CHOLERA has been with us since the onset of the rain season but the coming in of El Nino floods is bound to make the situation worse and areas being ravaged by these floods are more prone to the disease.
True to the predictions of the Tanzania Meteorological Agency that the current rains pounding most parts of the country are El Nino rains and that the rains will prolong until March, the country continues to experience heavy rains resulting in floods.
The floods are spreading and besides crippling Kongwa and Kilosa districts in Dodoma and Morogoro respectively, they recently attacked Arusha claiming one life and leaving dozen others homeless.
And, with the TMA having forecast that El Nino conditions will continue until March, then the country should not only prepare to deal with damages to property and loss of life but should also be prepared against outbreaks of diseases such as cholera.
According to the Wikipedia website, Cholera is an infectious gastroenteritis caused by enterotoxin-producing strains of the bacterium Vibrio cholerae and transmission to humans occurs through eating food or drinking water contaminated with Vibrio cholerae from other cholera patients.
The major reservoir for cholera was long assumed to be humans themselves, but considerable evidence exists that aquatic environments can serve as reservoirs of the bacteria.
Vibrio cholerae is a Gram-negative bacterium that produces cholera toxin, an enterotoxin, whose action on the mucosal epithelium lining of the small intestine is responsible for the disease's most salient characteristic, exhaustive diarrhoea.
In its most severe forms, cholera is one of the most rapidly fatal illnesses known, and a healthy person's blood pressure may drop to hypo tensive levels within an hour of the onset of symptoms; infected patients may die within three hours if medical treatment is not provided.
In a common scenario, the disease progresses from the first liquid stool to shock in 4 to 12 hours, with death following in 18 hours to several days, unless oral (or, in more serious cases, intravenous) rehydration therapy is provided.
Cholera Symptoms
Symptoms can occur within 24 to 48 hours of being infected with the cholera-causing bacteria. Cholera symptoms are generally mild; they include diarrhoea, vomiting, and muscle cramps. About one infected person out of 20 has severe signs and symptoms, such as increased heart rate, dehydration, and shock.
When a person becomes infected with the bacteria that cause cholera (Vibrio cholerae), the bacteria begin to multiply within the intestines. After 24 to 48 hours, symptoms of cholera can occur. The period between becoming infected and the start of cholera symptoms is called the cholera incubation period.
An infection with Vibrio cholerae is often mild or without symptoms, but sometimes symptoms are severe. Approximately one in 20 infected people has severe cholera symptoms. These people may experience a rapid loss of body fluids, which can lead to dehydration and shock. Without cholera treatment, death can occur within hours.
Transmission
People infected with cholera suffer acute diarrhoea. This highly liquid diarrhoea, colloquially referred to as "rice-water stool," is loaded with bacteria that can infect water used by other people. Cholera is transmitted through ingestion of water contaminated with the cholera bacterium, usually from feces or other effluent.
The source of the contamination is typically other cholera patients when their untreated diarrhoea discharge is allowed to get into waterways or into groundwater or drinking water supplies. Any infected water and any foods washed in the water, as well as shellfish living in the affected waterway, can cause an infection. Cholera is rarely spread directly from person to person.
Treatment
In most cases cholera can be successfully treated with oral rehydration therapy. Prompt replacement of water and electrolytes is the principal treatment for cholera, as dehydration and electrolyte depletion occur rapidly. Oral rehydration therapy or ORT is highly effective, safe, and simple to administer. In situations where commercially produced ORT sachets are too expensive or difficult to obtain, alternative home-made solutions using various formulas of water, sugar, table salt, baking soda, and fruit offer less expensive methods of electrolyte repletion. In severe cholera cases with significant dehydration and the administration of intravenous rehydration solutions may be necessary.
Antibiotics shorten the course of the disease, and reduce the severity of the symptoms. However, oral rehydration therapy remains the principal treatment. Tetracycline is typically used as the primary antibiotic, although some strains of V. cholerae exist that have shown resistance. Other antibiotics that have been proven effective against V. cholerae include cotrimoxazole, erythromycin, doxycycline, chloramphenicol, and furazolidone. Fluoroquinolones such as norfloxacin also may be used, but resistance has been reported.
The success of treatment is significantly affected by the speed and method of treatment. If cholera patients are treated quickly and properly, the mortality rate is less than one per cent; however, with untreated cholera the mortality rate rises to 50–60 per cent.
Prevention
Although cholera may be life-threatening, prevention of the disease is normally straightforward if proper sanitation practices are followed. Effective sanitation practices, if instituted and adhered to in time, are usually sufficient to stop an epidemic. There are several points along the cholera transmission path at which its spread may be (and should be) halted:
Sterilization: Proper disposal and treatment of infected fecal waste water produced by cholera victims and all contaminated materials (e.g. clothing, bedding, etc) is essential. All materials that come in contact with cholera patients should be sterilized by washing in hot water using chlorine bleach if possible.
Hands that touch cholera patients or their clothing, bedding and so on should be thoroughly cleaned and sterilized with chlorinated water or other effective anti-microbial agents.
Sewage: Anti-bacterial treatment of general sewage by chlorine, ozone, ultra-violet light or other effective treatment before it enters the waterways or underground water supplies helps prevent undiagnosed patients from inadvertently spreading the disease.
Sources: Warnings about possible cholera contamination should be posted around contaminated water sources with directions on how to decontaminate the water (boiling, chlorination etc.) for possible use.
Water purification: All water used for drinking, washing, or cooking should be sterilized by either boiling, chlorination, ozone water treatment, ultra-violet light sterilization, or anti-microbal filtration in any area where cholera may be present. Chlorination and boiling are often the least expensive and most effective means of halting transmission. Cloth filters, though very basic, have significantly reduced the occurrence of cholera when used in poor villages in Bangladesh that rely on untreated surface water. Better anti-microbial filters like those present in advanced individual water treatment hiking kits are most effective.
Public health education and adherence to appropriate sanitation practices are of primary importance to help prevent and control transmission of cholera and other diseases.
A vaccine for cholera is available in some countries, but prophylactic usage is not currently recommended for routine use by the Centers for Disease Control and Prevention (CDC). During recent years, substantial progress has been made in developing new oral vaccines against cholera. Two oral cholera vaccines, which have been evaluated with volunteers from industrialized countries and in regions with endemic cholera, are commercially available in several countries.
Sensitive surveillance and prompt reporting allow for containing cholera epidemics rapidly. Cholera exists as a seasonal disease in many endemic countries, occurring annually mostly during rainy seasons. Surveillance systems can provide early alerts to outbreaks, therefore leading to coordinated response and assist in preparation of preparedness plans.
Efficient surveillance systems can also improve the risk assessment for potential cholera outbreaks. Understanding the seasonality and location of outbreaks provide guidance for improving cholera control activities for the most vulnerable. This will also aid in the developing indicators for appropriate use of oral cholera vaccine
It is important to note that serious cholera symptoms and complications can occur rapidly; therefore, if a person is experiencing possible symptoms of cholera, he or she should see a healthcare provider immediately. Cholera treatment will reduce the chance of serious complications.
It is a challenge to all stakeholders to help wananchi in the war against cholera and to prevent it from spreading especially in areas hard hit by El Nino floods.
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