Introduction to Cholera Disease

Ethiopian Public Health Institute

Public Health Emergency Management
Bacterial Diseases Surveillance and Response

Dr. Lijalem G.(EPHI)

April 10/ 2023
Jimma, Oromia, Ethiopia

Cholera Surveillance and Outbreak Response

 Outline

 What is Cholera?
 Etiology
 Reservoir
 Mode of transmission
 Risk factor
 Clinical characteristics

Cholera Surveillance and Outbreak Response

 Enabling Objective

After completing this chapter, the training

participants will be able to:
1) Describe cholera disease, etiologic agent, and
reservoir
2) Summarize cholera disease mode of transmission
3) Identify risk factors and clinical features of cholera
disease

Cholera Surveillance and Outbreak Response

Activity 1.1. Self-reflection_15 minutes

Instruction: Read the following summary of

cholera report in Ethiopia and answer the
following questions (on your participant
manual page)
Question:
1.What comes in your mind when you hear
cholera?
2.Why do you think frequent occurrence of
cholera outbreak in Ethiopia?

Cholera Surveillance and Outbreak Response 4

 Cholera

 Cholera is a diarrheal disease caused by infection of

the intestine with the gram-negative bacteria Vibrio
cholerae, either type O1 or O139.
 Both children and adults can be infected.
 It is one of the key indicators of social development
 Become a challenge to low safe drinking water and
adequate sanitation access and utilization
Cholera Surveillance and Outbreak Response
 Cholera..

Etiology :
 There are over 100 vibrio species known but only
the “cholerae” species are responsible for cholera
epidemics.
 Vibrio cholerae species are divided into 2
serogroups
 Vibrio cholerae O1 &Vibrio cholerae O139
 Both biotypes subdivided into Classical and El Tor
biotypes

Cholera Surveillance and Outbreak Response

 Cholera
Species Vibrio cholera

Serogroup O139 O1

Biotype El Tor Classic

Hikojima Hikojima
Serotype
Ogwa Ogwa

Inaba Inaba

Cholera Surveillance and Outbreak Response

 cholera

 The three serotypes can co-exist during an

outbreak
This does not affect the epidemic pattern:
– Clinical features are similar, whatever the strain
– Regardless of the strain, the response is the same.
 Vibrios grow easily in saline water and alkaline
media.
 Survive at low temperatures but do not survive in
acid media

Cholera Surveillance and Outbreak Response

 Cholera

Reservoir:
 Humans are the main reservoir of vibrio cholerae
 Water
– V. Cholerae can live for years in some aquatic
environments
 Some molluscs fish and
 Aquatic plants

Cholera Surveillance and Outbreak Response

 Cholera

 Transmission
– Cholera is transmitted by the fecal-oral route
– Contaminated water or food
– Corpses of cholera patients
– Cholera treatment centers can become main sources of
contamination if hygiene and isolation measures are
insufficient
– Fruit and vegetables grown at or near ground level and
fertilized with night soil (human excreta) and then eaten
raw!

Cholera Surveillance and Outbreak Response

 Feco-oral rout

Cholera Surveillance and Outbreak Response

 Cholera

Common source_ Water

– Contaminated at its source
– Shallow wells, surface water
– Contaminated in the home / after storage
– When inadequately washed hands come in contact with
stored water
– If wash utensils in contaminated water
– If bathe in contaminated water

Cholera Surveillance and Outbreak Response

 Cholera

 Common source_ food

 Moist grains served at room temperature or lightly
heated
 Moist food is excellent environment for growth of V.
Cholerae
 Acidifying foods inhibits growth of V. Cholerae with
lemons, tomatoes, yogurt or fermented milk

Cholera Surveillance and Outbreak Response

 Cholera

Risk Factors
 Poor social and economic environment, precarious
(risky) living conditions associated with:
– Insufficient water supply (quantity and quality)
– Inappropriate and poor sanitation and hygiene practices
– Inadequate food safety (from preparation to table)
–- High population density: camps, slum populations,
internally displaced people (IDP) are highly vulnerable.
–- Conflict/War affected areas

Cholera Surveillance and Outbreak Response

 Cholera

 Risk factor
 Inadequate quantity and/or quality of water
 Inadequate personal hygiene
 Poor washing facilities
 Inappropriate or poor sanitation
 Inappropriate funeral services for cholera corpus

Cholera Surveillance and Outbreak Response

 Activity 1.3 Think Pair –Share(10m)

 Instruction: Think and discuss

the following questions with
your neighboring trainee for 5
minutes and share your ideas
within 5 minute.
 Question:
 The incubation period of
cholera?
 Describe the sign and symptoms
of cholera patient?

