07-UNICEF Cholera Prevention

8/2/2019 07-UNICEF Cholera Prevention

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CholeraPrevention

10 Key factors

UNICEF West and CentralAfrica


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OBJECTIVE OF NORWAYINITIATIVE

Develop systems for cholera

prevention and outbreak responseand to extend the benefits over alonger time frame to reduce

diarrhoeal disease incidence.


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1. What are the symptoms?

Very rapid onset of vomiting and diarrhoea withlarge volumes of very watery (rice water type)stools (>3 times a day)

Severe de-hydration, = low pulse, undetectableblood pressure, sunken eyes, wrinkled handsand feet

Slow recovery of shape after depression of skin

No urine output Laboratory confirmation but count all suspected

cases and treat


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2. How is it transmitted?

It is caused by a bacterium (Vibrio cholerae) whichlives naturally in brackish/freshwater amoeba,and is transmitted through -:

Unsafe water (7/8 investigations in Latin

America identified this as a major route) Unwashed fruit and veg (or washed in bad

water), left over rice not re-heated (3investigations +Lusaka 2004),

Lack of handwashing (food preparation, handshaking, childcare)

Cooked and uncooked sea food vibrio surviveslight cooking (2 investigations)


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3. Who is most at risk?

Those living near lagoons / low lying areaswith fresh/ brackish water/ fishing populations

With unsafe water sources

With poor faecal disposal practices

With poor personal hygiene

With poor food hygiene (esp. moist food ofneutral acidity)

Close to cholera patients in early stages(hyper-infectivity) and dealing with bodies


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4. When does cholera becomeepidemic?

After heavy period of rainfall

When water temperatures rise

When normal diarrhoeal incidenceincreases

Endemic cholera with good sanitation

needs permanent source of vibrio, but withpoor sanitation higher secondarytransmission can maintain endemic status


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5. How long does it take?

Incubation period 2hrs-5 days Infection 7-14 days, but most people do not

become ill or show any symptoms

Only about 10-20% of infected people showmoderate or severe symptoms.

Moderate symptoms difficult to differentiate

from other types of acute diarrhoea Group O blood group highest risk


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6. How is it treated?

Greatest risk in first 24 hours, so re-hydrate assoon as possible

Normally ORS (rice- rather than glucose-basedreduces purge rate,- sodium = or > 75mmol/l)

If vomiting, give intravenous fluid replacement(eg Ringers lactate) extreme cases.

Give food as soon as patient can take it

Extreme cases only should have 1-3 days

antibiotic (esp doxycycline single dose) toshorten illness, when vomiting stops


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7. How is it prevented?

Blocking routes of transmission waterdisinfection (source and /or household),hand washing, sanitation, good food

hygiene and well-cooked

Cholera vibrio doesnt like acid

environment (block with acidic water eg.

With citrus juice, healthy stomach acidlevels, acid food)

Oral vaccine (Dukoral) only for IDP setting


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8. What proportion will die?

Most people who die, do so within the first day ofsymptoms appearing

Without any treatment about 50% of people

survive With adequate re-hydration less than 2% will die

With good surveillance, rapid establishment of re-

hydration, and anti-biotics for worst cases, almostall deaths can be avoided (


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9.Risky cultural practices/beliefs

The following beliefs about causes of cholera mayreduce effectiveness of key messages -:

Witchcraft, eye, wind, climatic change cause the

sickness Childrens stools are not dangerous

Soap is believed to wash away luck

The following practices increase risks

Anal washing is often not followed by hand-washing

Handshaking transfers bacteria directly from oneperson to the next

Burial ceremonies may spread disease


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10. What are Key Messages?

Bad water is one source of cholera (disinfectsource or stored water) but others, especiallycontaminated food (clean and cook well) andassociated lack of hand washing (essential times

and methods for handwashing) should also behighlighted

Rapid transfer to clinics or use of ORT cornersspeeds up treatment and reduces cross infection.

Re-hydration as early as possible saves the mostlives- water quality in OR is of little importance

Good surveillance systems can identify causes andreduce infection rates


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Africa's percentage of Global cholera

0%

20%

40%

60%

80%

100%

120%

1996 1998 2000 2002 2004 2006

Africas global dominance?


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West Africa

LeagueTable

Country Total cases Incidence/1000Mortality Incidence

(sorted on mortality) 1997-2004 Ranking Average

Central African Republic 785 18 15.189 0.206579

Congo 8,319 5 11.285 2.291736

Cameroon 16,556 9 9.639 1.051175

Guinea 3,974 14 9.269 0.475359

Mali 6,276 12 8.530 0.497188

Mauritania 576 19 8.348 0.200697

Togo 8,536 6 6.985 1.778333

DR Congo 137,349 4 6.743 2.682598

Chad 23,943 3 6.467 2.867425

Niger 4,457 16 5.968 0.386088

Cte d'Ivoire 11,239 10 5.495 0.686771

Nigeria 46,803 15 5.409 0.387086

Burkina Faso 2,224 20 4.071 0.180813

Sierra Leone 3,472 11 3.829 0.590175

Ghana 26,280 7 2.431 1.283767

Benin 7,614 8 2.290 1.189688

Senegal 1,598 21 1.890 0.15104

Guinea-Bissau 21,968 1 1.866 16.15294

Equatorial Guinea 59 22 1.695 0.122661

Cape Verde 133 17 0.752 0.3325

Liberia 42,497 2 0.474 12.81188

Gabon 635 13 0.000 0.488462

TOTAL 375,293


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Endemic 1. Cholerareservoir, constant orsporadic few cases

Epidemic. Triggered byfactors in 4. reachespeak and then preventivemeasures dominate

Endemic 2. Continuedlevels higher than

endemic 1 while personto person infectioncontinues

Typical cholera curve

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07-UNICEF Cholera Prevention