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 ID: 531146
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Slide1
Global Health Issues: Cholera
Carime
Gordon
Alexandria Henry
Andrew Hendrix
Jordon GarmanSlide2
Cholera Overview
Acute
, diarrheal illness caused by infection of the intestine with the bacterium Vibrio
cholera.
Usually
found in
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 disasterSlide3
Effective Killer.
Signs & Symptoms
profuse watery diarrhea,
vomiting
,
leg crampsSevere dehydrationRapid heartbeatLow blood pressureRestlessness or irritabilityLoss of skin elasticity
Characteristics
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.
S
evere
dehydration can rapidly lead to shock and death.Slide4
History
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.Slide5
Diagnosis and Detection
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: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).Slide6
Origination of Cholera
India
: Ganges Delta River 1817
19th Century-Spread to Europe, Asia, North America, and Africa.
First reported in 1991 near Lima, Peru.
Disease spread throughout many South and Central American CountriesSlide7
Outbreaks
ECUADOR
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
rainforestSlide8
Outbreaks (Continued)
HAITI
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
684,085 Cases and 8,361 deaths have been reported
380,846 (55.4%) were hospitalizedSlide9
Current Outbreaks & Issues
Haiti Sues United Nations for Cholera outbreak
http://www.cnn.com/2013/10/09/world/americas/haiti-un-cholera-lawsuit/
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
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
Slide10
Current Outbreaks & Issues (Continued)
October
8, 2012-Sierra Leone, Africa
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.
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.Slide11
Treatments for Cholera
Oral rehydration salts for less severe patients.
Oral rehydration solutions such as electrolytes based drinks.
Intravenous fluids for more severe cases.
Antibiotics such as doxycycline for adults and azithromycine for children are the most effective.
Zinc therapy has also been shown to reduce duration and severity of cholera symptoms in children in the Bangladesh outbreak in 2011.Slide12
Clean water and uncontaminated food
Clean uncontaminated water is a necessity to control outbreak numbers and manage dehydration in the effected population.
Most common source is sealed bottled water but isn’t very cost effective
Ways
to treat contaminated
water
include methods such as
Boiling
water
Chlorine treatment
Bleach treatment ( 8 drops of household bleach per gallon and two drops of bleach per liter)
Pur
sachets (
flocculant
disinfectant powder),
aquatabs
, or
waterguard
solar disinfection
ceramic filtration
Slow sand filtrationSlide13
Clean water and uncontaminated food
Proper storage of clean water is also very important to maintain its drinkability.
Store in container with small openings and ones that contain a lid or covering of some sort
Container with spouts or spigots are preferable since they prevent people from reaching into the container
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
For fruit and vegetable, make sure they are washed in clean water and have a peel or are abled to be peeled.Slide14
Sanitation
Burying and burning of waste products can also slow and prevent the spread of cholera.
Building and implementation of use of latrines
Cleaning of latrines is also vital for prevention of spreading cholera; Clean with bleach solutions (one part bleach to 9 parts water).
If available use of chemical toilets for purposes of defecation
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.
Feces should also be buried safely away from water and food suppliesSlide15
Prevention
Proper hand washing with clean treated water and soap.
Use of the two dose cholera vaccines
Dukoral
and
Shanchol
Educating the community on proper hygiene, better sanitation practices, and how to prepare safe and useable water sources are the best cholera prevention measures.
Some ways to educate the population include;Direct one on one or small group teaching.
Use of pamphlets or public health announcements.
Using community leaders and public figures to demonstrate safe cholera prevention practices.Slide16Slide17Slide18Slide19
Impact of Cholera Solutions
Oral rehydration salts successfully treat about 80% of cases
T
wo types of safe and effective oral cholera vaccines currently available on the market
WC/
rBS
CVD 103-HgRpLimited duration of protectionSustained protection of over 50% Dukoral provides short-term protectionThe case fatality rate usually remain below 1% with proper treatmentSlide20
Global Studies on Cholera Solutions
Ecuador Studies
Lack of efficiency
In the three hospitals 45% of the observed cholera treatment costs were considered excessive
Mozambique Studies
Compared the characteristics of 43 case subjects with cholera and 172 matched controls
78 to 84 percent protection against cholera72% of those over the age of 15 were effectively treated by the vaccine Bangladesh StudiesDue to community immunity, if 70% of the population was vaccinated cholera could be eliminatedSlide21
Global Studies on Cholera Solutions (Continued)
Vietnam Studies
T
he vaccine efficacy after 2 doses was 66% on a population of 334, 000 people
India Studies
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 confirmedSlide22
Impact of Cholera Solution: Cholera Treatment Side Effects
Side Effects
1/100-1,000 people were affected by:
Headache, Diarrhea, Abdominal pain
1/1,000-10,000 people were affected by:
Dizziness, loss of appetite, cough, nasal inflammation, congestion, nausea and vomiting, fever
Less than 1 in 10,000 people were affected by:Rash, sweating, dehydration, drowsiness, insomnia, reduced sense of taste, sore throat, indigestion, faintingSlide23
Impact of Cholera Solution: Summary
The known solutions are highly effective
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
Taking the steps required to catch the first few cases of cholera in a country can stop an epidemicSlide24
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.Slide25
Citations
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.Slide26
Citations (Continued)
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/arsenicMalavade
, 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.Slide27
Citations (Continued)
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.aspxhttp://www.who.int/immunization/cholera_PP_slides_20_Mar_2010.pdfhttp://www.who.int/immunization/Cholera_PP_Accomp_letter__Mar_10_2010.pdf