Cholera

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					   Cholera is an infection of the small intestine that
    causes a large amount of watery diarrhea.

   Cholera is an acute, infectious gastroenteritis, caused
    by Gram-negative enterotoxin-producing strains of
    the bacterium Vibrio cholerae (CDC).

   The enterotoxin affects the mucosal epithelium lining
    of the small intestine leading to an exhaustive
    diarrhea.

Reference
   Centers for Disease Control and prevention.
    Cholera.
                               Vibrio spp.



              V. cholerae                            Other vibrios


V. cholerae
 Non-O1                     V. cholerae O1

                                             Biotype
                                             Classical
                                             El Tor
                                             Serotype
                                             Ogawa
                                             Inaba
                                             Toxin
                                             Toxigenic
                                             Non-toxigenic
   Cholera is caused by the bacterium Vibrio
    cholerae. The bacteria releases a toxin that
    causes increased release of water in the
    intestines, which produces severe diarrhea.
   Severe dehydration can cause death. Given
    adequate fluids, most people will make a full
    recovery

Reference:
 Guidelines for Cholera control. Retrieved on
  January 10,2010 from website:
  http://www.doh.gov.za/issues/cholera/guidelin
  es.html
 Water and food contamination
 Raw or undercooked seafood
 Rice, cereals, gruels left at ambient
  temperature
 Person to person transmission is not
  common
 Fecal-oral transmission is possible
 Cholera occurs in places with poor
  sanitation, crowding, war, and famine.
  Common locations for cholera include:
 Africa
 Asia
 India
 Mexico
 South and Central America
 The Mediterranean
 Exposure to contaminated or untreated
  drinking water
 Living in or traveling to areas where there
  is cholera

 Tests and diagnosis include:
 Blood culture
 Stool culture
   Fluids may be given by mouth or through
    intravenously, depending on your
    condition. Antibiotics may shorten the time
    you feel ill in order to replace fluid and
    electrolytes lost through diarrhea.

   An oral rehydration solution that is cheaper
    and easier to use than the typical
    intravenous fluid was developed by The
    World Health Organization (WHO). This
    solution of sugar and electrolytes is now
    being used internationally.
   The U.S. Centers for Disease Control and
    Prevention does not recommend
    cholera vaccines for most travelers.

   When outbreaks of cholera occur, efforts
    should be directed toward establishing
    clean water, food, and sanitation,
    because vaccination is not very
    effective in managing outbreaks.
 Increase in total cases of diarrhea
 Increase in cases of diarrhea in adults
 Deaths caused by dehydration
 Laboratory confirmation of cholera


   Reference:
WHO. (2009). Cholera: prevention and
 control. Retrieved from:
 http://www.who.int/topics/cholera/contr
 ol/en/index.html
 Ensure adequate treatment and
  surveillance
 Investigate modes of transmission
    › Case-control studies
    › Household surveys
    › Environmental testing
 Investigate unusually high case-fatality
  rates
 Control measures based on
  investigations
   In order to respond quickly to the cholera
    epidemic and to prevent deaths, health facilities
    must have access to adequate quantities of
    essential supplies, particularly oral rehydration
    solution and intravenous fluids.
   Every health facility should have capacity for oral
    or IV rehydration
   Train community health workers
   When and how to set up Cholera Treatment
    Centers

   Reference:
   Centers for Disease Control and prevention.
    Cholera
 Identify communities at risk
 Ensure that they are informed about
  sources of contamination and ways to
  avoid infection
 Investigate all bacteriologically proven
  cases to identify the sources of infection
 Monitor the spread of cholera in risk
  areas by periodically sampling strategic
  sewage effluent as an early warning
  system
   Ensuring a safe water supply by boiling before use.
   Encourage sanitary disposal of human waste without
    contaminating water sources and control of flies.
   Avoid any potentially contaminated food especially
    raw.
   Food of vegetable origin should be peeled or shelled.
    Boil or pasteurize of all milk.

Reference:
 Guidelines for Cholera control. Retrieved on January
  10,2010 from website:
  http://www.doh.gov.za/issues/cholera/guidelines.ht
  ml
 Cholera has been prevalent worldwide
  since the early 19th centuries. This
  disease has been prevalent also in Sub-
  Saharan African countries, including
  South Africa.
 In approximately 90% of cholera cases,
  the disease is mild; and it is difficult to
  differentiate it from other diarrheal
  diseases.
   Oral rehydration therapy is important in case management and
    can reduce the case fatality;

   Vaccination and other chemoprophylaxis are ineffective in
    preventing and controlling cholera;

   personal hygiene on drinking and eating habits, safe disposal of
    human waste have proven to be effective in controlling the
    disease

   Reference:
Brown, V., Jacquier, G., Bachy, C., Bitar, D., & Legros, D. (2002).
   Management of cholera epidemics in a refugee camp.
   Bulletin de la Société de pathologie exotique, 95, 351-354.

Medecins Sans Frontieres. (2004). Cholera Guidelines.
 Must enhance its international disease
  surveillance
 Work with the local governments to provide
  better understanding of the disease
 Train the locals about disease control and
  prevention

Reference:
   Centers for Disease Control and
    prevention. Cholera
   Food safety standards must be enacted
    and regulations must be enforced
   Develop better local reporting system and
    improve communications with UN and
    WHO.
   Improve sanitation management in large
    cities and towns—no open landfill
   Provide safe drinking water the population
   Improve the socioeconomic status of the
    people
   The Governing Council of the United Nations
    Environmental Programme (UNEP) must
    › Strengthened its cholera control measures
    › Provide sanitary control and personal hygiene workshops
      to the local government, ministries of health, and the
      general public
    › Provide surveillance in disaster areas an refugee camps

Reference:
   United Nations. Cholera. Accessed on January,
    2010 from Website:
       http://cyberschoolbus.un.org/special/health/
    disease/cholera.htm
 Must change their behavior towards the
  disease
 Practice personal hygiene and hand
  washing
 Practice food safety techniques
 Control houseflies
   Brown, V., Jacquier, G., Bachy, C., Bitar, D., & Legros, D. (2002).
    Management of cholera epidemics in a refugee camp. Bulletin de
    la Société de pathologie exotique, 95, 351-354.
   Centers for Disease Control and prevention. Cholera
   Guidelines for Cholera control. Retrieved on January 10,2010 from
    website: http://www.doh.gov.za/issues/cholera/guidelines.html
   Medecins Sans Frontieres. (2004). Cholera Guidelines.
   Moeller, D. W. (2005). Environmental health (3rd ed.). Boston:
    Harvard University.
   Prevention and control of cholera outbreaks: WHO policy. Retrieved
    from: www.emro.who.int/CSR/Media/PDF/cholera_whopolicy.pdf
   United Nations. Cholera. Accessed on January, 2010 from
    http://cyberschoolbus.un.org/special/health/disease/cholera.htm
   WHO. (2009). Cholera: prevention and control. Retrieved from:
    http://www.who.int/topics/cholera/control/en/index.html

				
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