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FACTS ABOUT CHOLERA

Publish by World Health Organization
Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Every year, there are an estimated 3 to 5 million cholera cases and 100,000 to 120,000 deaths due to cholera. The short incubation period of two hours to five days, enhances the potentially explosive pattern of outbreaks.

Symptoms
Cholera is an extremely virulent disease. It affects both children and adults and can kill within hours. About 75% of people infected with V. cholerae do not develop any symptoms, although the bacteria are present in their faeces for 7-14 days after infection and are shed back into the environment, potentially infecting other people

Among people who develop symptoms, 80% have mild or moderate symptoms, while around 20% develop acute watery diarrhoea with severe dehydration. This can lead to death if untreated.

People with low immunity - such as malnourished children or people living with HIV - are at a greater risk of death if infected Risk factors and disease burden

Cholera transmission is closely linked to inadequate environmental management. Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced people or refugees, where minimum requirements of clean water and sanitation are not met.

The consequences of a disaster, such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps, can increase the risk of cholera transmission should the bacteria be present or introduced. Epidemics have never arisen from dead bodies.

Cholera remains a global threat to public health and a key indicator of lack of social development. Recently, the re-emergence of cholera has been noted in parallel with the ever-increasing size of vulnerable populations living in unsanitary conditions.

The number of cholera cases reported to WHO continues to rise. From 2004 to 2008, cases increased by 24% compared with the period from 2000 to 2004. For 2008 alone, a total of 190,130 cases were notified from 56 countries, including 5143 deaths. Many more cases were unaccounted for due to limitations in surveillance systems and fear of trade and travel sanctions. The true burden of the disease is estimated to be 3-5 million cases and 100,000-120,000 deaths annually.

Prevention and control
A multidisciplinary approach based on prevention, preparedness and response, along with an efficient surveillance system, is key for mitigating cholera outbreaks, controlling cholera in endemic areas and reducing deaths.

Treatment
Cholera is an easily treatable disease. Up to 80% of people can be treated successfully through prompt administration of oral rehydration salts (WHO/UNICEF ORS standard sachet). Very severely dehydrated patients require administration of intravenous fluids. Such patients also require appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the duration of V. cholerae excretion. Mass administration of antibiotics is not recommended, as it has no effect on the spread of cholera and contributes to increasing antimicrobial resistance.

In order to ensure timely access to treatment, cholera treatment centres (CTCs) should be set up among the affected populations. With proper treatment, the case fatality rate should remain below 1%.

Outbreak response
Once an outbreak is detected, the usual intervention strategy is to reduce deaths by ensuring prompt access to treatment, and to control the spread of the disease by providing safe water, proper sanitation and health education for improved hygiene and safe food handling practices by the community. The provision of safe water and sanitation is a formidable challenge but remains the critical factor in reducing the impact of cholera.

 

 

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