Transcript October 8, 2012-Sierra Leone, Africa

Global Health Issues:
Cholera
Carime Gordon
Alexandria Henry
Andrew Hendrix
Jordon Garman
Cholera Overview
• Acute, diarrheal illness caused by infection of the intestine with the
bacterium Vibrio cholera.
• Usually found in
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water or food sources that have been contaminated by feces from an infected
person.
places with poor water treatment, sanitation, and hygiene.
brackish rivers and coastal waters.
raw or undercooked shellfish
Areas stricken by natural disaster
Effective Killer.
Signs & Symptoms
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profuse watery diarrhea,
vomiting,
leg cramps
Severe dehydration
Rapid heartbeat
Low blood pressure
Restlessness or irritability
Loss of skin elasticity
Characteristics
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short incubation period of two hours to five
days
Symptoms typically appear in 2-3 days.
present in feces of infected for 7–14 days after
infection and shed back into the environment.
If left untreated can cause acute renal failure,
severe electrolyte imbalances and coma.
Severe dehydration can rapidly lead to shock
and death.
History
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In the U.S., cholera was prevalent in the 1800s but water-related spread has been
eliminated by modern water and sewage treatment systems.
During the 19th century, cholera spread across the world from its original reservoir
in the Ganges delta in India.
The current (seventh) pandemic started in South Asia in 1961, and reached Africa in
1971 and the Americas in 1991.
Cholera is now endemic in many countries.
Estimated 3–5 million cholera cases and 100,000–120,000 deaths due to cholera
every year.
Diagnosis and Detection
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Some Cholera patients are asymptomatic, and as many as 20% have only a mild to
moderate diarrheal illness.
Approximately 5% will develop the classic symptoms and signs of severe cholera
Cholera can be detected by:
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culture of a stool specimen (gold standard for the laboratory diagnosis of cholera).
Crystal VC® rapid test kits (useful in epidemic settings but should not be used for routine
testing).
Origination of Cholera
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India: Ganges Delta River 1817
19th Century-Spread to Europe, Asia, North America, and Africa.
First reported in 1991 near Lima, Peru.
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Disease spread throughout many South and Central
American Countries
Outbreaks
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ECUADOR
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First case reported February 28, 1991 a few weeks after Peru
declared a cholera epidemic
Ecuadorian fisherman traveled to Peru and was exposed to cholera.
The disease spread rapidly leading to an epidemic.
Epidemic reached beyond the Andean Mountains to the Amazon
River and spread throughout the rainforest
Outbreaks (Continued)
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HAITI
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First detected October 21, 2010
Haitian Ministry of Health surveillance and reports from Pan
American Health Organization (PAHO) and other partners indicated
an upsurge of Cholera cases and deaths in parts of Haiti.
Cases seen in Departments of South-East, Grand-Anse, South and
West
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684,085 Cases and 8,361 deaths have been reported
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380,846 (55.4%) were hospitalized
Current Outbreaks & Issues
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Haiti Sues United Nations for Cholera outbreak
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http://www.cnn.com/2013/10/09/world/americas/haiti-un-cholera-lawsuit/
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The epidemic is thought to have been brought to Haiti by U.N. troops from
Nepal.
Several scientific and medical investigators concluded that a likely source of
the outbreak was sewage leaking from a UN base housing Nepalese
peacekeepers.
July 23, 2012-Democratic Republic of Congo (DRC), Africa
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The number of cholera cases has increased in the armed conflict area of
North Kivu. The most affected areas include Birambizo, Goma, Karisimbi
Kiroshe, Mutwanga, Mweso, and Rwanguba
Current Outbreaks & Issues
(Continued)
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October 8, 2012-Sierra Leone, Africa
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Ministry of Health and Sanitation (MOHS) continues to work closely with
partners at the national and international levels to step up response to the
ongoing cholera outbreak.
12 of the 13 districts in Sierra Leone have been affected since the beginning
of the year.
October 28, 2013-Mexico
• The Ministry of Health in Mexico has reported an additional five cases of
infection with Vibrio cholerae O1 Ogawa toxigenic.
