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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