Public Health Education on Cholera Prevention

Introduction

Cholera is an acute intestinal infectious disease that mainly affects communities that are devoid of safe drinking water supply and poor sanitation facilities. This condition is usually prevalent in developing countries and the low socioeconomic groups who fail to afford a better livelihood and are vulnerable to this waterborne infectious disease. The affected individuals usually present with diarrhea and abdominal pain. If not intervened at the right time, the patient may die due to loss of fluids and highly virulent infection. Many public health awareness programs have been conducted to create awareness about the importance of practicing good hygiene among the vulnerable population. Health sectors across the globe have devised measures to end cholera by 2030 by providing various sanitation and pure water supplies to the affected communities, thereby aiming to reduce the mortality rates by up to 90 percent.

What Causes Cholera?

• Cholera is an infectious waterborne disease caused by the bacteria Vibrio cholerae. This infection spreads from person to person by drinking contaminated water.

• Cholera can be an epidemic or endemic disease.

• Cholera-endemic disease refers to the isolation of the disease in a particular area or region, where the cases occur regularly for a long period of time, whereas the epidemic refers to the occurrence of new cases that were not found before in that particular region and can also spread to other regions due to the increased intensity of the spread.

What Are the Symptoms of Cholera?

• Cholera is a highly infectious disease caused by the bacteria Vibrio cholerae. The bacteria enter the intestine and multiply to give rise to a full-blown infection.

• The incubation period (time taken to exhibit the clinical symptoms) ranges from 12 hours to five days.

• Cholera infects both adults and children.

• The most important clinical features include:

1. Uncontrolled watery diarrhea.

2. Abdominal pain.

3. Fever and chills.

4. Severe dehydration.

• Treatment should be started immediately as the infection is highly virulent and can lead to death. The patient also dies of dehydration. Hence, immediate fluid replenishment must be initiated.

• The infection is usually contracted by consuming contaminated food and water.

• Many people remain asymptomatic without any symptoms. However, they will be infectious as they shed bacteria through the feces for about ten days and can contribute to spreading the infection. Hence, asymptomatic carrier patients need to be isolated.

Who Is at Risk of Getting Infected With Cholera?

Cholera cases are more prevalent in underprivileged areas of developing countries. The risk factors include:

• Areas with poor access to safe and clean water supply and improper sanitation facilities.

• Peri-urban slums and camps.

• Places where refugees are kept and have minimal water and sanitation facilities.

How Is Cholera Infection Treated?

• Cholera can be treated easily and successfully if the fluid replenishment is done in time.

• The lost fluid volume from the body can be replenished by administering ORS (oral rehydration solution).

• According to the standards of WHO (World Health Organization) / UNICEF (United Nation's International Children Emergency Fund), one ORS (Oral rehydration solution) sachet requires one liter of clean and safe drinking water and is mixed thoroughly and administered to the patients regularly to replenish the lost volume.

• Six liters of ORS is recommended on the first day for moderate dehydration in adults.

• Patients with severe dehydration need immediate administration of intravenous fluids to prevent the patient from going into shock.

• Also, antibiotics should be started immediately in such patients to destroy the bacterial load in the body, thus controlling the occurrence of diarrhea, decreasing the necessity of fluid resuscitation so that the patient can have lesser hospital stays, and also reducing the duration of shedding of Vibrio cholerae bacteria through the infected patient’s feces so that the community spread can be reduced.

• Antimicrobial resistance occurs in the case of mass administration of antibiotics. Hence, it should be avoided.

• The huge cholera outbreaks can be tackled by providing immediate access to treatment centers among the affected communities with 24-hour medical care and intravenous and oral rehydration facilities.

• The early and prompt treatment can bring down the mortality rates below one percent.

• Children below five years of age who suffer from diarrhea should be administered Zinc as an adjunctive therapy. Zinc plays an important role in reducing the frequency of diarrheal episodes and also helps in controlling it.

• Breastfeeding in cases of small children is beneficial.

What Are the Necessary Steps Adopted in Preventing and Controlling Cholera?

Cholera prevention and control is a multifaceted approach which includes:

1. Surveillance:

• Usually, people suffering from cholera present with symptoms of diarrhea. Such patients are subjected to investigations by collecting their stool samples.

• Once they are found positive, immediate treatment is initiated, and control measures are taken to prevent the community's spread.

• The detection of cholera during the surveillance process is facilitated with rapid diagnostic tests (RDTs), which aid in raising a cholera alert after the detection of one or two cases.

• All the suspected samples are sent to the laboratory and confirmed by either culture or PCR (polymerase chain reaction) tests.

• The effective functioning of a surveillance system is determined by its ability to identify the suspected cases, collect the samples, and subject them to investigations and thereby evaluate the reports and analyze the results, which helps in devising control strategies.

2. Water and Sanitation Facilities:

• Initiating economic development and providing safe water supply and sanitation facilities contributes to the long-term success of cholera control and prevention programs.

• The cholera outbreak can be prevented in the future by implementing WASH programs in economically weaker sections that are deprived of water and sanitation facilities and cholera hotspot areas.

• WASH refers to providing safe water, adequate sanitation, and teaching good hygiene practices.

• These WASH programs, along with targeting cholera prevention, will aid in tackling issues like poverty, malnutrition, and education by providing these benefits to the affected.

3. Hygiene Practices:

• Always ensure the use of safe and pure water for drinking and domestic purposes.

• Ensure to use chlorinated or properly boiled or filtered water if bottled water is not available.

• Wash hands before and after having meals.

• Wash hands before and after preparing food.

• Wash hands thoroughly with soap and water after using a toilet or caring for a baby.

• Wash hands properly after taking care of people who are sick or suffering from diarrhea.

• Make sure to use the toilet to dispose of children’s poop and urinals.

• If there is no access to a toilet, disposal of poop should be done about 30 meters away from the water bodies and should be buried.

• Latrines or temporary pit toilets need to be constructed about 1.6 feet deep and 30 meters away from the water bodies.

4. Oral Cholera Vaccines:

• The WHO has recommended three oral cholera vaccines (OCV), which include Dukoral, Shanchol, and Euvichol-Plus. These vaccines should be given in double doses.

• Dukoral is given to all above two years of age. It is administered with the buffer solution and needs 150 ml of water in the case of adults.

• Each dose can be given between the gap of seven days to six weeks; it should not exceed more than six weeks.

• Mostly, small children between two to five years of age need a third dose and are commonly used for travelers.

• Dukoral protects for two years if given in both the does.

• Shanchol and Euvichol-Plus contain the same formula and, unlike Dukoral, do not need a buffer solution.

• Shanchol and Euvichol can be given to everyone above one year. Two doses of vaccine are administered to protect for three years.

• The time interval between the two doses should not be less than two weeks.

• Vaccines need to be maintained in the cold chain temperature of around 2 to 8 degrees Celsius for a short duration of time and monitored continuously.

• Shanchol and Euvichol-Plus vaccines are used for vaccination campaigns.

Conclusion

Many preventive and control measures have been devised to end cholera. Many vaccinations are available. Mass vaccination campaigns have been conducted across the globe, administering around 100 million doses of oral vaccinations. These vaccination drives are usually conducted in outbreak areas and cholera hotspots. Providing adequate sanitation and drinking water facilities along with oral cholera vaccination drives can aid in reducing the occurrence of cholera to a great extent and thus contribute to preventing further outbreaks.