Cholera

Dr KABERA Ren
Medical Officer
UNSOS
Beledweyne/Somalia
Plan

Introduction

Presentation

Diagnosis

Treatment

Cholera/Dr Kabera R. 7/30/2017

 Introduction

Definition:

The word cholera is from Greek: Kholera the roof gutter; comparing the water

gushing through a roof gutter after a rainstorm.

Cholera believed to be originated from India.

Cholera is an intestinal, preventable, acute infection caused by Vibrio cholerae Pacini

1854

The major characteristic of the disease is profuse secretory diarrhea and vomiting

Cholera/Dr Kabera R. 7/30/2017

 Introduction

Hippocrates Waldemar H.
John Snow Robert Koch
Filippo Pacini
History :
Hippocrates 460-370 BC(Greece) described the same disease in his recordings
John Snow 1813-1858 (UK) discovered the contaminated water as origin of disease (1854) during an
outbreak of cholera in London

Filippo Pacini 1812-1883 (Italy) discovered The bacteria in 1854 as a vibrio in Florence, but the research
was rejected by the Italian scientists college who believed the disease was due to bad air Miasma

Robert Koch 1843-1910 (Germany) identified V Cholerae in 1883 during an outbreak in Egypt, and the
research was accepted
Waldemar Haffkine 1860-1930 (Russia) developed the first cholera vaccine in July 1892
7/30/2017

Cholera/Dr Kabera R.
 Introduction
Epidemiology

WHO: Cholera affects an estimated 35 million people worldwide, and causes

58,000130,000 deaths a year as of 2010.

This occurs mainly in the developing world and rare in developed countries

Poor hygiene and living conditions

Endemic, Epidemic, Pandemic

Recent Outbreaks : Goma-Zaire (94) 80000 deaths ,Harare Zimbabwe (2008) 4500
deaths ,Haiti (2010) 7000 deaths ,Yemen(2017) 1600 deaths, Nairobi (2017) 28
deaths

Somalia: Endemic especially in Beledweyne

Cholera/Dr Kabera R. 7/30/2017
Introduction

Epidemiology

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

With adequate re-hydration less than 2% will die

With good surveillance, rapid establishment of re-hydration, and anti-

biotics for worst cases, almost all deaths can be avoided (<0.2% die)

Cholera/Dr Kabera R. 7/30/2017

Physiopathology
Vibrio cholera Pacini 1854 is a comma-shaped, gram-negative aerobic or

facultatively anaerobic bacillus that varies in size from 1-3 m in length by 0.5-0.8 m

in diameter, with a single flagella, which lives naturally in freshwater

More than 200 serogroups of Vibrio cholerae have been identified

Vibrio cholerae O1(El Tor) and Vibrio cholerae O139 (Bengal)are the principal ones

associated with epidemic cholera.

Other serogroups which cause mild infection of cholera are grouped in so called

Non-O1 and Non-O139 Vibrio Cholerae

Vibrio Cholerae cause disease by producing an enterotoxin that promotes the

secretion of fluid and electrolytes into the lumen of the small intestine
Cholera/Dr Kabera R. 7/30/2017
Physiopathology

Transmission

Unsafe water

Unwashed fruit and vegetables (or washed in bad water)

Lack of handwashing (food preparation, hand shaking)

Cooked and uncooked sea food vibrio survives light cooking

Cholera/Dr Kabera R. 7/30/2017

Presentation

Signs and symptoms

Diarrhea and Vomiting
Dehydration

Diagnosis
Clinical
Laboratory : Electronic microscope, Rapid tests and stool culture
To be differentiated with other Watery diarrhea Disease
Cholera/Dr Kabera R. 7/30/2017
Treatment

Prevention -Population at High risk

Those living near lagoons / low lying areas with 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 of neutral acidity)
Close to cholera patients in early stages (hyper-infectivity) and dealing
with bodies

Cholera/Dr Kabera R. 7/30/2017

Treatment
Prevention

Blocking routes of transmission water disinfection (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 acid levels, acid food)

Oral vaccine (Dukoral)

Preparedness Cholera Contingence Plan

Curative

Rehydration /parenteral and oral: Ringer lactate and Oral rehydration salts

Antibiotics :Doxycycline, Ciporfloxacine ,furazolidine and tetracycline

Cholera/Dr Kabera R. 7/30/2017

 References

Koch R. An address on cholera and its bacillus. Br Med J. 1884;2:4037. 453-9

Asoke C. Ghose. Lessons from cholera & Vibrio cholerae. Indian J Med Res. 2011
Feb; 133(2): 164170.
WHO. Cholera/Kenya 2017
Wikipedia 2017:Hippocrates,John Snow, Filippo Pacini, Robert Koch and
Waldemar H.
Who first discovered cholera? - UCLS Fielding School of Public Health
Medscape.Cholera.2017

Cholera/Dr Kabera R. 7/30/2017

Thank you

Cholera/Dr Kabera R. 7/30/2017