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CONDITIONS

Cholera

Cholera

Cholera is a bacterial disease that may lead to infection causing severe diarrhoea and dehydration, and death, if untreated. Cholera is generally caused by a bacteria Vibrio cholerae, which is found in food and/or water that is contaminated. Modern sewage and water treatment has generally eliminated cholera from developed countries, but it is still rampant in the SouthEast region, especially countries like India.

Is Cholera present in India?

Owing to contaminated water in many parts of India and poor hygiene and sanitation, there are rampant cholera outbreaks in India. Only 16% (Dated 2022) of rural population receives piped drinking water and defecation in public is a common practice which makes people more prone to infection. There are approximately 560 cholera outbreaks every year with the recent one in May 2023 with a fatality rate of 0.6%. Government programs such as Swacch Bharat Mission has helped in decreasing the mortality rate.

What are the symptoms of Cholera?

Most people may be affected by cholera and not show any symptoms, but they are liable to transmit and infect others. People who show symptoms may do so even within few hours of infection or after 5 days after infection. In most patients, the symptoms of cholera are mostly mild, but some may develop severe signs and symptoms causing severe dehydration. Signs and symptoms of cholera are:
  • Diarrhoea – Appears suddenly and quickly causes dangerous fluid loss. The loss may resemble pale, milky
  • Vomiting – Most likely in early stages of cholera and can last for hours
  • Dehydration – Can develop almost immediately within hours of cholera symptoms and may range from mild to severe. A more than 10% or more of body weight indicates severe dehydration.
  • Signs of dehydration –
    • Rapid heart rate
    • Loss of skin elasticity (the ability to return to original position quickly if pinched)
    • Dry mouth, increased thirst
    • Low blood pressure
    • Irregular heartbeat
    • Little or no urination

      • Dehydration if left untreated may result in shock and death in a matter of hours.

What are the causes of cholera?

The bacteria Vibrio cholerae usually finds a way to transmit from an infected person via feces into the water or food and this contaminated food and water consumed by a healthy person results in cholera. The common sources of infection are:

  • Municipal water supplies or water from public wells, especially in rural areas where there is lack of adequate sanitation may result in large outbreaks. Even ice made from municipal water that is contaminated
  • Foods and drinks sold by street vendors – since the water and hygiene is questionable
  • Fruits and vegetables – Raw fruits and vegetables are common sources in the area of outbreak. Also using uncomposted manure containing feces for growing vegetables may contaminate the vegetables in the field
  • Raw or undercooked fish and seafood caught in waters polluted with sewage.

How is cholera diagnosed?

The doctor usually takes a rectal swab or stool sample which is send to the laboratory to be tested for cholera.

How is cholera treated?

Cholera is generally an easily treatable disease by replacing the fluids and salts lost by the body due to diarrhea.

Patients are asked to drink large amounts of Oral Rehydration Solution (ORS), which is a prepackaged mixture of sugar and salts that is mixed with 1 liter of water. This is the worldwide solution to treat diarrhea. In severe cases, intravenous fluid replacement is recommended. With prompt treatment, fewer than 1% of cholera patients die.

Antibiotics may hasten recovery but are not as important as rehydration.

How can cholera be prevented?

With certain precautions, cholera can be prevented. These are:

Safe drinking water: Drink water that has been boiled, or chemically disinfected, or bottled water. Use this water for drinking, preparing food, brushing teeth, washing fruits and vegetables, etc.

Drinking hot beverages is generally safe, but wiping the surface before dirnking is advisable. Do not add ice unless it is made from safe water.

Food: Wash raw fruits and vegetables before eating, while eating food that is hot and completely cooked is advisable. Avoid eating from street vendor and if consumed, eat those foods that are cooked in front of you and steaming hot.

Maintain hygiene and sanitation: Proper handwashing before meals, after using the toilet, is a must to avoid transmission of cholera. Wash hands with a soap for atleast 15 seconds before washing with water and if soap is unavailable, then alcohol-based sanitizer can be used.

A vaccine for cholera is available and advisable for specific people who travel to cholera-sensitive areas between ages 2 and 64. It is usually taken by mouth atleast 10 days before arrival.

References

  1. Muzembo BA, Kitahara K, Debnath A, Ohno A, Okamoto K, Miyoshi SI. Cholera Outbreaks in India, 2011-2020: A Systematic Review. Int J Environ Res Public Health. 2022 May 8;19(9):5738.
  2. Emergency Situational Updates. Multi-country outbreak of cholera, External situation report #5 – 4 August 2023. January 2024. WHO. https://www.who.int/publications/m/item/multi-country-outbreak-of-cholera–external-situation-report–5—4-august-2023
  3. Mary Anne Dunkin. Cholera. January 2024. WebMD. https://www.webmd.com/a-to-z-guides/cholera-faq#1-3
  4. Cholera. January 2024. Centre for Disease control (CDC). https://www.cdc.gov/cholera/general/index.html#one
  5. Cholera. January 2024. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-20355287
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