Cholera is a disease borne of filth. To put it bluntly, you only get this disease when you directly or indirectly ingest the faeces or vomitus of someone who is infected and to a lesser extent that of a carrier. This contamination may be through our food or water.

The disease is characterized by passing copious amounts of diarrhoeal stools (sometimes referred to as rice-water stools, because of their appearance), and it may also be associated with vomiting. The rate of losing body fluids is so fast that it may quickly lead to dehydration and death, if one does not receive proper care. The mortality rate for unmanaged cholera may be as high as 50%, but under professional care, this figure may drop to less than 1%. It is important that you RUSH to hospital with any case of severe diarrhoea. You may be sorry if you wait too long. Symptoms typically start one to five days after ingestion of water or food containing the bacterium vibrio cholera.

Historical data

Cholera has spread widely throughout the world since 1961 and in Ghana the first reported case was in 1970. In many developing countries, major epidemics continue to occur with shorter remission periods. In some instances cases of cholera have been reported in every region of a country during outbreaks. This disease appears to have become endemic in certain parts of some countries especially in coastal regions. This puts everyone living in or travelling to a developing country at risk if the right attitude is not adopted.
Cholera is a major health hazard yet sometimes difficult to diagnose because, many of those who are infected do not become ill yet they still carry and transfer the bacteria. Of those who become ill 80% to 90% experience mild to moderate diarrhoea. Since diarrhoea is a common symptom in areas with poor sanitary conditions there may be a delay in diagnosing and many more people will end up being infected.

What Symptoms may one Experience?

Most of the symptoms that we experience are a consequence of dehydration. They include:
• Diarrhoea, the predominant symptom. One may lose close to 20 litres of fluid over a 24-hour period. The stool contains flecks of whitish material about the size of rice. It smells ‘fishy’
• Vomiting
• Thirst
• Muscle cramps
• Rapid heart rate
• Dry mucous membranes (including the tongue) and sometimes sunken eyes
• Restlessness or irritability, especially in children.
Note that the symptoms may sometimes be very mild. Some carriers may be symptom-free, but they can still infect you.

Managing an Infection

Many diarrhoeal diseases may be self-limiting, but cholera may be fatal if the right treatment is not given. You must:
• Quickly replace lost fluids, and in many cases this should be done intravenously (through the veins). If you are not vomiting copiously, you may also use ORS. Note that you should always start taking in fluids orally, as you rush to hospital.
• Take antibiotics. This is also very important and tends to shorten the duration and severity of symptoms. People will still recover if they are adequately rehydrated even without antibiotics.


Why Sporadic Outbreaks of Cholera?

Cholera outbreaks occur where there are disasters, or where for other reasons there is a loss of sanitary human waste disposal and the lack of safe water and food for people to ingest. A classic example is what happened in Haiti after the earthquake. In many developing countries, indiscriminate defecation, poor waste disposal, and a general disregard for hygiene, have been the cause of cholera outbreaks.








How can we Prevent Infection?
Prevention of cholera requires commitment on several fronts, but each of us can do our bit to reduce the chances of infection. Remember, even if cholera does not kill an individual, it costs money to treat, and also causes morbidity . All these add up to the loss of money from our already fragile economy.
We can prevent cholera infection in the following ways:

• Health education on the mode of spread and prevention
• Hygiene, in particular:
o Washing hands thoroughly with soap and clean water before touching food or water
o Eating warm food. Avoid food prepared in ‘suspicious’ surroundings
o Taking extreme caution when preparing food - especially seafood, vegetables and fruits
o Desisting from communal eating and sharing of cups, plates, etc.
o Ensuring that food vendors cover their products appropriately, and encouraging them to undergo their routine health screening.
• Proper refuse disposal. For instance:
o All refuse should be well covered
o The soiled clothing of an infected person should be decontaminated or appropriately disposed off
o Indiscriminate defecation should be avoided (can you imagine how faeces may leak into burst pipelines?)
• Provision of potable drinking water
o All water storage containers should be tightly covered
o Drinking water should be boiled and filtered (boiled, at least), and allowed to cool before drinking.
We all have a role to play in preventing outbreaks of cholera. Let us ensure personal and environmental hygiene; encourage others to do the same; and task the appropriate authorities to provide the necessary services.

References:
1. Ghana Health Service – Data on Cholera
2. World Health Organization. 2007. Cholera.
3. Public Health Agency of Canada. 2006. Cholera.