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Cholera Infectious Disease

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Overview of the Chain of Infection for Cholera

Cholera is a bacterial disease that is typically spread through water contamination.

Cholera causes severe diarrhea and dehydration. If not treated, cholera can be lethal within a

short period of time. In industrialized nations, water treatment and modernized sewage have

essentially eliminated cholera. However, cholera still exists in Southeast Asia, Haiti, and Africa.

The infectious disease is mostly found in Latin America, the Middle East, India, Africa, and Asia

(Dowshen, 2017). It is rare in the U.S. but that does not mean that people cannot get it. When

natural calamities, war, or poverty compel individuals to live in congested environments with

lack of proper sanitation, the likelihood of a cholera rate rises. The common cholera cases in

industrialized countries are caused by food contamination, whereas water contamination is more

common in developing ones. Food transmission can occur when individuals collect seafood such

as oysters in sewage-infested waterways. The Centers for Disease Control and Prevention (2022)

asserts that Cholera can be contracted by drinking polluted water or eating food that is

contaminated. In an epidemic, the source of pollution is often an infected person's excrement,

which pollutes food or water. In locations with inadequate drinking water treatment and sewage

plants, the illness can spread faster. Cholera is most prevalent in places with, inadequate water

treatment and hygiene, and poor sanitation. Therefore, the mode of transmission or chain of

infection is through contaminated food by flies and food handlers, through faecally contaminated

water, and vegetables and fruits washed with contaminated water. Casual contact with an

infected individual is not a risk factor since cholera infection is not likely to be transmitted

directly form one individual to another. However, it can spread in overcrowded dwellings from

person to person contact where there is lack of hygienic facilities and careless handling of human

waste (excreta). After an individual ingests cholera bacteria, it usually takes two to three days for
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symptoms to become present, however it can range from several hours to five days. The

specimen for lab diagnosis for cholera include stools, food samples, water, and vomitus. They

help to identify the source or the chain of cholera infection.

Clinical Signs and Symptoms

According to the World Health Organization (2022a), the common signs and symptoms

of cholera include: nausea and vomiting, low blood pressure and unbalanced heartbeat

(arrhythmia), lack of tears and low urine output, dry, shriveled skin, dry mouth and extreme

thirst, unusual sleepiness, lack of energy, and irritability, sunken or glassy eyes, cramps,

particularly in the legs and abdomen, and large amounts of watery, pale-colored diarrhea.

Cholera can cause vomiting watery diarrhea, causing patients to become dehydrated quickly. If

severe dehydration is not treated, it can lead to major health concerns. It has even been linked to

seizures and kidney failure. Individuals who do not get adequate medical attention may even die.

Treatment

Cholera is an illness that is easily treated. Most patients can be treated successfully

through the administration of oral rehydration solution (ORS). In 1 litre (L) of clean water,

dissolve the UNICEF/WHO ORS standard sachet. On day one, to address mild dehydration,

adult patients may require up to 6 L of rehydration solution (World Health Organization, 2022a).

Patients who are extremely dehydrated are at danger of shock and need administration of

intravenous fluids immediately. Antibiotics are also prescribed to these patients to lessen

diarrhea rate, reduce the quantity of rehydration fluids needed, and the amount and duration of V.

cholerae excretion in their stool. It is recommended not to provide antibiotics in large volumes

because they have no known effect on the prevalence of cholera and may result in antimicrobial

resistance. In the event of a cholera outbreak, there need to be quick access to treatment which is
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vital. In addition to larger treatment centers that can provide 24 hour care and intravenous fluids,

communities should have access to oral rehydration. With appropriate and prompt treatment, the

case fatality rate should be kept below 1%. For children below 5 years, zinc is an important

added therapy that lowers the severity of diarrhea and can stop potential cases of other sources of

severe watery diarrhea (World Health Organization, 2022a). Breastfeeding should be encouraged

as well.

Relevant epidemiological data in Africa (Cameroon)

. Today, cholera is affecting most parts of the world. According to the World Health

Organization (2022b), Cameroon is one of several Central and West African countries facing

recurring cholera outbreaks. A total of 6652 suspected cases were reported, including 134 deaths

between October 29, 2021 and April 30, 2022. Since the beginning of 2021, Cameroon has

reported suspected cholera cases. Health officials confirmed the outbreak on Oct 29, 2021, and it

has been occurring ever since. 6652 suspected cases of cholera had been reported from six

regions as of 30 April 2022, including the North (no death, 15 cases), Central (4 deaths, 125

cases), South (2 deaths, 183 cases), Littoral (51 deaths, 1704 cases), Far North (no death, 8

cases) and South-West (77 deaths, 4617 cases). In 2022, 5960 instances (90%) including 93

deaths (69%) were reported out of 6652 suspected cases. The region on the South-West remained

to be the most affected as of 30 April, having 77 deaths (CFR 1.6%) and 4617 cases (69%), of

which 4069 cases (88%) were reported in 2022. With 51 deaths (CFR 3%) and 1704 (26%)

cases, the Littoral is the second most impacted area, with 1684 (99%) cases reported in 2022

(World Health Organization, 2022b).

