Cholera Final
Cholera Final
Cholera Final
Chetan Khadka
Deeptanshu Sharma
Dhiraj Raj Regmi
Introduction
•Acute diarrhoeal disease
•Causative organism Vibrio cholerae Classical
El Tor
•Nowadays commonly due to El Tor biotype
•Majority of infections are mild or asymptomatic
•Case fatality as high as 30%-40% (unless rapid
replacement of fluid and electrolytes)
Typical cases:
• Onset of profuse, effortless, watery diarrhoea
followed by
• Rapid dehydration
• Muscular cramps
• Suppression of urine
Global Scenario
• In 2015 - 42 countries reported a total of
172,454 cases including 1304 deaths, resulting in
an overall case fatality ratio (CFR) of 0.8%.
• Afghanistan, the Democratic Republic of the
Congo (DRC), Haiti, Kenya, and the United
Republic of Tanzania accounted for 80% of all
cases.
• In 2014 - 190 549 cases
2012 34 0 0%
2011 12 0 0%
Epidemiological features
•Both epidemic and endemic
•Epidemicity and endemicity depend on
1)Characteristics of agent
Ability to survive
Its virulence
Average no of organism required to cause
infection
2) Characteristics of the system
Number of susceptibles
Opportunities for transmission of infection
Epidemics
• Characteristically abrupt
• High potential to spread fast
• Self limiting in nature
• Reaches a peak and subsides as “force of infection” declines.
• Self limiting due to acquisition of temporary immunity and
due to occurrence of large number of sub clinical cases
Force of infection
• 2 components
1)Force of infection through water
2) Force of infection through contacts
El tor Classical
Incubation period
From a few hours to 5 days, but commonly 1-2
days
Carriers in cholera
• A cholera carrier is an apparently healthy
person who is excreting V. cholerae O1
(classical or El Tor) in stools.
• There are four types of cholera carriers:
a) Preclinical or Incubatory Carriers
b) Convalescent Carrier
c) Contact or Healthy Carrier
d) Chronic Carrier
Pathogenesis
• The cholera vibrio gets through the mucus which
overlies the intestinal epithelium. It secretes
mucinase which helps it move rapidly through the
mucus. Then it gets attached to the intestinal
epithelial cells with the help of adherence factors in
its surface.
a) Stage of evacuation:
abrupt onset profuse painless watery diarrhoea
followed by vomiting. As many as 40 stools that
may have “rice water” appearance
b) Stage of collapse:
Occurs because of dehydration. The classical
signs are:
i) sunken eyes
ii) hollow cheeks
iii) scaphoid abdomen
iv) sub normal temperature
v) washerman’s hands and feet
vi) absent pulse
vii) unrecordable blood pressure
viii) loss of skin elasticity
ix) shallow and quick respiration
x) decreased urine output that may
eventually cease
xi) restlessness, intense thirst and cramps
a) Collection of specimens:
The Sample should be collected before the
person is treated with antibiotics.
i) Stool: using rubber catheter or rectal swab
ii) Vomitus
b) Transportation
Stool collected should be transported in
sterilized 30ml capacity McCartney bottles
containing Alkaline peptone water or VR medium.
1ml of stool in 10 ml of transport media will
suffice.
Specimen collected by rectal swab should be
transported in alkaline peptone water or Cary-Blair
medium
c) Direct examination:
Dark field microscopy is used to view Vibrio
cholerae that evoke the image of shooting star in
dark sky.
1) Verification of Diagnosis
-Investigation of all cases of diarrhoea for cholera
-Bacteriological diagnosis of cholera
Control of Cholera
2) Notification
-Notify the local health authority
-Cholera is notifiable to WHO within 24 hours of
occurrence
-Number of cases and deaths reported daily and weekly
-Area is declared free of cholera when twice the
incubation period (10 days) elapsed since the death,
recovery or isolation of last case
5)Rehydration therapy
-Mildly dehydrated patients (90%)- ORS at home
-Severely dehydrated- iv fluids at hospital or treatment centre
6) Adjuncts to therapy
-Antibiotics given after vomiting stopped
-Fluoroquinolone, Tetracycline, Azithromycine, Ampicillin
-No other medications
Control of Cholera
7) Epidemiological investigations
-To define the extent of outbreak and identify modes of
transmission
-Effective and specific control measures can be applied
Control of Cholera
8) Sanitation measures
Water Control
-
Boiling, Chlorination
- Excreta disposal
Provision of sanitary latrines
Handwashing with soap after defecation
-Food sanitation
Cooked hot food
Cleaning and drying of utensil after use
Housefly is a indicator of level of sanitation
Control of Cholera
-Disinfection
Disinfection of patient’s clothes and personal items, latrine
Disinfectant with RW coefficient>5 like Cresol
9) Chemoprophylaxis
- Chemoprophylaxis of close household contacts
- Mass chemoprophylaxis not advised
- Tetracycline or Doxycycline
Control of cholera
10) Vaccination
Oral Vaccines: Dukoral and Sanchol and mORCVAX
a) Dukoral
Monovalent
Based on formalin and heat killed whole cells of V. cholerae O1
plus recombinant cholera toxin B subunit
3 ml single dose vial with bicarbonate buffer
Control of Cholera
Schedule and administration of Dukoral
Primary immunisation : 2 oral doses given >7 days but <6 weeks
Booster dose: After 2 years
For children 2-5 years: 3 doses >7 days but <6 weeks apart
Booster dose: 6 months