As cholera claims lives in Sierra Leone find out more about the disease from our water and sanitation expert, Jason Snuggs.
What causes a cholera outbreak?
Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Outbreaks are likely to occur in overcrowded communities that have little access to safe or protected water, inadequate sanitation and toilets and poor personal hygiene. Cholera is, unfortunately, often a disease of the poor and marginalised. Many outbreaks occurred in the poor areas of London during the mid-1800’s and Dr John Snow, now regarded as the father of public health, was the first person to succeed in ending an outbreak of cholera.
He did this by removing the handle of a water pump in Broad Street that had been contaminated. That hand pump is still there today!
Why does cholera kill so quickly?
Cholera is a fast acting disease with a short incubation period of a few hours to a few days. A person with a severe case of cholera can go from having no symptoms to death within just a few hours. Unlike other diarrhoeal diseases, the cholera toxin has the ability to cause not just ordinary diarrhoea but very acute watery diarrhoea either with or without vomiting. The profuse diarrhoea which has the appearance of rice water means a person can lose 10-20 litres of fluid per day, resulting in rapid dehydration. It’s this rapid dehydration that ultimately leads to death if effective treatment isn’t quickly given.
How many countries are affected by cholera each year?
In 2011, a total of 589,854 cases were reported from 58 countries, including 7,816 deaths. However many more cases are likely to have occurred but health facilities in low income countries are often unable to properly diagnose or report cases. The stigma around cholera means countries are fearful of trade and travel sanctions and will often not report cholera cases. The true burden of the disease is estimated to be 3–5 million cases and 100,000–120,000 deaths each year. While these are significant numbers it’s worth remembering that diarrhoeal diseases, of which cholera is just one of many, remain the second leading cause of death for children under five years old, killing more than 1.5 million children every year, 80 per cent of whom are less than 2 years old.
When was the last case of cholera in the UK?
The last indigenous case of cholera in England and Wales was reported in 1893 although occasional imported cases do occur. However the risk of an outbreak in the UK is very small due to modern sanitation, treated water supplies, and high standards of food hygiene.
How can cholera be prevented?
In many countries, cholera is endemic. Preventing cholera in the long-term requires sustained improvements in water and sanitation infrastructure so that communities have access to sufficient quantities of clean drinking water and adequate sanitation and toilets. Communities also need to practice safe hygiene behaviour and have the means to maintain those behaviours over time.
In an emergency situation like Sierra Leone when an outbreak has been detected, the usual intervention strategy is to reduce deaths by ensuring prompt access to treatment, and to control the spread of the disease by providing safe water, proper sanitation and health education for improved hygiene and safe food handling practices by the community.
The provision of safe water and sanitation is often extremely difficult, but remains the critical factor in reducing the impact of cholera. The challenge is to act quickly so that the cholera outbreak doesn’t spread further.
How can cholera be treated?
80 per cent of cholera cases can be treated by just using Oral Rehydration Salts (ORS), which is essentially clean water with a little sugar and salt. It’s cheap and very effective. Very severely dehydrated patients require intravenous fluids and antibiotics to diminish the duration and impact of diarrhoea.
Are you testing people for cholera?
In most cases acute watery diarrhoea is being treated as if it were cholera. Confirmation of cholera cases is a matter for the Sierra Leone government and the World Health Organisation.
Are you vaccinating people for cholera?
Although there is a vaccine available for cholera, the most effective way to prevent the spread of the disease is to ensure clean drinking water, good sanitation and treatment of those with acute watery diarrhoea.
How CARE is responding in Sierra Leone:
To date, CARE has provided information and education via radio discussions and public service announcements and distributed cholera prevention kits, which include soap, oral rehydration sachets and water purification tablets. CARE is working with volunteers in communities across affected regions to help prevent further spread of the disease.