Chapter 1-Introduction To Cholera

Introduction to Cholera Disease
Ethiopian Public Health Institute

Public Health Emergency Management
Bacterial Diseases Surveillance and Response
Dr. Lijalem G.(EPHI)

April 10/ 2023
Jimma, Oromia, Ethiopia
Cholera Surveillance and Outbreak Response

Outline
 What is Cholera?
 Etiology
 Reservoir
 Mode of transmission
 Risk factor
 Clinical characteristics

Enabling Objective
After completing this chapter, the training

participants will be able to:
1) Describe cholera disease, etiologic agent, and
reservoir
2) Summarize cholera disease mode of transmission
3) Identify risk factors and clinical features of cholera
disease

Activity 1.1. Self-reflection_15 minutes
Instruction: Read the following summary of

cholera report in Ethiopia and answer the
following questions (on your participant
manual page)
Question:
1.What comes in your mind when you hear
cholera?
2.Why do you think frequent occurrence of
cholera outbreak in Ethiopia?
Cholera Surveillance and Outbreak Response 4

Cholera
 Cholera is a diarrheal disease caused by infection of

the intestine with the gram-negative bacteria Vibrio
cholerae, either type O1 or O139.
 Both children and adults can be infected.
 It is one of the key indicators of social development
 Become a challenge to low safe drinking water and
adequate sanitation access and utilization
Cholera..
Etiology :
 There are over 100 vibrio species known but only
the “cholerae” species are responsible for cholera
epidemics.
 Vibrio cholerae species are divided into 2
serogroups
 Vibrio cholerae O1 &Vibrio cholerae O139
 Both biotypes subdivided into Classical and El Tor
biotypes

Cholera
Species Vibrio cholera
Serogroup O139 O1
Biotype El Tor Classic
Hikojima Hikojima
Serotype
Ogwa Ogwa
Inaba Inaba

cholera
 The three serotypes can co-exist during an

outbreak
This does not affect the epidemic pattern:
– Clinical features are similar, whatever the strain
– Regardless of the strain, the response is the same.
 Vibrios grow easily in saline water and alkaline
media.
 Survive at low temperatures but do not survive in
acid media

Cholera
Reservoir:
 Humans are the main reservoir of vibrio cholerae
 Water
– V. Cholerae can live for years in some aquatic
environments
 Some molluscs fish and
 Aquatic plants

Cholera
 Transmission
– Cholera is transmitted by the fecal-oral route
– Contaminated water or food
– Corpses of cholera patients
– Cholera treatment centers can become main sources of
contamination if hygiene and isolation measures are
insufficient
– Fruit and vegetables grown at or near ground level and
fertilized with night soil (human excreta) and then eaten
raw!

Feco-oral rout

Cholera
Common source_ Water

– Contaminated at its source
– Shallow wells, surface water
– Contaminated in the home / after storage
– When inadequately washed hands come in contact with
stored water
– If wash utensils in contaminated water
– If bathe in contaminated water

Cholera
 Common source_ food

 Moist grains served at room temperature or lightly
heated
 Moist food is excellent environment for growth of V.
Cholerae
 Acidifying foods inhibits growth of V. Cholerae with
lemons, tomatoes, yogurt or fermented milk

Cholera
Risk Factors
 Poor social and economic environment, precarious
(risky) living conditions associated with:
– Insufficient water supply (quantity and quality)
– Inappropriate and poor sanitation and hygiene practices
– Inadequate food safety (from preparation to table)
–- High population density: camps, slum populations,
internally displaced people (IDP) are highly vulnerable.
–- Conflict/War affected areas

Cholera
 Risk factor
 Inadequate quantity and/or quality of water
 Inadequate personal hygiene
 Poor washing facilities
 Inappropriate or poor sanitation
 Inappropriate funeral services for cholera corpus

Activity 1.3 Think Pair –Share(10m)
 Instruction: Think and discuss

the following questions with
your neighboring trainee for 5
minutes and share your ideas
within 5 minute.
 Question:
 The incubation period of
cholera?
 Describe the sign and symptoms
of cholera patient?
Cholera Surveillance and Outbreak Response 17

Cholera
Clinical Features_ Pathogenesis:

 The large majority of ingested bacteria are destroyed
by stomach acidity
 surviving bacteria colonize intestinal cells, where they
multiply and produce a very powerful enterotoxin
 That causes profuse watery diarrhea by a secretion
mechanism.
 The toxin adheres to intestinal cells and causes an
excretion of isotonic fluid in the intestinal lumen: it is
the enterotoxin that causes fluid loss and diarrhea.
Cholera
 Incubation Period and Period of Infectivity

