Cholera and the situation so far in Nigeria

1. CHOLERA
By
Dr. ANUGOM Emeka.

2. 1. WHAT IS CHOLERA?
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An acute diarrhoeal disease that can kill within hours if untreated in both children and adults.
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There are 3-5 million cases every year, with 100,000 to 120, 000 deaths from cholera every year. Common in Asia and Africa
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Incubation period is from 6 hours to 5 days.
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It’s caused by bacteria Vibrio cholerae, with two serotypes O1 (mainly) and O139 having the potential of causing outbreaks
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3. 2. HOW IS CHOLERA SPREAD?
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Poor Sanitation
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Drinking Contaminated Water
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Eating Contaminated Food
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COMMON SOURCES
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- Raw or poorly cooked seafood
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- Raw fruit and Vegetables
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- Other foods contaminated during preparation and
storage.
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Main source is bacteria in faeces of infected person.
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Poor sewage and water treatment.
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Over populated areas have highest risk.
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4. 3. THE SITUATION IN NIGERIA
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Nigeria reported Cholera epidemics in 2010 and 2011, with an estimated 2000 deaths during
this period.
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This was mainly due to poor sanitation and over population, scarcity of clean drinking water
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It is usually prevalent in the rainy seasons between April to October.
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Currently in 2013, there have been over 1600 reported cases, with an estimated 86 deaths from
cholera.
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Zamfara and Nasarawa states in Nigeria are the worst hit states.
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However cases have also been reported in Kebbi, Sokoto, Plateau, Lagos, Ogun and Oyo state
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5. 4. THE SITUATION IN NIGERIA
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6. 5. SYMPTOMS OF CHOLERA
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Mostly mild diarrhoea or no symptoms at all.
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However in 5-10% of patients, very severe
watery diarrhoea (rice-water stool) and
vomiting may occur
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If untreated, this leads to:
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Severe dehydration from fluid loss and
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Death within hours.
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7. 6. PREVENTION OF CHOLERA
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Simple Rule:
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Boil it – Cook it – Peel it OR Forget it.
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1. Drink only properly treated water
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N:B Beverages (tea/coffee), Wine, Beer, Carbonated water and Soft
drinks, Bottled/packaged fruit juices are usually safe to drink.
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2. Avoid Ice unless you’re sure it’s from safe water source.
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3. Eat food that has been well cooked and served still hot.
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(food at room temperature for several hours and served without
reheating is a source of infection)
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8. 7. PREVENTION OF CHOLERA
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4. Avoid raw seafood and other raw foods. (Fruits and
Vegetables properly peeled and shelled by you is an
exception)
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5. Boil unpasteurized milk before drinking it.
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6. If in doubt of reliability of source of ice cream, avoid it .
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7. Ensure meals bought from street vendors are thoroughly
cooked in your presence and do not contain uncooked foods.
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8. Proper hand washing , especially before food preparation,
during meals, work and after use of sanitary facilities
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9. 8. TREATMENT FOR CHOLERA
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1. SEEK MEDICAL HELP URGENTLY
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2. REHYDRATION:
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MOST important, especially for diarrhoea and
vomiting, to replace water and salt lost early.
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A. Use oral rehydration salts, if unavailable take water
and other non-sweetened fluids e.g. soup.
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B. Give intravenous fluid infusion in the severely
dehydrated.
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10. 9. TREATMENT OPTIONS FOR CHOLERA
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3. ANTIBIOTICS:
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May be used in some cases to shorten illness
duration.
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However not recommended for MASS treatment as it
doesn’t limit the spread
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ANTIDIAARHOEAL DRUGS:
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Loperamide (Imodium) use is NOT recommended and
should NOT be given.
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11. 10. IMMUNIZATION FOR CHOLERA
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VACCINATION:
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INJECTABLE CHOLERA VACCINE:
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Formerly used and gives incomplete, unreliable protection for
short period. With adverse effects and thus no longer
recommended.
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ORAL CHOLERA VACCINE:
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There are two types that give good protection for up to 3years.
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But doesn’t give 100% protection. Hygiene and sanitary
precautions should also be applied.
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Given in 2 doses for those above 6yrs old and 3 doses for those
2-6yrs old, 7days to 6 weeks apart.
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12. 11. IMMUNIZATION FOR CHOLERA
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They are both whole-cell killed vaccines, licensed for use in over 60
countries by WHO.
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No meal should be taken 1 hour before and after taking it to ensure
gut absorption.
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No country requires proof of this vaccination.
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SHANCHOL
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This is gives long-term protection against V cholerae O1 and O139 in
children under 5years.
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DUKORAL
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This has recombinant B-sub unit, with short term protection 85-90%
against V. cholerae O1 in all age groups 4-6mths of immunization
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Given in 150ml of water
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Also useful in diarrhoea caused by Enterotoxigenic E.Coli (ETEC)
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13. 12. REFERENCES
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http://www.who.int/mediacentre/factsheets/fs107/en/
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http://www.who.int/topics/cholera/faq/en/
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http://www.patient.co.uk/health/cholera-immunisation
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https://www.internationalsos.com/en/country-guides.htm
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https://www.internationalsos.com/demo/CountryGuides/DiseasesPrevention.cfm?Img=Dp&Pg=Diseases%20Prevention
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http://www.niaid.nih.gov/topics/cholera/Documents/CholeraFactSheet.pdf
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http://news.yahoo.com/cholera-kills-nine-100-hospitalised-nigeria-195406146.html
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http://www.npr.org/blogs/health/2010/10/29/130923065/tracking-the-origins-of-haiti-s-cholera-strain
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http://liveshots.blogs.foxnews.com/2011/01/10/haiti-one-year-later-the-cholera-crisis/
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http://www.cdc.gov/cholera/
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http://minustahphoto.blogspot.com/2010/11/cholera.html
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http://intrd187-f11-grosovsky.wikispaces.umb.edu/Cholera
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http://www.bbc.co.uk/news/world-africa-11093831
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http://telegraphng.com/2013/10/cholera-outbreak-kills-47-zamfara/
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http://evatese.wordpress.com/
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http://www.bbc.co.uk/blogs/africahaveyoursay/2010/08/what-do-you-know-about-cholera-1.shtml
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http://edition.cnn.com/2010/WORLD/africa/10/26/nigeria.cholera/
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http://scannewsnigeria.com/breaking-news/cholera-kills-50-in-northern-nigeria/
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http://www.nigeriahealthwatch.com/2010/09/nigeria-at-50-cholera-outbreak-and.html
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http://www.un.org/apps/news/story.asp?NewsID=39145&Cr=cholera&Cr1
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http://www.rayur.com/cholera-causes-symptoms-and-treatment.html
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http://www.msf.org.au/from-the-field/field-news/field-news/article/cameroon-chad-niger-nigeria-medecins-sans-frontieres-intervenes-in-several-cholera-outbreaks.html
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http://newshopper.sulekha.com/nigeria-cholera_photo_1502991.htm
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http://www.haiti.mphise.info/health-education?page=1
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14. QUESTIONS
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