Cholera: Overview, Causes, Symptoms, Treatment, Prevention & Recent Outbreak

Overview

Key Facts

1. Cause: Cholera is caused by the bacterium Vibrio cholerae, typically contracted through contaminated water or food.
2. Symptoms: Primary symptoms include severe diarrhoea, vomiting, and dehydration. Untreated, it can lead to death within hours.
3. Transmission: Cholera spreads through the “faecal-oral route”, which means the disease is transmitted when a person ingests food or water contaminated with the faeces of an infected person. This is particularly common in areas with poor sanitation and hygiene.
4. Treatment: Rehydration, either orally or intravenously, is crucial. Antibiotics can also reduce the duration and severity of symptoms.
5. Prevention: Ensuring safe drinking water, sanitation, and hygiene are key. Vaccines provide temporary protection in high-risk areas.
6. Global Prevalence: Annually, there are an estimated 1.3 to 4.0 million cholera cases, causing 21,000 to 143,000 deaths worldwide (WHO).
7. Outbreaks: The Yemen outbreak, starting in 2016, had over 2.5 million suspected cases and around 4,000 deaths by early 2021, highlighting its devastating impact in conflict zones where access to clean water and sanitation is severely limited.
8. Oral cholera vaccines should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and prevent them in areas known to be at high risk for cholera.
9. A global strategy on cholera control, ‘Ending cholera: a global roadmap to 2030 ‘, was launched in 2017. This comprehensive plan aims to reduce cholera deaths by 90% by 2030 through a combination of improved access to clean water and sanitation, vaccination, and early detection and response to outbreaks.

Cholera: A Global Threat

The NCDC stated that from January 1 to June 11, 2024, over 1,141 suspected and over 65 confirmed cases of cholera, resulting in over 30 deaths, had been reported from 96 LGAs in 30 states in Nigeria.

Many people have heard about cholera but may not fully understand it.

It is a severe diarrheal illness caused by eating or drinking contaminated food or water.

Cholera may be an old foe; however, it’s still a significant threat today, especially in regions facing sanitation challenges and poor water (and food) hygiene.

Understanding Cholera

Cholera is a serious disease caused by the bacterium Vibrio cholerae (V. cholerae). It causes watery diarrhea, extreme fluid loss, and severe dehydration.

Each year, it affects 3 to 5 million people and causes over 100,000 deaths worldwide. If untreated, it can be fatal, especially for children and infants.

Cholera was common in the U.S. in the 1800s but is now rare due to better sanitation practices.

Travelers to parts of Asia, Africa, and Latin America should get vaccinated, drink only boiled or sealed bottled water, and wash their hands regularly.

The key symptom of cholera is diarrhoea, caused by infection with V. cholerae, discovered in 1883 by Robert Koch.

The bacteria live in shallow, salty water on microscopic crustaceans and form biofilms on surfaces like water and plants.

They produce a toxin that causes severe diarrhoea.

Cholera spreads quickly in areas with poor sanitation but can be controlled with improved hygiene and sanitation practices.

What Causes Cholera?

Cholera is more common in overcrowded areas with poor sanitation.

1. Contaminated Water: Drinking water contaminated with human waste.
2. Raw or Undercooked Seafood: Eating raw or undercooked shellfish like oysters or crabs from polluted waters.
3. Poorly Cleaned Vegetables: Consuming vegetables irrigated with contaminated water.
4. Street Food: Eating foods and drinks from street vendors using contaminated water.
5. Municipal Water Supplies: Drinking water or ice made from contaminated municipal water.

In places with poor sanitation, like refugee camps, a single infected person can contaminate the water supply.

When consumed, the bacteria release a toxin in the intestines that causes severe diarrhoea. Casual contact with an infected person is unlikely to spread cholera.

Cholera Symptoms

Only about 1 in 20 people with cholera develop severe symptoms, and many people show no symptoms at all.

When Symptoms Appear

• Symptoms can start 12 hours to 5 days after being exposed.

