Cholera

Cholera is an acute infections disease caused by cholera vibrio (Vibrio cholerae)
Mode of transmission: Oro-faecal route.
Incubation period: Few hours to 5 days
Clinical manifestations
• Sudden onset of severe diarrhoea otherwise known as rice water stools.
• Vomiting • Eyes are sunken
• Skin pale • Husky voice
• Extremities are cold. • Pulse rapid and feabile.
• Blood pressure is low. • Urine output is reduced or stopped.
• Muscular cramps
In Children – Fever, convulsions or coma, loss of muscular tone. Treatment
• Replacement of fluids and Electrolytes.
• Antibiotics : Tetracycline or ceptardine 250 mg – 500 mg QDS od.orally or parently as prescribed by the physician.
• Antidiarrhoeals
• Nutrition : Rice conjee, buttermilk etc.
• If the child is breastfed ask the mother to continue breast feeding.
Control measures
1. Verification of the diagnosis : All cases of diarrhea should be investigated even on the slightest suspicion for specific diagnosis of cholera, it is important to identify V. Cholera in the stools of the patient.
2. Notification : Cholera is a notifiable disease locally, nationally and internationally. Health workers at all levels should be trained to identify and notify cases immediately to the local health authority.
3. Early case finding : An aggressive search for case (mild, moderate, severe) should be
made in the community to be able to initiate prompt treatment.
4. Establishment of treatment centres : It is necessary to establish easily accessible treatment facilities in the community. The mildly dehydrated patients should be treated at home with oral rehydration fluid. Severely dehydrated patients, requiring intravenous fluids, should be transferred to the nearest treatment centre to hospital. Where health services are poor and cholera is endemic or threatening mobile teams should be established at the district level.
5. Rehydration therapy : The rehydration may be oral or intravenous
6. Adjuncts to therapy : Antibiotics should be given as soon as the vomiting has stopped which is usually after 3 to 4 hours of oral rehydration.
The antibiotics for children
a) Tetracycline 12.5 mg 1 kg QID x 3 days
b) Trimethroprim TMP 5 mg/kg Bd x 3 days
c) Sulfamethoxazole and smx 25 mg/kg
Adults
a) Doxycycline 300 mg stat
b) Tetracycline 500 mg QID x 3 days.
c) Trimethroprime TMP 160 mgbd x 3 days
d) Sulfamethoxazole smx 600 mg
e) Fulrazolidone 100 mg QID x 3 days for pregnant women.
7. Epidemiological investigations
Epidemiological studies must be undertaken to define the extent of the outbreak and identify the modes of transmission.
8. Sanitation measures
a) Water Control: All steps must be taken to provide properly treated or otherwise safe water to the community for all purposes (drinking, washing, cooking) .
b) Excreta Disposal: Provision of simple, cheap and effective excreta disposal system is vital during epidemics of cholera .Health education messages should stress the proper use of such facilities.
c) Food sanitation : Steps to be taken to improve food sanitation, particularly sale of foods under hygienic conditions. Health education regarding eating cooked hot food, and of proper individual food handling techniques.
d) Disinfection : Both concurrent and terminal disinfection to be done. Most effective disinfectant is coal tar and bleaching powder clothes and personal items to be disinfected with dettol solution.
9. Chemoprophylaxis : Tetracycline is the drug of choice. It has to be given over a 3 day period in a twice daily dose.
10. Vaccination : Parentral vaccine : Serotypes of V.cholerae 01 per ml, so that each milliliter of the vaccine contains a total of 12,000 million vibrios.
Oral Vaccine : A vaccine consisting of killed whole cell v.cholerae 01 in combination with a recombinant B-sub unit of cholera toxin (we/rBs) given orally in two dose schedule 10-14 days apart.
11. Health Education

• The effectiveness of simplicity of oral rehydration therapy
• The benefits of early reporting for prompt treatment.
• Food hygiene practices
• Hand washing after defecation and before eating.
• The Benefits of cooked hot food and safe drinking water.
• During the year 1980-81, strategy of the National cholera control programme was undergone changes and it is termed as Diarrhoeal Diseases control programme. Oral Rehydration solution is promoted as first line of treatment.