Cholera in the African setting: What is it? Who gets it? How to treat and prevent it

DLHA Staffwriter

Representation of vibrio cholerae, the germ (bacteria) causing cholera

What is Cholera?

Cholera is an infection of the small bowel caused by some strains of the bacterium known as Vibrio cholerae.

Common sources of exposure to the bacterium range from ingestion of contaminated food including vegetables that is grown or rinsed in impure water; to ingestion of street food lying uncovered for hours. Due to poor or lack of effective sanitation and pipe-borne water supply especially in developing countries like in Africa, the commonest source of the contamination is human feces containing the bacteria.  Under-cooked sea foods are also a common source of the infection.

Risk factors for the disease include:

• Poor sanitation.
• Lack or poor supply of potable water.
• Poverty and underdevelopment.
• War-ravaged territories.
• Camps for refugees or internally displaced persons.
• Over populated peri-urban slums with poor public health infrastructure.

Who gets Cholera?

Humans are the only animal affected by cholera.

It is a disease that is common in peri-urban slums with rapid population growth in which large numbers of people that moved from rural areas into big cities, live in conditions with poor basic facilities.

Cholera affects an estimated 1.3 –4 million people worldwide and causes 21,800–143,000 deaths a year¹.

The majority of cholera sufferers live in developing countries of Africa, Southeast Asia and Haiti. The disease is rare in developed countries.

Children bear the highest risk of the disease as well as the highest death rate.

The risk of death among cholera patients can be as low as 5% and as high as 50% Lack of immediate access to treatment results in higher death rates.

Cholera occurs as both sporadic outbreaks (as in the most recent outbreak in Nigeriia) as well as chronically in most countries of Africa (see image).

Example of African countries with reported sporadic outbreaks as well as chronic occurrence of cholera in some areas include, Nigeria, Liberia, Kenya, Tanzania, Democratic Republic of the Congo, South Sudan and others.

Symptoms of Cholera

These are variable; from none, to mild, moderate and severe.

The classic symptoms of cholera include:

• Passage of large amounts of watery stool that may last a few days;
• Nausea, vomiting and muscle cramps
• Severe dehydration because of rapid loss of fluid and salt from the body.
• Sunken eyes and cold, clammy and wrinkled skin.
• Weakness and dizziness due to drop in blood pressure resulting from salt and water loss.
• Poor urine output
• Rapid deterioration in consciousness, seizures and coma (in children)

The symptoms may start from few hours to about five days after exposure to the vibrio cholerae.

Treatment of Cholera

Treatment of cholera is simple and effective if it is provided on time. Delay in treatment leads to severe consequences and in many cases death.

Treatment of cholera cases include the following:

Oral Rehydration

The highest concern for cholera sufferers is the loss of fluids and salts from the body. For this reason, cholera patients are advised, in mild cases, to take plenty of fluids orally. The fluid may be as simple as mild sugar and salt water, or coconut water, or sugar cane juice. Pre-formulated commercial oral rehydration salts (ORS) are alternative sources of supplements to use in preparing clean water for drinking in mild cases of cholera.

Up to 80% of Cholera cases have been successfully treated with ORS in Africa.

IV fluids

Severely dehydrated patients may require intravenous fluids like 0.9% normal saline, lactated ringers, or 5% dextrose in water, etc., to restore hydration rapidly.

Antibiotics

Antibiotics are not necessary for treatment of cholera but yes, it does help in moderate to severe cases to reduce the amount of both diarrhea and vomiting. With antibiotics both duration and intensity of the diseases can be reduced.

Prevention and control

The World Health Organisation recommends a multifaceted approach to prevent and control cholera, and to reduce deaths.

The approach includes:

• Surveillance for early detection, diagnosis and treatment of cases.

• Long term investment in water and sanitation intervention that includes:
  • the development of public piped water systems with water treatment facilities (chlorination);
  • interventions at the household level (I.e.. adoption of water filtration, safe water storage or solar disinfection of water)
  • construction of safe sewage disposal including latrines

• Public health hygiene promotion through health education campaigns to include:
  • Effective and regular hand washing with soap and clean water;
  • Safe water and food storage practice;
  • Non-consumption of poorly cooked and/or unsafely stored or washed foods;
  • Effective and safe disposal of feces of children; and
  • Social mobilization for early community detection and report of cases for prompt intervention.  

• Access to oral cholera vaccines
  • Currently there are 3 WHO pre-qualified oral cholera vaccines: Dukoral®, Shanchol™, and Euvichol®. All 3 vaccines require 2 doses for full protection.

Takeaway

• Cholera is an infectious disease that is still common in many African countries in the form of recurrent outbreaks or chronically.

• The infection is acquired through contamination of food and drinking water by feces containing the Vibrio cholerae bacteria.

• Risk factor for cholera infection include rapid population growth, peri-urban slums with poor water supply and sanitation infrastructure, refugee camps, war, poverty and underdevelopment.

• Symptoms of cholera may become apparent within 2 hours to five days following exposure to the bacteria.

• The symptoms of cholera infection may range from mild, moderate or severe. Common and early symptoms include, passage of frequent copious watery stool, frequent vomiting, dehydration with sunken eyes, loss of skin elasticity, weakness and muscle cramps. Additional symptoms and signs in children include rapid deterioration in consciousness, seizures and coma.

• The treatment of cholera can be as simple as encouraging frequent oral intake of clean salt and water solution in the home environment for mild cases. In moderate to severe cases, intravenous fluid solutions may need to be administered under close supervision in hospital or outpatient clinic.

• Antibiotics are not always needed to treat cholera, but when indicated, they help to reduce the severity and duration of an infection.

• Prevention of cholera infection is possible and should be encouraged. This involves both short and long term public health interventions as well as promotion of personal hygiene and adoption of effective and safe water storage and waste disposal.

• Oral cholera vaccines are available to immunize populations against the disease.

• If you suspect you have been exposed to cholera bacteria, visit your doctor as soon as possible for advise, diagnosis and care.

Related:

Top 10 vaccine preventable diseases in Africa (Slideshow)

Source:

World Health Organisation. Cholera – Overview, factsheet and more

Published: December 8, 2019

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