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From Sept. 9th to date, a total of 176 confirmed cases, including one death,
has been reported in the country. This is the first local transmission of cholera
recorded since the 1991-2001 cholera epidemic in Mexico.
Treatments for Cholera
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Oral rehydration salts for less severe patients.
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Oral rehydration solutions such as electrolytes based drinks.
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Intravenous fluids for more severe cases.
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Antibiotics such as doxycycline for adults and azithromycine for
children are the most effective.
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Zinc therapy has also been shown to reduce duration and
severity of cholera symptoms in children in the Bangladesh
outbreak in 2011.
Clean water and uncontaminated
food
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Clean uncontaminated water is a
necessity to control outbreak numbers
and manage dehydration in the
effected population.
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Most common source is sealed bottled
water but isn’t very cost effective
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Ways to treat contaminated water
include methods such as
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Boiling water
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Chlorine treatment
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Bleach treatment ( 8 drops of
household bleach per gallon
and two drops of bleach per
liter)
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Pur sachets (flocculant
disinfectant powder),
aquatabs, or waterguard
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solar disinfection
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ceramic filtration
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Slow sand filtration
Clean water and uncontaminated
food
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Proper storage of clean water is also very important to maintain its
drinkability.
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Store in container with small openings and ones that contain a lid or
covering of some sort
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Container with spouts or spigots are preferable since they prevent
people from reaching into the container
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For food items always make sure they are cooked and not consumed
raw (especially so for seafood) and that food is eaten while still hot
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For fruit and vegetable, make sure they are washed in clean water and
have a peel or are abled to be peeled.
Sanitation
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Burying and burning of waste products can also slow and prevent the spread of
cholera.
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Building and implementation of use of latrines
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Cleaning of latrines is also vital for prevention of spreading cholera; Clean
with bleach solutions (one part bleach to 9 parts water).
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If available use of chemical toilets for purposes of defecation
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If building of latrines are not an available option NO defecation should be done
within 30 meters of any body of water or food supply.
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Feces should also be buried safely away from water and food supplies
Prevention
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Proper hand washing with clean treated water and soap.
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Use of the two dose cholera vaccines Dukoral and Shanchol
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Educating the community on proper hygiene, better sanitation practices, and
how to prepare safe and useable water sources are the best cholera prevention
measures.
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Some ways to educate the population include;
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Direct one on one or small group teaching.
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Use of pamphlets or public health announcements.
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Using community leaders and public figures to demonstrate safe
cholera prevention practices.
Impact of Cholera Solutions
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Oral rehydration salts successfully treat about 80% of cases
Two types of safe and effective oral cholera vaccines currently available on the market
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CVD 103-HgRp
Limited duration of protection
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WC/rBS
Sustained protection of over 50%
Dukoral provides short-term protection
The case fatality rate usually remain below 1% with proper treatment
Global Studies on Cholera Solutions
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Ecuador Studies
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Lack of efficiency
In the three hospitals 45% of the observed cholera treatment costs were considered excessive
Mozambique Studies
