2. Cholera is an acute diarrheal
illness caused by infection of the
intestine with the bacterium called
3. • It can lead dehydration and
even death if untreated.
• Cholera caused by eating
food or drinking water
• Cholera was prevalent in U.S.
in the 1800s,before modern
water and sewage treatment
systems eliminated its
spread by contaminated
• Cholera is most common in
places with poor sanitation ,
crowding , war and famine.
4. HOST FACTOR
1. Age and Sex: Cholera affects all ages and both
sexes. In endemic areas ,attack rate is highest in
2. Gastric acidity: An effective barrier. The vibrio is
destroyed in an acidity may influence individual
3. Population mobility: Movement of population (e.g. ;
pilgrimages, marriages, fairs and festivals) results in
increased risk of exposure to infection. In this jet
age, cases and carriers can easily transfer infection
to other countries.
4. Immunity: An attack of cholera is followed by
immunity to reinfection, but the duration and degree
of immunity are not known. The presence of
antitoxin antibodies has not been associated with
protection. Vaccination gives only temporary, partial
immunity for 3-6 months.
5. Economic status: The incidence of cholera tends to
be the highest in the lower social-economics
groups, and this is attributable mainly to poor
5. • Vibrio transmission is readily
possible in a community with poor
• The environmental factors of
importance include contaminated
water and food.
• Flies may carry V.cholera but not
vectors of proven importance.
6. Cholera causes
• Vibrio cholerae , the bacterium that
causes cholera , is usually found in food
or water contaminated by feces from a
person with the infection.
• Common sources includes:
1. Municipal water supplies.
2. Ice made from municipal water
3. Food and drinks sold by street vendors
4. Vegetables grown with water containing
5. Raw or uncooked fish and seafood caught
in waters polluted with sewage.
When a person consumes the contaminates
food and water , the bacteria release a toxin
in the intestines that produces severe
7. a. FEACALLY CONTAMINATEDWATER: Uncontrolled water
sources such as wells, lakes, ponds, streams, and
rivers pose a great threat.
b. CONTAMINATED FOOD AND DRINKS: Ingestion of
contaminated food and drinks have been associated
with outbreaks of cholera. Bottle feeding could be a
significant risk factor for infants. Fruits and vegetables
washed with contaminated water can be a source of
infection. After preparation, cooked food may be
contaminated through contaminated hands and flies.
c. DIRECT CONTACT: In developing countries, a
considerable proportion of cases may result from
secondary transmission, i.e., person to person
transmission through contaminated fingers while
careless handling excreta and vomit of patients and
contaminated linen and fomites.
Symptoms of cholera can begin as soon as a few
hours or as long as five days after infection. Often,
symptoms are mild. But sometimes they are very
serious. About one in 20 people infected have severe
watery diarrhea accompanied by vomiting, which can
quickly lead to dehydration. Although many infected
people may have minimal or no symptoms, they can
still contribute to spread of the infection.
o Low blood pressure
o Muscle cramps
o Abdominal cramps
o Weight loss
9. The incubation period may vary from
a few hours to five days, with the
average incubation period being
about two to three days. About 6 to
12 hours is considered a very rapid
incubation period and may suggest
that rapid/immediate intervention is
required for recovery.
10. REHYDRATION THERAPY: Cholera is now the
most effective treated disease. Mortality
rates have been brought down to less than
1 percent by effective rehydration therapy.
The rehydration may be oral or intravenous.
ADJUNCTS TO THERAPY: Antibiotics should
be given as soon as vomiting has stopped,
which is usually after 3 to 4 hours of oral
rehydration. Injectable antibiotics have no
special advantages. The commonly used
antibiotics for the treatment of cholera are
AZITHROMYCIN, AMPICILLINE and
(SMX). No other medication should be given
to treat cholera like Antidiarrheal,
Antiemetic, Antispasmodics. If diarrhea
persists after 48 hours of treatment,
resistance to antibiotic should be
11. EPIDEMIOLOGICAL INVESTIGATION: Epidemiology
studies must be undertaken to define the extent of
outbreak and identify the modes of transmission so
that more effective and specific control measure can
be applied. The epidemiology must maintain contact
with all health and civic units in the area to ensure
detection of new foci disease.
VACCINATION: Three types of oral vaccines are
• DUKORAL (WC-Rbs): Dukoral is a monovalent vaccine
based on formalin and heat-killed whole cells (WC) of
V. cholerae plus recombinant cholera toxin B subunit.
The vaccine is provided in 3 ml single-dose vial
together with the bicarbonate buffer. Vaccine and
buffer are mixed in 150 ml of water for person aged
>5 years and in 75ml of water for children aged 2-5
Dukoral is not licensed for children <2.
• SANCHOL AND mORCVAX: The closely related bivalent
oral cholera vaccines . Unlike Dukoral, these vaccines
do not contain the bacterial toxin B subunits therefore
it does not required buffer. According to the
manufacturer, vaccine should be administered orally
in 2 liquid doses 14 days apart for individual ager >1
years. A booster dose is recommended after 2 years.
• EUVICHOL: It was prequalified in December 2015 and
has same characteristics as Sanchol.
12. o Wash your hands with soap and
o Drink only safe water
o Eat food that’s completely cook
o Avoid sushi
o Stick to fruits and vegetables that
you can peel