Cholera: Causes, Symptoms and Treatment

Table of Contents

What is Cholera?

Cholera is a severe diarrheal disease caused by an infection of the Vibrio cholerae bacteria.
Cholera is a bacterial disease primarily spread through contaminated water.
Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death, if left untreated.
The extreme diarrhea and dehydration brought on by cholera can be lethal within hours, if left untreated.

Key Facts About Cholera

The risk of cholera is highest where poverty, war or natural disasters force people to live in crowded conditions without adequate sanitation.
The majority of infected people will have no symptoms or rather minor ones, and Oral Rehydration Solution (ORS) can effectively treat them.
Ending Cholera: A Global Roadmap to 2030, a global cholera control strategy, was introduced in 2017. Its goal is to reduce cholera mortality by 90%.
Cholera is a global threat to public health and an indicator of inequity and lack of social development
According to World Health Organization, there are about 1.3 to 4.0 million cases of cholera each year, and the disease is responsible for between 21,000 and 143,000 deaths globally.
To stop and manage the spread of cholera and other waterborne diseases, it is essential to provide safe water and sanitation.
Patients in severe condition of cholera require rapid intravenous hydration and antibiotic treatment for recovery and treatment.
To manage cholera outbreaks and for prevention in regions known to have a high risk for cholera, oral cholera vaccines should be administered in conjunction with improvements in water and sanitation.

Causes

Cholera is an infection brought on by the Vibrio cholerae
Cholera is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.
A toxin that the bacteria in the small intestine create is what causes the disease’s lethal effects. The toxin makes the body excrete a ton of water, which causes diarrhea. As a result, salts and fluids are lost quickly (electrolytes).
The main cause of cholera infection is contaminated water sources. The bacterium can be discovered in:

Well or surface water: Large-scale cholera epidemics frequently originate from contaminated public wells.
Seafood: Consuming raw or undercooked seafood, particularly shellfish, from specific regions puts you at risk of contracting cholera bacterium.
Raw fruits and vegetables: In locations where cholera is present, raw, unpeeled fruits and vegetables are frequently a source of cholera infection. Production in the field can become contaminated in underdeveloped nations by uncomposted manure fertilizers or irrigation water containing raw sewage.
Grain: In areas where cholera is common, grains like rice and millet can produce cholera bacteria if they are tainted after cooking and left at room temperature for several hours.

Incubation Period

The incubation period of cholera is about 12 hours to 5 days.
It takes between 12 hours to 5 days for a person to show symptoms after ingesting contaminated food or water.

Signs and Symptoms

Most people infected with cholera may not show symptoms of cholera. However, the bacteria is present in their faeces for around 1-10 days after infection.
Majority of the people have mild or moderate symptoms and only minority have acute watery diarrhea with severe dehydration.
In the early stages of cholera, the following symptoms are common and affect about 1 in 10 people:
Excessive watery stools, often known as “rice-water stools,”
Leg cramps
Thirst
Restlessness or irritation

When examining a patient who has profuse watery diarrhea, medical professionals should check for signs of dehydration. These consist of:

Quick heartbeat
Skin elasticity loss
Dried-up mucous membranes
Reduced blood pressure
Tiredness
Sunken eyes
Dry mouth
Reduced urine output

Risk Factors of Cholera

Except for infants who get immunity from nursing mothers who have already had cholera, everyone is susceptible to cholera.
You may still be more susceptible to the disease or more prone to experience severe signs and symptoms depending on a number of circumstances.

Risk factors of cholera include:

1. Poor sanitary conditions

When it is difficult to maintain a sanitary environment, including a reliable water supply, cholera is more likely to spread.
These circumstances are typical of refugee camps, underdeveloped nations, and regions affected by starvation, conflict, or natural disasters.

2. Decreased or absent stomach acid

Acidic conditions are inhospitable to cholera bacteria, and regular stomach acid frequently acts as a preventative measure against infection.
However, those who lack this defense, such as youngsters, the elderly, those who take antacids, H-2 blockers, or proton pump inhibitors, are more susceptible to cholera.

3. Household exposure

If there is a family member with the illness, the risk of contracting cholera rises among other members of the family.

4. O-blood type

Persons with type O blood are twice more prone to contract cholera than people with other blood types, for unknown reasons.

Prevention and Control Measures

Cholera can be prevented by having access to clean, safe water.
Effective remedies frequently include adequate chlorination of public water sources and, in some situations, the delivery of chlorine tablets to homes.
Public awareness to boil the water before consuming it, if chemical disinfection is not an option.
Sometimes, even more straightforward techniques can work. Environmental water supplies can now be tested and monitored for the presence of Vibrio cholerae. The identification of potential causes of cholera outbreaks can be facilitated by rapid detection utilizing such techniques.
The sanitary disposal of human waste is another significant action. Effective use of latrines can greatly reduce the risk of illness in regions without sophisticated sewerage systems.
Food safety assurance is yet another crucial control method. Additionally, it’s critical to always wash your hands after using the toilet and before preparing food.
Stored food should also be covered to prevent contamination.
Travelers to regions where cholera is a prevalent disease should avoid eating foods sold by street vendors since they have been frequently cited as sources of infection.

Treatment

Patients with cholera need to be diagnosed and treated right away. Even gravely ill people can be saved with the right care.
Rehydration therapy, which is the main course of action for cholera patients, refers to the quick replenishment of lost salts and fluids.
Indications for antibiotic treatment include severe cholera cases, which result in decreased hydration requirements and shorter illness duration.
Children’s cholera symptoms have been demonstrated to improve with zinc therapy.

In summary, common methods for treating cholera are:

Oral rehydration salts, which are mixed with water
Other electrolyte solutions
Intravenous (IV) fluid rehydration
Antibiotics
Zinc supplements

Vaccination for Cholera

The WHO has endorsed three oral vaccines for cholera via its vaccines prequalification program. They are:

- Dukoral
- Euvichol-Plus/Euvichol
- ShanChol
All three immunizations require two doses for complete protection.
Dukoral offers about 65% protection for two years and must be taken with clean water. It is not necessary to take Shanchol or Euvichol with water, and they offer 5 years of 60% protection.

WHO Response

The Global Task Force on Cholera Control (GTFCC), established at WHO with a secretariat, was revitalized in 2014.
The GTFCC is a network of more than 50 partners working to combat cholera on a worldwide scale. These partners include universities, NGOs, and UN agencies.
With assistance from donors and the GTFCC, WHO seeks to:
- Encourage the creation and implementation of international plans to help build global cholera prevention and control capabilities;
- Offer a venue for technical discussion, coordination, and cooperation on cholera-related initiatives to improve national cholera prevention and control capabilities;
- Supporting the development of a research agenda with a focus on evaluating innovative approaches to cholera prevention and control in affected countries,
- Disseminating technical guidelines and operational manuals, supporting countries’ implementation of effective cholera control strategies
- Monitoring progress, raising awareness of cholera as a significant global public health problem