Preventing Recurring Cholera Outbreaks

Cholera outbreak usually occurs during the raining season, thus the need for proactive measure.

The Nigeria Centre for Disease Control and Prevention (NCDC) recently reported 1,141 suspected and 65 confirmed cases of cholera with 30 deaths.

The cases were reported from 96 local government areas (LGAs) in 30 States.

According to NCDC,  Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa and Lagos State are the 10 states that contributed 90 percent to the burden of cholera presently in the country.

Cholera is a food and water-borne disease, caused by the ingestion of the organism Vibrio Cholerae in contaminated water and food.

On food and water contamination, NCDC explained that“Water is usually contaminated by the faeces of infected individuals, adding that contamination of drinking water can occur at the source, during transportation, or during storage at home.

Food may be contaminated by soiled hands, either during preparation or while eating.

Beverages prepared with contaminated water and sold by street vendors, ice, and even commercial bottled water have been implicated as vehicles of transmission, as have cooked vegetables and fruits freshened with untreated wastewater.”

The time between infection and the appearance of symptoms is two  hours to five days. It has a higher risk of transmission in areas that lack adequate sanitation facilities and/or a regular supply of clean water. Unsafe practices such as improper disposal of refuse and open defecation endanger the safety of water used for drinking and personal use.”

On those at risk, NCDC said people of all ages living in places with limited access to clean water, People living in areas with poor sanitation and poor hygiene and people living in slum areas where basic water or sanitation infrastructure is missing are at risk.

Others include people living in rural areas who depend on surface water or unsafe piped or borehole

well water sources for drinking, people who consume potentially contaminated food or fruits without washing and cooking properly, people who do not perform hand hygiene at appropriate times, relatives who care for sick people with cholera at home, healthcare workers including doctors, nurses, and other health workers who provide direct patient care in the absence of standard precautions.

The centre has, therefore, alerted the public of the increasing trend of cholera cases across the country as the raining season intensifies.

It also called for prevention measures while urging the public to ensure that they boil their water and store it in a clean and covered container before drinking, as well as practice  good personal hand hygiene by regular hand washing with soap under clean running water.

“Ensure that food is well cooked before consumption. Only consume raw food such as  fruits and vegetables, after washing thoroughly with safe water. After cooking food or  boiling water, protect against contamination by flies and unsanitary handling; left over  foods should be thoroughly reheated before ingestion. Persons with diarrhoea should  not prepare or serve food or haul water for others.

Avoid open defecation, indiscriminate refuse dumping, ensure proper disposal of waste  and frequent clearing of sewage. If you or anyone you know experience sudden watery diarrhoea, please do not self medicate, visit a healthcare facility immediately,” the centre advised.

According to the World Health Organisation (WHO), cholera is an acute diarrheal infection  which can lead to dehydration and even death if untreated, adding that the disease remains a global threat to public health and an indicator of inequity and lack of social development.

WHO said the long-term solution for cholera control lies in economic development and universal access to safe drinking water and adequate sanitation.

The organisation said actions targeting environmental conditions include the implementation of adapted long-term sustainable WASH solutions to ensure use of safe water, basic sanitation and good hygiene practices to populations most at risk of cholera.

In addition to cholera, WHO said such interventions prevent a wide range of other water-borne illnesses, as well as contributing to achieving goals related to poverty, malnutrition, and education.

Symptoms

Sudden acute watery diarrhoea in children and adults with or without vomiting. Other symptoms include nausea and weakness. Cholera is highly contagious and in severe cases, can lead to death within hours.

Treatment

Cholera is an easily treatable disease.  According to WHO, the majority of people can be treated successfully through prompt administration of oral rehydration solution (ORS). The WHO/UNICEF ORS standard sachet is dissolved in 1 litre (L) of clean water. Adult patients may require up to 6 L of ORS to treat moderate dehydration on the first day.

Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids. These patients are also given appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of V. cholerae excretion in their stool.

Prevention and control

WHO says a multifaceted approach is key to control cholera.  “A combination of surveillance, water, sanitation and hygiene, social mobilisation, treatment, and oral cholera vaccines are used.“