Cholera Surveillance and Outbreak Response 17

 Cholera

Clinical Features_ Pathogenesis:

 The large majority of ingested bacteria are destroyed
by stomach acidity
 surviving bacteria colonize intestinal cells, where they
multiply and produce a very powerful enterotoxin
 That causes profuse watery diarrhea by a secretion
mechanism.
 The toxin adheres to intestinal cells and causes an
excretion of isotonic fluid in the intestinal lumen: it is
the enterotoxin that causes fluid loss and diarrhea.
Cholera Surveillance and Outbreak Response
 Cholera

 Incubation Period and Period of Infectivity

 The incubation period is usually 1 to3 days but can
range from several hours to 5 days.
 Symptoms usually last 2 to 3days, although in some
patients they can continue up to 5 days.
 Infected persons whether they are symptomatic or
not, can carry and transmit vibrios during 1 to 4
weeks
 Antibiotic therapy can decrease the duration of
symptoms and the period of infectivity.
Cholera Surveillance and Outbreak Response
 Cholera

 Signs and Symptoms

 Of the people infected with cholera
– Around 75% have no symptoms
– Around 20% have mild or moderate diarrhea (which can
produce dehydration)
– Around 5% have severe diarrhea, vomiting, and severe
dehydration

Cholera Surveillance and Outbreak Response

 Cholera

 The case-fatality rate in untreated cases may reach

30–50% if there is not prompt treatment.
 Treatment is straightforward (basically rehydration)
 If treatment is applied appropriately the case-
fatality rate can be minimized to below 1%.

Cholera Surveillance and Outbreak Response

 Cholera

 Symptomatic cholera:
– Acute watery diarrhea(AWD)
– Profuse, "rice water" stools
– No fever, no abdominal cramps
– Vomiting and leg cramps common
– It is usually odorless or has a mild fishy smell.
– People with a severe case of cholera can pass one liter of
stool per hour or more, and leads to dehydration.

Cholera Surveillance and Outbreak Response

 Dehydration
 Can lose up to 10% of body weight
 Fluid losses up to 1 liter / hour
 Must replace fluids and electrolytes to avoid
hypovolemic shock, renal failure and death.

Cholera Surveillance and Outbreak Response

 Figure 1. Signs of severe dehydration

 Sunken eyes, lethargy and slow recall of skin

Cholera Surveillance and Outbreak Response
 Cholera

“Rice water" stool

Cholera Surveillance and Outbreak Response
 Cholera

 Key cholera prevention and control measure

 Surveillance:
– Early detection and containment of cases
– Risk factor identification ..
 Proper case management:
– Reduce CFR
– Establish CTC/CTU as soon as possible in affected
community
 Conduct OCV camping: helps in controlling the
outbreak
Cholera Surveillance and Outbreak Response
 Cholera

 Water and sanitation improvements

– Construct latrines
– Construct above-ground sewage tanks (e.g., in urban areas)
– Distribute safe water (e.g., water delivery by truck)
– Distribute point-of-use water purification tools (e.g., AquaTabs)
– Improved water storage containers (e.g., containers with
narrow mouths or spigots)
– Flocculation-disinfectant powder sachets
– Filtered water using cloth
– Monitor Free chlorin residual (FCR) at point of consumption

Cholera Surveillance and Outbreak Response

 Cholera

 Use community leaders, teachers, broadcast

and print media to tell messages:
– Hand washing with soap after defecation or cleaning an
infant’s bottom
– Hand washing with soap before handling food, eating, or
breastfeeding
– Boiling water before drinking or using it in cooking
– Safe food preparation and storage practices
– Breastfeeding infants

Cholera Surveillance and Outbreak Response

Cholera Surveillance and Outbreak Response