Here’s everything you need to know about cholera

The City of Joburg has confirmed that four of the five reported cholera cases in South Africa are in Johannesburg. The cases are of sisters who had recently travelled to Malawi for a funeral and developed symptoms on their return to Johannesburg, according to MMC for health and social development Ennie Makhafola.

The third case is a contact of the sisters, and the fourth case is a man from Alexandra township. The department of health has recorded its first death related to cholera as laboratory-confirmed cases continue to rise.

Minister of Health Joe Phaahla said the 24-year-old man lived in Wattville, Benoni in Ekurhuleni, and had no prior local or international travel history. He was admitted to Tambo Memorial Hospital with profuse watery diarrhoea and died a few days later.

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The difference between endemic and epidemic

Cholera can be endemic or epidemic. A cholera-endemic area is an area where confirmed cholera cases were detected during the past three years with evidence of local transmission (meaning the cases are not imported from elsewhere).

A cholera outbreak/epidemic can occur in both endemic countries and in countries where cholera does not regularly occur.

Cholera transmission is closely linked to areas where there is poor access to clean water and sanitation facilities. That is why it will be commonly seen in rural areas, townships, informal settlements and camps where minimum requirements of clean water and sanitation are not met.

What is Cholera?

Cholera is an acute diarrhoeal infection caused by eating and drinking of food or water contaminated with the bacterium Vibrio cholerae.

Symptoms

Most people infected may not develop any symptoms, although the bacteria can be found in their faeces for 1-10 days after infection and are shed back into the environment, potentially infecting other people.

Symptoms start appearing between 12 hours and five days after eating contaminated food or water and can affect both children and adults and can kill within hours if untreated.

The commonest symptom is severe acute watery diarrhoea. Among people who develop symptoms, the majority have mild or moderate symptoms, while a minority develop acute watery diarrhoea with severe dehydration. This can lead to death if left untreated.

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Prevention and control

A multifaceted approach is key to control cholera, and to reduce deaths. A combination of surveillance, water, sanitation and hygiene, social mobilisation, treatment, and oral cholera vaccines are used.

Medical practitioners need to be extra vigilant so we do not miss any cases of cholera. Cholera surveillance should be part of an integrated disease surveillance system that includes feedback at the local level and information-sharing at the global level.

Cholera cases are detected based on clinical suspicion in patients who present with severe acute watery diarrhoea. The suspicion is then confirmed by identifying V. cholerae in stool samples from affected patients. The samples are sent to a laboratory for confirmation by culture or PCR.

Countries affected by cholera are encouraged to strengthen disease surveillance and national preparedness to rapidly detect and respond to outbreaks. Under the International Health Regulations, notification of all cases of cholera is no longer mandatory. However, public health events involving cholera must always be assessed against the criteria provided in the regulations to determine whether there is a need for official notification.

Water and sanitation interventions

As a country we need to ensure that all our people have access to safe drinking water and adequate sanitation. Interventions include actions to ensure use of safe water, basic sanitation and good hygiene practices in cholera hotspots.

In addition to cholera, such interventions prevent a wide range of other waterborne illnesses, as well as contributing to achieving goals related to poverty, malnutrition, and education.

Treatment for cholera

Cholera is an easily treatable disease. The majority of people can be treated successfully through prompt administration of oral rehydration solution (ORS) dissolved in one litre of clean water. Adult patients may require up to six litres of ORS to treat moderate dehydration on the first day.

Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids (drip). These patients are also given appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of bacteria excretion in their stool.

People must have fast access to treatment. With early and proper treatment, the case fatality rate should remain below 1%.

Zinc is an important addition to treatment for children under five, which also reduces the duration of diarrhoea and may prevent future episodes of other causes of acute watery diarrhoea. Breastfeeding should also be promoted. Communities need to be educated on safe water and food practices. This can be done in schools and churches where many people congregate.

Basic hygiene practices like handwashing with soap, safe preparation and storage of food and safe disposal of the faeces of children, funeral practices for individuals who die from cholera to prevent infection among attendees must be emphasised. There are oral vaccines available and these should be provided to everyone who has not received a dose.

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