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Compared the characteristics of 43 case subjects with cholera and 172 matched controls
78 to 84 percent protection against cholera
72% of those over the age of 15 were effectively treated by the vaccine
Bangladesh Studies
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Due to community immunity, if 70% of the population was vaccinated cholera could be eliminated
Global Studies on Cholera Solutions
(Continued)
• Vietnam Studies
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The vaccine efficacy after 2 doses was 66% on a population of 334, 000 people
• India Studies
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66, 900 participants
An analysis after 2 years displayed that 2 vaccine doses brought an overall protective
efficacy of 67% against cases of cholera that had already been confirmed
Impact of Cholera Solution: Cholera Treatment
Side Effects
Side Effects
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1/100-1,000 people were affected by:
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Headache, Diarrhea, Abdominal pain
1/1,000-10,000 people were affected by:
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Dizziness, loss of appetite, cough, nasal inflammation, congestion, nausea and vomiting,
fever
Less than 1 in 10,000 people were affected by:
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Rash, sweating, dehydration, drowsiness, insomnia, reduced sense of taste, sore throat,
indigestion, fainting
Impact of Cholera Solution: Summary
• The known solutions are highly effective
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Rehydration salts
Vaccines
• Those at risk for receiving cholera should seek treatment immediately
• With help from the U.N. the eradication of cholera is possible
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Taking the steps required to catch the first few cases of cholera in a country can stop an
epidemic
Conclusion
Cholera is an acute disease that is predominantly found in areas that lack clean sources of
water or that have been stricken by natural disaster. It has many symptoms from irritability to
profuse watery diarrhea. Originating in India, throughout its history it has reached every
continent on Earth and has killed about 100, 000 people a year on average. Cholera can be
detected by culture of a stool specimens and Crystal VC® rapid test kits. From various
outbreaks through the years we have learned there are many ways to combat cholera. The
majority of the countries that face cholera epidemics rely on the United Nations for help. The
only way to prevent cholera outbreaks is by spreading the knowledge we have gained over the
years to those who are most likely to come in contact with the disease. In addition, the United
Nations has to help with the funding for the treatments for cholera. With these components
put into place, if someone in a population does become ill from cholera we can eradicate it and
prevent the nasty history of this disease from repeating itself.
Citations
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Cerda, R., & Lee, P. T. (2013). Modern Cholera in the Americas: An Opportunistic Societal Infection.
American Journal Of Public Health, 103(11), 1934-1937. doi:10.2105/AJPH.2013.3011567
Health Promotion Materials. (2013, July 11). Centers for Disease Control and Prevention. Retrieved
November 20, 2013, from http://www.cdc.gov/cholera/materials.html
Household Water Treatment. (2012, March 21). Centers for Disease Control and Prevention. Retrieved
November 20, 2013, from http://www.cdc.gov/safewater/household-water.html
Ali, M., Lopez, A., Young Ae, Y., Young Eun, K., Sah, B., Maskery, B., & Clemens, J. (2012). The global
burden of cholera. Bulletin Of The World Health Organization, 90(3), 209-218A.
Cerda, R., & Lee, P. T. (2013). Modern Cholera in the Americas: An Opportunistic Societal Infection.
American Journal Of Public Health, 103(11), 1934-1937.
Citations (Continued)
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Poirier, M. P., Izurieta, R., Malavade, S. S., & McDonald, M. D. (2012). Re-emergence of
Cholera in the Americas: Risks, Susceptibility, and Ecology. Journal Of Global Infectious
Diseases, 4(3), 162-171.
Richardson, S. D., (2007). Water Analysis: Emerging Contaminants and Current Issues.
National Exposure Research Laboratory, U.S. Environmental Protection Agency, Athens,
Georgia 30605, 79(Chem.), 4295-4324.
www.epa.gov/ safewater/arsenic
Malavade, S. S., Narvaez, A. A., Mitra, A. A., Ochoa, T. T., Naik, E. E., Sharma, M. M., & ...
Izurieta, R. R. (2011). Cholera in Ecuador: Current Relevance of Past Lessons Learnt.
Journal Of Global Infectious Diseases, 3(2), 189-194.
Jenson, D., & Szabo, V. (2011). Cholera in Haiti and Other Caribbean Regions, 19th Century.
Emerging Infectious Diseases, 17(11), 2130-2135.
Citations (Continued)
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http://www.cdc.gov/haiticholera/pdf/haiticholera_trainingmanual_en.pdf
http://www.scielosp.org/scielo.php?pid=S1020-49891999000200002&script=sci_arttext
http://www.who.int/mediacentre/factsheets/fs107/en/
http://www.nejm.org/doi/full/10.1056/NEJMoa043323#t=articleResults
http://www.netdoctor.co.uk/travel-health/medicines/dukoral.html
http://www.niaid.nih.gov/topics/cholera/research/Pages/treatments.aspx
http://www.who.int/immunization/cholera_PP_slides_20_Mar_2010.pdf
http://www.who.int/immunization/Cholera_PP_Accomp_letter__Mar_10_2010.pdf