
Close to cholera patients in early stages
(hyper-infectivity) and dealing with

4. When does cholera become

epidemic?
After heavy period of rainfall
When water temperatures rise
When normal diarrhoeal incidence
increases
Endemic cholera with good sanitation
needs permanent source of vibrio,
but with poor sanitation higher
secondary transmission can maintain
endemic status

5. How long does it take?

Incubation period 2hrs-5 days
Infection 7-14 days, but most people do
not become ill or show any symptoms
Only about 10-20% of infected people
show moderate or severe symptoms.
Group O blood group highest risk

6. How is it treated?
Greatest risk in first 24 hours, so rehydrate as soon as possible
Normally ORS (rice- rather than glucosebased reduces purge rate,- sodium = or >
75mmol/l)
If vomiting, give intravenous fluid
replacement (eg Ringers lactate)
extreme cases.
Give food as soon as patient can take it
Extreme cases only should have 1-3 days
antibiotic (esp doxycycline single dose) to
shorten illness, when vomiting stops

7. How is it prevented?
Blocking routes of transmission
water disinfection (source and /or
household), hand washing,
sanitation, good food hygiene and
well-cooked
Cholera vibrio doesnt like acid
environment (block with acidic water
eg. With citrus juice, healthy
stomach acid levels, acid food)
Oral vaccine (Dukoral).

8. What proportion will

die?
Most people who die, do so within the first
day of symptoms appearing
Without any treatment about 50% of people
survive
With adequate re-hydration less than 2%
will die
With good surveillance, rapid establishment
of re-hydration, and anti-biotics for worst
cases, almost all deaths can be avoided
(<0.2% die)