Cholera; An Epidemic or Endemic Water-borne Infection.

When I wrote about typhoid sometime back, it brought to my mind quickly that, the water problem in so many rural regions particularly in underdeveloped countries causes so many problems asides from typhoid, amongst the problem caused is Cholera and that is the reason why I will be writing on Cholera today.
Cholera is a serious diarrhea illness that is caused by an intestinal infection with the toxigenic bacterium Vibrio cholera. Cholera is a public health disease associated with high morbidity and mortality, before we go on with the deep-rooted issues of cholera, I will like to take you through some of the history.

There was a disease that was thought to be cholera, and it was found back in Sanskrit in the 5th century BC, the disease had existed in the Indian subcontinent for centuries. In 1817, cholera begins to spread beyond the Indian subcontinent and then came six worldwide cholera pandemics that lasted between 1817-1923.
A London physician named John Snow then made a proposition that cholera was a communicable disease that lasted between 1849-1854, and he also mentioned that stool contained infectious materials and that these infectious materials could spread to drinking water supplies, leading to the transmission of cholera.

A comma-shaped form was found in cholera stool through the help of a microscope, this was done through the help of a scientist known as Filippo Pacini who was working independently in Italy in the year 1854. In 1884 as well, Robert Koch isolated V.cholerae in pure culture, this work began in Egypt and continued in Kolkata, India.
The ongoing seventh cholera pandemic started in 1961, and it spread all through Asia to Africa, Europe, and Latin America.

The bacterium cholera is often found in water or food that has previously been contaminated by feces from a person who is infected with the bacteria. It is easier for cholera to spread through an environment in brackish rivers and coastal waters, when shellfish is consumed raw, it is a source of infection. Vibrio cholerae is the one prevalent in developing countries, it is a facultative, gram-negative, coma-shaped, and oxidase-positive rod. O1 is the one responsible for recent outbreaks, on the other hand, O139 causes sporadic outbreaks, particularly in Asia.

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V.cholrae is found in food and water that is not properly sanitized and it is spread through fecal-oral routes, particularly common to regions where there is inadequate food and water hygiene. It is not a rare case because according to researchers, there are around four million cases of cholera on a yearly basis worldwide. Cholera is a virulent disease that can cause serious water diarrhea, and it takes around 12 hours to 5 days for an infected person to begin to show symptoms after ingestion of contaminated water or food. Cholera can affect anyone regardless of gender or age, it can kill within hours as well if not treated.

Most of the people infected with Vibrio cholerae, may not show symptoms, but the bacteria in feces will last for 1-10 days, and get shed back into the environment, infecting everyone who comes in contact with it. Amongst the people who contact it, a majority have just mild symptoms whilst the majority experience moderate symptoms, the few persons with serious symptoms will have acute watery diarrhea with serious dehydration and if left untreated, death is the outcome.

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Cholera can either be epidemic or endemic. An area is cholera-endemic when cholera cases are detected within the previous three years with evidence of local transmission, this basically means the infection is not imported from another location, it is within the same local jurisdiction. A cholera outbreak can happen at any time, even in regions where cholera does not happen frequently. On the other hand, cholera-endemic countries can experience a seasonal or sporadic outbreak that represents a greater and expected number of cases. For countries where cholera does not happen all the time, an outbreak is defined by the occurrence of at least one confirmed case of cholera with evidence of local transmission in regions where there is always no cholera.

The risk of cholera transmission can be attributed to the disruption of water and sanitation systems, and population displacement in overcrowded and inadequate camps, can seriously increase the risk of cholera transmission in case the bacteria is introduced or even present.

In order to control the spread of cholera, a multifaceted approach is the key to controlling and reducing cases of death. A combination of surveillance, water, hygiene, sanitation, treatment, social mobilization, treatment, and oral cholera vaccination is used. The long-term solution to cholera control is economic development as well as viral access to safe drinking water and proper sanitation.
Actions that target environmental conditions must ensure water safety, in line with seeking out goals that will contribute to malnutrition, poverty, and illiteracy.

Cholera is easily treatable and treatment is possible through the prompt administration of oral rehydration solution (ORS). UNICEF/WHO ORS is dissolved in a clean lite of water, but adult patients may require up to 6 liters of ORS in order to treat modern dehydration on the first day. Patients that are seriously dehydrated stand a risk of shock and the rapid administration of intravenous fluids, and alongside antibiotics are also administered in order to diminish the time frame of diarrhea, limit the volume of re-hydration as well as shorten the amount and duration of V.cholera excretion in their stool. W must put in mind that, antibiotics supplied in its mass are not recommended as it has not shown any antimicrobial resistance to the spread of cholera.

During a cholera outbreak, immediate access to treatment is important, oral dehydration has to be made available in communities, in addition to that, a wider space for treatment needs to be instantly provided with a 24-hour car plan. For children who are under the age of 5, Zinc is an important therapy, and it may prevent future episodes of other cases of acute watery diarrhea.
The place of community engagement is also highly crucial, it means that communities and people are a part of implementation and development.

References.

bmcpublichealth.biomedcentral

statpearls.com/ArticleLibrary

thelancet.com/journals

cdc.gov/cholera/general

who.int/news-room

ncbi.nlm.nih.gov