Factors that increase the community in Cameroon susceptibility to acquiring Cholera

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Cameroon is endemic for cholera. The outbreaks of Cholera in various regions of the

country since 2018, including the currently impacted regions, have been recorded on an annual

basis (Littoral, Centre, and South-West) (Mengel, Delrieu, Heyerdahl & Gessner, 2016). Several

risk factors are associated with the spread of Vibrio cholera in Cameroon, including lack of

health care facilities and restricted access to safe drinking water in the affected regions of the

capital city of Yaoundé, South-West region and cultural practices that leads to unsafe WASH

settings (World Health Organization, 2022b). The continuous cholera outbreaks in Cameroon

can be ascribed to a number of risk factors, including the widespread distribution of Vibrio

cholerae throughout the country, in some places, there are restricted access to safe drinking

water, inadequate WASH conditions, and a seasonal pattern of cholera occurrence (Ngha, 2019).

Effective preventative measures are difficult to implement in the absence of an appropriate

sanitation inspection system, a highly disorganized private health sector, and a big but mostly

accessible public health system. The combination of these elements most likely accounts for

people of Cameroon susceptibility to Cholera.

Identify and discuss two relevant SDOH that influence the spread of Cholera

People who live and work in poor conditions suffer from material and social deprivation,

which has a negative impact on their health. These events also result in significant psychological

and physiological stress. Unstable employment, insufficient working condition, food poverty,

poor quality housing, and low income, and other forms of discrimination based on race,

immigration status, gender, disability, and ancestry all contribute to these stressful experiences.

According to Raphael, Bryant, Mikkonen and Raphael (2020) explains that Dahlgren-Whitehead

model is used to identifying health disparities that draws relations between people, and their

health and environment. In Toronto, the model developed in 2002 in NYC has shown to be
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useful for comprehending the reason why some Canadians have good health compared to others

(influential model of health determinants). Some of the SDOH in this model include ancestry

race, immigration, education, conditions food security, housing, social exclusion, among others

(Auger and Alix, 2016). All these are categorized into three: individual lifestyle factors, social

and community networks, and general environmental, cultural, and socioeconomic conditions.

The two relevant social determinants of health that influence the spread of Cholera in

Cameroon include food insecurity and education. In Cameroon, Sewage treatment plants are not

enough to handle all liquid and solid waste (Ngha, 2021). The network of man-made ditches,

streams, and rivers are in poor condition and during the rainy seasons man-made ditches

frequently overflows. Latrine contents are frequently dumped directly into the environment.

Social factors such as the continuation of traditional views and urban tribal reformation

regarding water and food consumption and waste disposal have not only resulted in risky

activities but have also created barriers to the education of hygiene and sanitation (World Health

Organization, 2022b).

Discuss how these two determinants inform your practice as a nurse or kinesiologist to

prevent and manage the spread Cholera within the community.

There need to be clean water and food for people to help manage and prevent the spread

of Cholera within the community. People need to be educated on ways to enhance their living

standard, how to maintain hygiene, and methods that help conserve the natural environment. It is

recommended that surveillance be strengthened, particularly at the neighborhood level. To

reduce mortality, significant case management, including improved care access, should be

undertaken in outbreak-impacted areas. To reduce the risk of cholera spreading to new areas,

ensuring national preparedness to detect and respond to cholera outbreaks would be required.
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Because the outbreak is taking place in border areas with active people movements, respective

countries must maintain collaboration and regular information exchange. The community need to

improve hygiene habits, food safety, waste management, and access to clean water and food to

avoid the spread of cholera. To control and prevent cholera outbreaks in risky regions, oral

cholera vaccines need to be applied together with enhancements in water sanitation.

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References

Auger, N., & Alix, C. (2016). Income, income distribution, and health in Canada. In D. Raphael

(Ed.), Social Determinants of Health: Canadian Perspectives, 3rd edition (pp. 90-109).

Toronto: Canadian Scholars’ Press.

Centers for Disease Control and Prevention. (2022). Cholera – Vibrio cholera infection.

Retrieved 7 October 2022, from https://www.cdc.gov/cholera/general/index.html

Dowshen, S. (2017). Cholera. TeensHealth. Retrieved 7 October 2022, from

https://kidshealth.org/en/teens/cholera.html

Mengel, M., Delrieu, I., Heyerdahl, L., & Gessner, B. (2016). Cholera Outbreaks in Africa.

Cholera Outbreaks, 117-144. doi: 10.1007/82_2014_369

Ngha, K. (2019). Water Accessibility and Cholera in Douala, Cameroon. The International

Journal of Humanities &Amp; Social Studies, 7(2). doi:

10.24940/theijhss/2019/v7/i2/hs1902-057

Ngha, K. (2021). Environment, Subsistence and Cholera in Douala, Cameroon. The

International Journal of Humanities &Amp; Social Studies, 9(2). doi:

10.24940/theijhss/2021/v9/i2/hs2102-044

Raphael, D., Bryant, T., Mikkonen, J. and Raphael, A. (2020). Social Determinants of Health:

The Canadian Facts. Oshawa: Ontario Tech University Faculty of Health Sciences and

Toronto: York University School of Health Policy and Management.

World Health Organization. (2022a). Cholera. Retrieved 7 October 2022, from

https://www.who.int/news-room/fact-sheets/detail/cholera

World Health Organization (2022b). Cholera – Cameroon. Retrieved 7 October 2022, from

https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON374