Cholera

Causes and Symptoms

- Cholera is caused by the bacteria Vibrio cholerae, which
infects the host through water or food. There are several
strains of the species but all cause the same symptoms to
varying degrees,
- The main symptoms of cholera are watery diarrhoea, nausea
and vomiting, and dehydration.
- Symptoms can be absent, or mild to acute
- The disease can be fatal from a few hours after symptoms
develop due to dehydration and electrolyte imbalance
Pathogen - Vibrio cholerae

- V. cholerae is a comma shaped baterium with

a flagellum at one end
- It causes cholera by secreting cholera toxin
and coregulated pilus, both proteins, while
attached to the mucosal layer of the
intestine
- Spread through contaminated water or food,
the result of lack of clean water and
sanitation
- Often spread overseas through seafood
 Morbidity, Mortality, Incidence,
-
Prevalence
Researchers have estimated that each year there are 1.3
million to 4.0 million cases of cholera, and 21 000 to 143 000
deaths worldwide due to cholera.
- The average global annual incidence rate is 2.0 cases per
1000 people at risk.
- Since it became widespread in the 19th century, cholera has
killed tens of millions of people. In Russia alone, between
1847 and 1851, more than one million people perished of the
disease. It killed 150,000 Americans during the second
pandemic. Between 1900 and 1920, perhaps eight million
people died of cholera in India.
1854 Cholera Pandemic Mapping in
London
Deaths: 616
 Factors Causing Spread of Cholera
- Transmission is usually through the fecal-oral route
(Pathogens in fecal particles pass from one person to
the mouth of another person) of contaminated food or
water caused by poor sanitation. Food transmission
can occur when people harvest seafood such as
oysters in waters infected with sewage.
- V. cholerae also exists outside the human body in
natural water sources, either by itself or through
interacting with phytoplankton (Autotrophic
components of the plankton community) or
zooplankton (Heterotrophic plankton). Drinking such
water can also result in the disease, even without prior
contamination through fecal matter.
Disease control
Prevention
- The main way to prevent the spread of
cholera is clean water and sanitation -
purified water for drinking and cooking,
hand washing, toilet facilities
- Filtration can be done cheaply with sari
cloth
- Health campaigns can raise awareness
- Quarantine used to stop spread across
countries
- Wars, extreme climate events can prevent
access for aid workers and destroy facilities
- Rise in sea levels may increase prevalence
Treatment
- Most common and simple treatment is oral
rehydration solution (ORS) consisting of
sugar, salt and sometimes bananas
- Large amounts must be administered until
fluid is replaced - 10% of body weight in 2
hrs
- Electrolytes and intravenous injections used
in severe cases
- Antibiotics can be sued in severe cases (in
conjunction with ORS)
- Cholera vaccine available - 100% - 38%
effective, useful to travellers to cholera
affected areas
 Impact
- Cholera is in theory easily treated - oral rehydration solution is
easily administered if clean drinking water is available, and
reduces mortality to 1%.
- Practising good hygiene and quarantine is also effective
- Thus, with treatment mortality should drop from 28,800 -
148,000 to 288 -1480.
- Though preventable, cholera is still a global public health issue
due to the lack or resources given to developing countries and
the inaccessibility or complex situations of warzones or natural
disasters.
- Thus, cholera epidemics still occur, such as after the 2010
earthquake in Haiti, where 800,000 people were infected and Cholera rates continue to rise and fall in response to
humanitarian disasters
over 9,000 died
 Other Historical, Culturally
Diverse and Current Strategies
- In the past, vessels flew a yellow quarantine flag if any crew members
or passengers were suffering from cholera. No one aboard a vessel
flying a yellow flag would be allowed ashore for an extended period,
typically 30 to 40 days.
- In the 1854–1855 outbreak in Naples camphor was used as a
remedy. Tomato syrup was also used as a home remedy from northern
America. Elecampane, a herb, was recommended in the United
Kingdom.
- The administration of oral rehydration solution (ORS), which involves
drinking water with modest amounts of sugar and salts is the most
suitable treatment for cholera. Appropriate sanitation hygiene
procedures are the most suitable methods of prevention.
John Snow
He was an English physician and a leader in the development of
anaesthesia and medical hygiene. He is considered one of the fathers
of modern epidemiology, in part because of his work in tracing the
source of a cholera outbreak in Soho, London, in 1854. Oxford
University researchers state that Snow's findings inspired the
adoption of anaesthesia as well as fundamental changes in the water
and waste systems of London, which led to similar changes in other
cities, and a significant improvement in general public health around
the world.
Bibliography
Sahealth.sa.gov.au. (2012). Cholera - including symptoms, treatment and prevention :: SA Health. [online] Available
at:
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/healt
h+conditions+prevention+and+treatment/infectious+diseases/cholera/cholera+-
+including+symptoms+treatment+and+prevention
Who.int. (2017). Cholera. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/cholera
Wikipedia. (n.d.). [online] Available at: https://en.wikipedia.org/wiki/Main_Page