Prevention and control of cholera outbreaks: WHO policy and recommendations
Cholera is an acute enteric infection caused by the ingestion of bacterium Vibrio cholerae present in faecally contaminated water or food. Primarily linked to insufficient access to safe water and proper sanitation, its impact can be even more dramatic in areas where basic environmental infrastructures are disrupted or have been destroyed. Countries facing complex emergencies are particularly vulnerable to cholera outbreaks. Massive displacement of IDPs or refugees to overcrowded settings, where the provision of potable water and sanitation is challenging, constitutes also a risk factor. In consequence, it is of paramount importance to be able to rely on accurate surveillance data to monitor the evolution of the outbreak and to put in place adequate intervention measures Coordination of the different sectors involved is essential, and WHO calls for the cooperation of all to limit the effect of cholera on populations.
Cholera is characterized in its most severe form by a sudden onset of acute watery diarrhoea that can lead to death by severe dehydration. The extremely short incubation period - two hours to five days - enhances the potentially explosive pattern of outbreaks, as the number of cases can rise very quickly. About 75% of people infected with cholera do not develop any symptoms. However, the pathogens stay in their faeces for 7 to 14 days and are shed back into the environment, possibly infecting other individuals. Cholera is an extremely virulent disease that affects both children and adults. Unlike other diarrhoeal diseases, it can kill healthy adults within hours. Individuals with lower immunity, such as malnourished children or people living with HIV, are at greater risk of death if infected by cholera.
- Cholera is transmitted through contaminated water or food.
- Prevention and preparedness of cholera require a coordinated multidisciplinary approach.
- Cholera can rapidly lead to severe dehydration and death if left untreated.
Cholera Treatment and Prevention
Although there is a vaccine against cholera, the CDC and World Health Organization don't normally recommend it, because it may not protect up to half of the people who receive it and it lasts only a few months. However, you can protect yourself and your family by using only water that has been boiled, water that has been chemically disinfected, or bottled water. Be sure to use the bottled, boiled, or chemically disinfected water for the following purposes:
- Preparing food or drinks
- Making ice
- Brushing your teeth
- Washing your face and hands
- Washing dishes and utensils that you use to eat or prepare food
- Washing fruits and vegetables
To disinfect your own water, boil it for one minute (or 3 minutes at higher elevations) or filter it and use a commercial chemical disinfectant. You should also avoid raw foods, including the following:
- Unpeeled fruits and vegetables
- Unpasteurized milk and milk products
- Raw or undercooked meat or shellfish
- Fish caught in tropical reefs, which may be contaminated
If you develop severe, watery diarrhea and vomiting -- particularly after eating raw shellfish or traveling to a country where cholera is epidemic -- seek medical help immediately. Cholera is highly treatable, but because dehydration can happen quickly, it's important to get cholera treatment right away.
Hydration is the mainstay of treatment for cholera. Depending on how severe the diarrhea is, treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of emergency treatment for mild cases. But they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent the spread of the disease.