Let’s be wary of cholera

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By Elizabeth Sitotombe

ON February 15 2023, Zimbabwe confirmed a case of cholera in Chegutu Town, Mashonaland West Province, and on February 17 another was confirmed.

The first victim has since recovered but there is so much cause for concern. 

Currently, there is a cholera outbreak in the SADC region affecting Malawi, Zambia and Mozambique. 

With the high movement between our countries, one can never be too careful.

 To date over 43 000 cases and 1 400 deaths have been reported in the region since January 2023.

Cholera outbreaks are not new to Zimbabwe, with a deadly outbreak ravaging the country from  August 2008 to June 2009. 

The outbreak began in Chitungwiza and spread to all provinces by the end of December 2008.

The cholera outbreak resulted in 98 585 reported cases and 4 287 deaths.

It was a horrid experience, one that the country must prevent from happening again.

Again in 2018 to 2019, at least 10 000 cases and 69 deaths were recorded.

Cholera is a bacterial disease usually spread through contaminated water. 

Cholera can be fatal within a few hours if left untreated as it causes severe diarrhoea and dehydration.

Contaminated water supplies are the main source of cholera infection.

Most people who have been exposed to the cholera bacterium do not become ill and may not even be aware that they have been infected. But because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water.

According to the WHO: “Cholera can be endemic or epidemic. A cholera-endemic area is an area where confirmed cholera cases were detected during the last three years with evidence of local transmission (meaning the cases are not imported from elsewhere). A cholera outbreak/epidemic can occur in both endemic countries and in countries where cholera does not regularly occur.”

In cholera endemic countries an outbreak can be seasonal or sporadic and represents a greater than expected number of cases. In a country where cholera does not regularly occur, an outbreak is defined by the occurrence of at least one confirmed case of cholera with evidence of local transmission in an area where there is not usually cholera.

Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities. Typical at-risk areas include peri-urban slums and camps for internally displaced persons or refugees, where minimum requirements of clean water and sanitation are not met.

The number of cholera cases reported to WHO has continued to be high over the last few years. During 2020, 323 369 cases and 857 deaths were notified from 24 countries. The discrepancy between these figures and the estimated burden of the disease is due to many cases not being recorded due to limitations in surveillance systems and fear of impact on trade and tourism.

Prevention and control

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

Surveillance

“Cholera surveillance should be part of an integrated disease surveillance system that includes feedback at the local level and information-sharing at the global level. Cholera cases are detected based on clinical suspicion in patients who present with severe acute watery diarrhoea. The suspicion is then confirmed by identifying V. cholerae in stool samples from affected patients. Detection can be facilitated using rapid diagnostic tests (RDTs), where one or more positive samples triggers a cholera alert. The samples are sent to a laboratory for confirmation by culture or PCR. Local capacity to detect (diagnose) and monitor (collect, compile, and analyse data) cholera occurrence, is central to an effective surveillance system and to planning control measures.

Countries affected by cholera are encouraged to strengthen disease surveillance and national preparedness to rapidly detect and respond to outbreaks. Under the International Health Regulations, notification of all cases of cholera is no longer mandatory. However, public health events involving cholera must always be assessed against the criteria provided in the regulations to determine whether there is a need for official notification.”

Symptoms of cholera infection can include:

  • diarrhoea-cholera related diarrhoea is sudden
  •   one can lose fluids quickly about a litre per hour. 
  • the stool is often pale, with a milky appearance that resembles water in which rice has been rinsed.
  • Nausea and Vomiting – this often occurs in the early stages of cholera and can last for hours.
  • Signs of dehydration include irritability, fatigue, sunken eyes, a dry mouth, extreme thirst, dry and shrivelled skin that is slow to bounce back when pinched.
  •   Sometimes little or no urine comes out.
  • One can have low blood pressure or an irregular heartbeat.

 Causes

  • Surface or well water
  • Contaminated public wells are frequent sources of large scale cholera outbreaks.
  • People in crowded conditions without adequate sanitation are at high risk
  • Grains such as rice that are contaminated after cooking and kept at room temperature for several hours can grow cholera bacteria 
  • Unwashed fruits and vegetables are a frequent source in areas where there is cholera

Prevention 

Sanitising or washing your hands with soap and water frequently especially after using the toilet and before one handles food.

Drink safe water that has been boiled, disinfected or bottled water. Even when brushing your teeth.

Avoid buying food on the streets. Be sure to eat hot food that is well cooked. Avoid foods you cannot peel yourself such as grapes instead opt for bananas or oranges.

Members of the public must be on alert and report to the nearest health facility if one presents any diarrhoeal symptoms that may point to cholera.

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