CHOLERA ADVISORY FOR HEALTHCARE WORKERS AND PROVIDERS: RECOGNITION, MANAGEMENT AND PREVENTION OF CHOLERA
The Nigeria Centre for Disease Control (NCDC) is issuing this public health advisory to healthcare workers to enhance their level of awareness of risk factors, signs and symptoms and management of Cholera, with the aim of reducing morbidity and mortality from the disease.
WHAT IS CHOLERA?
Cholera is a highly contagious disease that causes acute watery diarrhoea in children and adults which if left untreated can lead to death within hours. It is endemic in Nigeria with cases occurring mainly during the rainy season, usually between April and September. This is primarily as a result of contamination of food and drinking water supplies by the faeces of infected people.
Cholera which is caused by the bacterium Vibrio cholerae, is transmitted by ingestion of contaminated food and water. Risk factors for transmission include overcrowded environments (e.g. urban slums and camps for internally displaced people or refugees), poor sanitation and hygiene practices, lack of potable water, and open defecation.
Majority of infected people either have no symptoms or display mild symptoms with only about one in ten of them showing the characteristic symptoms of rapid onset of profuse watery diarrhoea (rice water stools), with or without vomiting within a few days of infection. Other symptoms include:
• Nausea and weakness with clinical features of dehydration which may include increased thirst, dry eyes and mouth, muscle cramps, lethargy and tachycardia. Complications can develop quickly—within a matter of hours—due to loss of electrolytes and large volume of fluids.
• Worrisome clinical features of severe dehydration and electrolyte loss include low blood sugar, hypotension, loss of skin elasticity, fever and chills, changes in breathing pattern, altered mental state, oliguria/anuria, and coma.
• If not treated, shock and death can result in a matter of hours highlighting the central importance of prompt evaluation and treatment as necessary.
Case fatality ratios can be up to 50% especially in people without access to treatment but this drops to 1% with adequate treatment. People with low immunity – such as malnourished children or people living with HIV – are at a greater risk of death if infected.
Cholera is an easily treatable disease, if detected early. Highlighted below are some important clinical points to consider in managing cholera:
• The majority of people affected can be treated successfully through prompt administration of oral rehydration solution (ORS).
• Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids, preferably Ringer lactate if available; otherwise normal saline and ORS will suffice
• Appropriate antibiotics can be given to severe cases to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed and shorten the duration of V. cholerae excretion.
• Zinc supplementation can significantly reduce the duration and severity of diarrhoea in children suffering from cholera or any acute watery diarrhoea, and should be started immediately. For children below 6 months of age, add zinc 10mg daily for 2 weeks. For children from 6 months to 12 years, add zinc 20mg daily for 2 weeks.
• Ensure strict Infection Prevention and Control (IPC) measures to control the spread. Persons caring for cholera patients can avoid acquiring the illness by washing their hands after touching anything that might be contaminated and properly disposing of contaminated items and human waste.
Counsel patients and relatives on the following precautionary measures:
• Water should be boiled, stored in a clean and safe container before drinking
• Ensure that the seals of bottled water are in place before storage or consumption
• Wash hands frequently with soap and clean running water. Use alcohol-based hand sanitiser if soap and clean water are not available
• Ensure food is well cooked before consumption. Avoid raw food such as fruits and vegetables, except you have washed them in safe water or peeled them yourself. Avoid open defecation and indiscriminate refuse dumping and ensure proper disposal of waste and clearing of sewage Take anyone with the above signs or symptoms to a health care facility immediately