 The incubation period is usually 1 to3 days but can
range from several hours to 5 days.
 Symptoms usually last 2 to 3days, although in some
patients they can continue up to 5 days.
 Infected persons whether they are symptomatic or
not, can carry and transmit vibrios during 1 to 4
weeks
 Antibiotic therapy can decrease the duration of
symptoms and the period of infectivity.
Cholera
 Signs and Symptoms

 Of the people infected with cholera
– Around 75% have no symptoms
– Around 20% have mild or moderate diarrhea (which can
produce dehydration)
– Around 5% have severe diarrhea, vomiting, and severe
dehydration

Cholera
 The case-fatality rate in untreated cases may reach

30–50% if there is not prompt treatment.
 Treatment is straightforward (basically rehydration)
 If treatment is applied appropriately the case-
fatality rate can be minimized to below 1%.

Cholera
 Symptomatic cholera:
– Acute watery diarrhea(AWD)
– Profuse, "rice water" stools
– No fever, no abdominal cramps
– Vomiting and leg cramps common
– It is usually odorless or has a mild fishy smell.
– People with a severe case of cholera can pass one liter of
stool per hour or more, and leads to dehydration.

 Dehydration
 Can lose up to 10% of body weight
 Fluid losses up to 1 liter / hour
 Must replace fluids and electrolytes to avoid
hypovolemic shock, renal failure and death.

 Figure 1. Signs of severe dehydration
 Sunken eyes, lethargy and slow recall of skin

Cholera
“Rice water" stool

Cholera
 Key cholera prevention and control measure

 Surveillance:
– Early detection and containment of cases
– Risk factor identification ..
 Proper case management:
– Reduce CFR
– Establish CTC/CTU as soon as possible in affected
community
 Conduct OCV camping: helps in controlling the
outbreak
Cholera
 Water and sanitation improvements

– Construct latrines
– Construct above-ground sewage tanks (e.g., in urban areas)
– Distribute safe water (e.g., water delivery by truck)
– Distribute point-of-use water purification tools (e.g., AquaTabs)
– Improved water storage containers (e.g., containers with
narrow mouths or spigots)
– Flocculation-disinfectant powder sachets
– Filtered water using cloth
– Monitor Free chlorin residual (FCR) at point of consumption

Cholera
 Use community leaders, teachers, broadcast

and print media to tell messages:
– Hand washing with soap after defecation or cleaning an
infant’s bottom
– Hand washing with soap before handling food, eating, or
breastfeeding
– Boiling water before drinking or using it in cooking
– Safe food preparation and storage practices
– Breastfeeding infants


Chapter 1-Introduction To Cholera

Uploaded by

Copyright:

Available Formats

Chapter 1-Introduction To Cholera

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chapter 1-Introduction To Cholera

Uploaded by

Copyright:

Available Formats

Introduction to Cholera Disease

Ethiopian Public Health Institute

Dr. Lijalem G.(EPHI)

Cholera Surveillance and Outbreak Response

Cholera Surveillance and Outbreak Response

After completing this chapter, the training

Cholera Surveillance and Outbreak Response

Instruction: Read the following summary of

Cholera Surveillance and Outbreak Response 4

 Cholera is a diarrheal disease caused by infection of

Cholera Surveillance and Outbreak Response

Biotype El Tor Classic

Cholera Surveillance and Outbreak Response

 The three serotypes can co-exist during an

Cholera Surveillance and Outbreak Response

Cholera Surveillance and Outbreak Response

Cholera Surveillance and Outbreak Response

Cholera Surveillance and Outbreak Response

Common source_ Water

Cholera Surveillance and Outbreak Response

 Common source_ food

Cholera Surveillance and Outbreak Response

Cholera Surveillance and Outbreak Response

Cholera Surveillance and Outbreak Response

 Instruction: Think and discuss

Cholera Surveillance and Outbreak Response 17

Clinical Features_ Pathogenesis:

 Incubation Period and Period of Infectivity

 Signs and Symptoms

Cholera Surveillance and Outbreak Response

 The case-fatality rate in untreated cases may reach

Cholera Surveillance and Outbreak Response

Cholera Surveillance and Outbreak Response

Cholera Surveillance and Outbreak Response

 Sunken eyes, lethargy and slow recall of skin

“Rice water" stool

 Key cholera prevention and control measure

 Water and sanitation improvements

Cholera Surveillance and Outbreak Response

 Use community leaders, teachers, broadcast

Cholera Surveillance and Outbreak Response

You might also like