Cholera is an acute infectious disease of the intestinal tract characterised by sudden onset of severe diarrhoea and vomiting leading to rapid dehydration often resulting in death of the patient. It is both endemic and epidemic disease.
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It occurs in summer and autumn and generally fades away with the onset of winter. It affects all ages. Mainly people with poor personal and environmental hygiene are affected more. The chances of spread of this disease are more where large numbers of people get together like fairs, males etc.
Causative Agent:
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Cholera is caused by two types of vibrios:
(i) Classical cholera vibrios and
(ii) El Tor vibrios.
Mode of Spread:
(i) It spreads by ingestion of contaminated water, food, milk, milk products or drinks with discharges of the patient.
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(ii) By careless handling of fomites of infected persons and not washing the hands properly thus contaminating the food and drinks themselves.
(iii) Flies act as mechanical carriers.
Incubation Period:
Incubation period is very short ranging from a few hours to 5 days (usually 1-2 days).
Signs and Symptoms:
Signs and symptoms of cholera include sudden onset of severe diarrhoea (rice water stools) and vomiting. The patient complains of intense thirst, cramps in legs and abdomen. There is suppression of urine followed by rapid dehydration, often resulting in death. Dehydration occurs due to rapid loss of water and salts from the body in stools and vomits.
Prevention and Control:
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(i) Detect the case as early as possible and immediately notify to the health authorities.
(ii) Isolate the patient in the hospital or at home.
(iii) Give immediate treatment to the patient because minutes and hours count; delay and neglect may prove dangerous.
(iv) During epidemics everybody should be inoculated against cholera.
(v) Patient’s clothes and utensils should be thoroughly disinfected.
(vi) Patient’s stools and vomits should be collected in a covered pot containing some disinfectant and disposed of immediately.
(vii) All latrines and drains etc. should be cleaned with phenyl or any other disinfectant and sprinkled with lime or bleaching powder.
(viii) Clean and safe drinking water should be used. For drinking purposes water should be consumed after boiling.
(ix) Milk must be boiled before use.
(x) Anti-fly measures should be taken.
(xi) All cut fruits and vegetables exposed to dust and flies should not be eaten; if they are to be used then they must be consumed after thorough washing.
(xii) All foods, drinks and sweetmeats must be protected against flies.
(xiii) It is safe not to use ice, ice cream etc. of doubtful purity.
(xiv) Special care must be taken regarding the cleanliness of the surroundings as well as personal hygiene. One must wash the hands with soap and water after going to toilet and before eating meals.
(xv) Hot drinks and meals should be taken. Taking of curd, lemon juice and butter milk is advisable during epidemic.
Treatment:
Each case of cholera can be effectively treated if medical attention is given promptly. The treatment consists of rehydration and antibiotics. During cholera there is great loss of water and salts from the body in diarrhoea and vomiting which leads to dehydration, therefore oral rehydration therapy must be given.
For use, the contents of the packet are dissolved in one liter of safe drinking water and consumed within 24 hours. The solution should be made fresh daily and consumed within 24 hours.
If the above mentioned packet of ‘ORS’ is not available a simple mixture of common salt (5 gm) and sugar or gur (20 gm) is dissolved in one liter of water and given to the patient.
In severe dehydration intravenous rehydration therapy is given. For this purpose Ringer’s lactate solution is used.
Antibiotics are given along with rehydration therapy to cut short the duration of illness. Tetracycline is the drug of choice which is given 500 mg four times a day for 3 days.