September 24, 2021


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What you need to know about cholera

By Doris Obinna

The Nigeria Centre for Disease Control (NCDC) has said cholera outbreak claimed no fewer than 816 lives between January and Auguat 2021. It said the deaths were recorded from about 31,425 suspected cases reported across Nigeria since the beginning of the year.

The agency, in a statement, announced that 27 per cent of the cholera patients were between the ages of five and 14, with 51 per cent being males and 49 per cent females.

Cholera is an acute diarrhoeal infection caused by eating or drinking food or water that is contaminated with the bacterium Vibrio cholerae. Cholera remains a global threat to public health and is an indicator of inequity and lack of social development.

Researchers have estimated that every year there are 1.3 to 4.0 million cases of cholera, and 21,000 to 143,000 deaths worldwide due to the infection.

According to World Health Organisation (WHO), cholera is an extremely serious disease that can cause severe acute watery diarrhoea with severe dehydration. It takes between 12 hours and five days for a person to show symptoms after consuming contaminated food or water. Cholera affects children and adults and can kill within hours, if untreated.

“Most people infected with Vibrio cholerae do not develop any symptoms, although the bacteria are present in their faeces for 1 to 10 days after infection. This means the bacteria are shed back into the environment, potentially infecting other people.

“Cholera is often predictable and preventable. It can ultimately be eliminated where access to clean water and sanitation facilities, as well as good hygiene practices are ensured and sustained for the whole population.”

A public health expert, Dr. Olalekan Sunday, said cholera was a frequent cause of outbreaks globally, particularly in areas with inadequate water, sanitation and hygiene (WaSH) services.

“Cholera is an acute diarrhoea disease that can kill within hours, if left untreated. Up to 80 per cent of cases can be successfully treated with oral rehydration salts. Provision of safe water and sanitation is critical to control cholera and other water-borne diseases. Oral cholera vaccines are an additional way to control cholera, but should not replace conventional control measures.

“Cholera is spread through faecal-oral routes, and studies demonstrate that ingestion of Vibrio cholerae occurs from consuming contaminated food and water, contact with cholera cases and transmission from contaminated environmental point sources.

“WaSH guidelines recommending interventions for the prevention and control of cholera are numerous and vary considerably in their recommendations. To date, there has been no review of practice guidelines used in cholera prevention and control programmes,” he said.

He further disclosed that, during the 19th Century, cholera spread across the world from its original reservoir in the Ganges delta in India: “Six subsequent pandemics killed millions of people across all continents. The current (seventh) pandemic started in South Asia in 1961, and reached Africa in 1971 and the Americas in 1991. Cholera is now endemic in many countries.”



He said: “Cholera is an extremely virulent disease. It affects both children and adults and can kill within hours. About 80 per cent of people infected with V. choleraedo not develop any symptoms, although the bacteria are present in their faeces for up to 10 days after infection and are shed back into the environment, potentially infecting other people.

“Among people who develop symptoms, 80 per cent have mild or moderate symptoms, while around 20 per cent develop acute watery diarrhoea with severe dehydration. This can lead to death.”


Risk factors and disease burden

Cholera transmission is closely linked to inadequate environmental management, according to WHO.

“Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced persons or refugees, where minimum requirements of clean water and sanitation are not met.

“The consequences of a humanitarian crisis, 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. Dead bodies have never been reported as the source of epidemics.”

Sunday added: “Cholera remains a global threat to public health and a key indicator of lack of social development. The number of cholera cases reported to WHO continues to be high. During 2013, a total of 129,064 cases were notified from 47 countries, including 2,102 deaths.

“The discrepancy between those figures and the estimated burden of the disease is due to the fact that many cases are not recorded due to limitations in surveillance systems and fear of trade and travel sanctions.”


Prevention and control

“A multidisciplinary approach is key for reducing cholera outbreaks, controlling cholera in endemic areas and reducing deaths,” stated WHO.

Also, director-general, NCDC, Dr. Chike Ihekweazu, maintained that none of the medical interventions would solve the underlying issues leading to cholera outbreaks.

He said, without proper WaSH, Nigeria remained at risk of cholera cases and deaths and the long-term solution for cholera control was in access to safe drinking water and maintenance of proper sanitation and hygiene.

He, however, urged state governments to prioritise actions for solutions that ensure access to safe water, basic sanitation and good hygiene practices in communities.



The public health expert stated that cholera was an easily treatable disease: “Up to 80 per cent of people can be treated successfully through prompt administration of oral rehydration salts (WHO/United Nations Children’s Fund ORS standard sachet). Very severely dehydrated patients require the administration of intravenous fluids.

“These patients also need 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 should be set up within the affected communities. With proper treatment, the case fatality rate should remain below 1 per cent.”


Water and sanitation interventions

“The long-term solution for cholera control, which benefits all diseases spread by the faecal-oral route, lies in economic development and universal access to safe drinking water and adequate sanitation, which is key in preventing epidemic and endemic cholera.

“Actions targeting environmental conditions include: the development of piped water systems with water treatment facilities (chlorination, interventions at the household level (water filtration, water chemical or solar disinfection, safe water storage containers), as well as the construction of systems for sewage disposal and latrines.

“Most of those interventions require substantial long-term investments and high maintenance costs, which are difficult to fund and sustain by the least developed countries, where they are also most needed,” WHO stated.

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