Cholera symptoms can take five days to develop — Expert: Cholera recently killed five persons in Ogun State, with many others hospitalised. Dr Ismail Lawal, Chairman of the Nigerian Medical Association, Ogun State chapter, talks to DAUD OLATUNJI about the causes, symptoms, treatment and prevention of cholera
What is cholera?
Cholera is an old, extremely virulent disease causing acute or sudden passage of watery stool after ingestion of food or water contaminated with the bacterium, Vibrio cholerae. Importantly choleragenic, Vibrio cholerae serotypes O1 and O139 are the causative agents of the disease. Cholera usually occurs suddenly with an explosive outbreak that spreads within and outside a community, one state to another, or even to countries. The disease continues to occur as a major public health problem in many developing countries, including Nigeria.
Cholera epidemic was first experienced in the early 70s in Nigeria. However, intermittent outbreaks have been occurring and there have been sporadic cases. Several epidemics have occurred and are still occurring in Nigeria. It still remains a major public health problem with a high number of fatalities. Prompt intervention from all stakeholders is usually integral to averting the incidence of cholera.
How is it contacted?
Cholera is caused by a bacterium called Vibrio cholerae, a curved gram-negative bacillus belonging to the family, Vibrionaceae. Vibrio cholerae comprises both cholerogenic and noncholerogenic strains. Vibrio cholerae O1 and O139 are cholerogenic serotypes that cause (the) disease. Noncholerogenic serotypes are known as non 0, non 0139 serotypes; they usually cause a milder form of gastroenteritis than O1 and O139 and more of sporadic cases. Vibrio cholerae 01 ElTor is the commonest strain in Nigeria.
Transmission of the agent that causes cholera is by faecal-oral route. It can be attributed to contaminated food, unsafe water, poor sanitation and poor hygiene. The 2010 outbreak occurred in many states like Jigawa, Bauchi, Gombe, Yobe, Borno, Adamawa, Taraba, FCT, Cross River, Kaduna, Osun and Rivers, and children were mostly affected. This was attributed to the washing of the sewage into wells and ponds, where the residents obtained water for drinking and for other uses. These factors are usually targeted when it comes to control of cholera.
What are the symptoms?
Symptoms occur in about one quarter of infected people. It takes about 12 hours to five days for a susceptible person to develop symptoms. The symptoms include passage of grey-coloured stool with flecks of mucoid generally referred to as “rice-water stools”. There will be associated dehydration from the loss of water and salt from the body. Patients will feel thirsty and later develop muscle cramps and weakness. Some become unconscious. There will be reduced urine output because of loss of fluid from frequent passage of watery stool. There will be wrinkled skin and sunken eyes. Complications can be renal failure, shock, coma and death. It is important to note that faecal material from a nonsymptomatic patient has infective bacteria that can infect residents if shed back into the environment. This can last up to 10 days after infection.
How can it be treated?
The most important treatment is rehydration or simply fluid replacement therapy either with Oral Rehydration Salt Water Therapy (ORS) or intravenous fluid. This will replace the lost fluid and electrolytes. It depends on the severity; taking intravenous fluid acts fast but ORS is cheaper and requires no experts. Antibiotics can be given in severe cases.
How can people safeguard themselves?
People should ensure the blocking of transmission avenues in the environment. Drinking of safe water is important. Many houses do not have good sources of drinking water, so provision of drinkable water is essential. Then, we can talk about protection of water sources, treatment of water sources in term of chlorination, boiling and filtration of water. There are safe water collection and storage practices like usage of narrow-mouthed vessels, chlorination and other practices.
Food protection and having safe food at social gatherings, market places and food vendors by ensuring that foods are cooked thoroughly and stored carefully are important. Reheat foods thoroughly before consumption; avoid contacts between raw and cooked foods. Wash your hands repeatedly during food preparation.
There should be safe sanitation and proper sewage disposal by connecting toilet to septic tank. Pour-flush latrines can be provided. Pit latrines or ventilated improved latrines and replacement bucket latrines and trenches with improved latrines are also options.
Early detection and prompt management, following contacts up, especially family members go a long way. About 50 per cent of patients will die if not treated.
Vaccination with oral vaccine is recommended and effectiveness varies between 40per cent and 90 per cent. The use of antibiotics to prevent cholera is not advisable and should be discourage by people.
It appears it mostly affects children, why is that?
Yes, children are more affected. This is as a result of their immature immune status, poor breastfeeding history coupled with the fact that they have a lower body surface area compared to adults.
It recently killed people in Ogun State, what do you think predisposed the area to it?
It was basically as a result of poor sanitation and lack of safe drinking water.
What are the risks of getting it?
Over-populated communities and refugee camps, with poor sanitation and unsafe drinking water, are at risk. In addition, incubation period is very short; the number of cases can rise rapidly.
What are the things many people don’t know about cholera?
Cholera is preventable by ensuring safe drinking water, good sanitation and good hygiene. It can be treated easily with ORS but it can kill within hours if prompt treatment is not employed.