Common Symptoms:

• Watery Diarrhea: Large volumes, sometimes called “rice water stools” because they look like water used to wash rice.
• Vomiting
• Leg Cramps

People with cholera can lose up to 20 litres of fluids a day, leading to severe dehydration and shock if left untreated.

Signs of Dehydration

• Loose skin
• Sunken eyes
• Dry mouth
• Decreased secretion (e.g., less sweating)
• Fast heartbeat
• Low blood pressure
• Dizziness or lightheadedness
• Rapid weight loss

Severe dehydration can lead to shock, causing the circulatory system to collapse.

This is a life-threatening condition and a medical emergency.

Treatment

Cholera treatment focuses on rapid rehydration and electrolyte replacement.

Key approaches include:

• Oral Rehydration Salts (ORS): A simple, cost-effective treatment that can be administered at home.
• Intravenous Fluids: Necessary for severe cases where rapid rehydration is crucial.

Antibiotics: Antibiotics may shorten the illness’s duration and reduce the severity of symptoms, although they are not always required.

Zinc Supplements: These are beneficial, especially in children, as they reduce the duration and severity of diarrhoea.

Prevention And Control

Several public health measures should be aimed at improving sanitation and hygiene:

• Clean Water: Ensuring access to safe drinking water.
• Sanitation: Proper disposal of sewage and maintaining clean living environments.
• Hygiene: Promoting handwashing with soap and safe food handling practices.
• Vaccination: Oral cholera vaccines (OCVs) are available and recommended for high-risk areas. Vaccines like Dukoral, Shanchol, and Euvichol provide varying degrees of protection

Outbreak In Nigeria

Recently, Nigeria has been facing a major cholera outbreak.

On June 13, 2024, The Nigeria Centre for Disease Control and Prevention (NCDC) announced that they had found 1,141 suspected cases, and 65 were already confirmed, while 30 deaths were reported across 96 local councils in 30 states.

According to the centre, 10 states—Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa, and Lagos—bore 90 per cent of the burden in the country.

Lagos state is reported to be the most affected region in Nigeria, considering statistics and incidence.

Fresh reports show that Lagos alone had recorded about 401 suspected cases and 21 deaths.

However, reports from authorities claim that cases were subsiding across the state due to the state government’s intervention.

The outbreak has worsened due to heavy rains and flooding, which have contaminated water supplies, making it easier for the bacteria to spread. In addition, the weak water infrastructures in many states in Nigeria, especially Lagos and other northern states, have contributed to making matters worse.

Rapid response to cholera outbreaks is critical.

It involves:

• Immediate establishment of treatment centres.
• Mass distribution of ORS and other rehydration solutions.
• Intensive public health education campaigns.
• Coordination with international health organizations for support and resources.

Why Nigeria?

Nigeria’s ongoing cholera outbreaks highlight a broader issue – access to clean water and proper sanitation.

Many communities lack these basic necessities, making them vulnerable to waterborne diseases like cholera.

The country’s healthcare system is also stretched thin, especially in areas affected by conflict and displacement, further complicating efforts to control the outbreak.

What’s Being Done?

The Nigerian government and international organizations like the World Health Organization (WHO) and UNICEF are working hard to combat the outbreak.

Efforts include setting up treatment centres, distributing ORS, and promoting hygiene practices. Initiatives to improve water quality and sanitation infrastructure to prevent future outbreaks are also underway.

How Can You Help?

Understanding cholera and spreading awareness is crucial.

Here’s what you can do:

• Promote Good Hygiene: Regular handwashing with soap and clean water.
• Support Clean Water Initiatives: Donate to organizations working to provide clean water and better sanitation in affected areas.
• Stay Informed: Follow updates from reliable sources to stay aware of how cholera is impacting communities globally and locally.

Final Thoughts

Cholera is more than just an isolated medical issue; it’s a global human issue that affects real people and communities.

By staying informed and supporting efforts to improve water and food sanitation, we can all play a part in fighting this preventable disease.

References

Resources

• WHO Cholera Outbreak Toolbox

• Preventing Cholera: Five Basic Steps