Millions of people across the world get cholera infection each year. The bacteria infections usually happens in place without modern systems for sewage and clean water. Cholera is an acute diarrhea illness caused by infection of the intestine. An estimated 29 million cases and 95,000 deaths occurs each year around the world. Cholera is transmitted through contaminated foods or drinking water, as well as person to person contact through the faecal oral route, symptoms includes acute watery diarrhea, and vomiting which can result in severe dehydration or water loss. When left untreated, death can occur rapidly,sometimes within hours. Sanitary conditions inthe environment plays an important role, since the V cholera bacterium survives and multiply outside  the human body and can spread rapidly where living conditions are crowded and water sources unprotected and where there is no safe disposal of faeces.


    The infection is often mild or without symptoms, but can be severe in most cases. Approximately 2 in 10 people who get sick with cholera will develop severe symptoms such as, watery diarrhea, vomiting, and leg cramp. In these periods, rapid loss of body fluids leads to dehydration and shock,which without treatment death can occur within hours. Cholera outbreak can spread rapidly, cause many deaths, and quickly become a serious public health issues. It is nearly impossible to prevent cholera from being introduced into an area, but the spread of the disease canbe prevented through early detection, timely confirmation of cases, and a coordinative and and effective responsive efforts. Millions of people around the world gets cholera infection each year. The bacteria infection usually happens in places without modern systems for sewage or clean water, examples includes, undeveloped countries and refugee camps,as well as part of the middle East, Asia,South America, and Africa. Cholera outbreaks are more common in more climatic regions, sometimes happens after natural disaster, like, earthquake, hurricane, this disaster can damage sewage system.


                     Causes of cholera

   Cholera comes from the V cholera bacterium, people infected with this bacteria can spread diseases through their feces. They do so when infected faeces get into the water system, if the water is not properly treated, when a person eat or drink foods or water that contains V cholera, the bacteria grow inside them. The bacteria then make the small intestine secrets fluids leading to diarrhea. This are the major causes of cholera
  • Uncontrolled water sources, such as, lakes, ponds,Wells, stream, and river pose a great threat. 
  • Contaminated foods and drink ;ingestion of contaminated foods and drinks have been associated with outbreak of cholera.
  • Bottle feeding could be a significant risk factors for infants. 
  • Fruits and vegetables washed with contaminated water can be a source of infection.
  • After preparation, cooked foods may be contaminated through contaminated hands and flies.
  • Municipal water supply 
  • Foods and drink sold by street vendors
  • Vegetables grown witn contaminated humans waste
  • Raw and undercooked fish and seafood caught in water polluted polluted with sewage. 
    When a person consumes the contaminated foods or water, the bacteria release a toxins inthe intestine, that produces severe  cholera.
  •  Cholera canbe caused by infection such as, dysentery, Diarrhea i8, and typhoid.
  • Unpeeled fruits and vegetables 
  • Unpasteurised milk and milk products 
  • Raw or undercooked meat or shell fish 
  • Fish caught in tropical reefs, which may be contaminated 
  • Unclean conditions (poor sanitation and contaminated water)  
     

                Symptoms of cholera 

    These symptoms starts suddenly, usually one to five days after infection, and as a result of the toxins produced by the  vibrio cholerae bacterium that compels profuse amounts of fluids from the blood supply into the large and small intestine. The primary symptoms of cholera are;
  •  Profuse diarrhea , sometimes called the rice water stool 
  • Abdominal pain 
  • Vomiting 
  • Leg cramps 
  • Rapid pulse
  • Unusual sleeping 
  • Lethargy 
  • Nausea 
  • Excessive thirst
  • Lack of tears
  • Low urine output 
 An untreated cholera patients may produce several gallons of diarrhea fluids per day. Due to rapid loss of fluids severe dehydration and shock can occur, in this individuals shock may occur due to collapse of the circulatory system and if the fluid is not replaced the patients may die within several hours. The complications of untreated cholera are mainly shock and death from massive fluid loss. Massive electrolytes loss can lead to lethal cardiac rhythm disturbance and seizures, low blood sugar, kidney failure, food poisoning, secretory diarrhea.

 Prevention and control of cholera 

There are many means of preventing cholera, just by following some simple steps, living in a clean and healthy environment will reduce your risk of having cholera. But if you are in an area with cholera cases, certain strategies can help prevent infection. 

Wash your hands regularly 

Wash your hands with soap and clean water. 
  • Before you eat or prepare foods 
  • Before feeding your children
  • After using the toilet, after cleaning your child bottom
  • After taking care of someone ill with diarrhea 
If soap is not available, use hand sanitizer made of at least 60 percent alcohol. You can practice some local washing methods by scrubbing hands often with Ash, sand, and rinse with safe water.

Maintain a healthy environment 

Keep your environment safe and clean at all times, avoid stagnant water and unhealthy disposal of waste products. Clothes and diapers should be washed 30 metres (98feets) away from drinking water sources.

Drink and use safe water

  •  Bottled water with unbroken seals and canned carbonated beverages are safe to use and drink.
  • Use clean water to brush your teeth, wash and prepare foods and make ice.
  • Clean food preparation areas and kitchen wares with soap and clean water and let dry before reuse. 
To be sure water is safe to drink and use, take the following steps 
  • Boil, or treat your water with a chlorine products or household bleach.
  • To treat your Water with chlorine, use one of the locally available treatments products and follow the instructions  
  • Always store your treated water in a clean, covered container.

Avoid indiscriminate defecating

  • Use latrine or other sanitation systems, like chemical toilets, to dispose off feces
  • Defecate at least 30 metres away from any body of water and then Bury your feces
  • Do not put plastic bag in a chemical toilet 

Foods should be well cooked 

  • Cook food well, keep it covered, eat it warm, and peel fruit and vegetables before eating 
  • Be sure to cook seafood especially shellfish, until its very hot all the way through. 
  • Avoid raw fruits other than fruits and vegetables you have peel yourself

           Treatments for cholera

     If you develop any cholera symptoms, immediately contact a health care provider. Mild symptoms may go away on their own in a few days. But dehydration can become deadly very quickly,early treatment can save your life. Dehydration from cholera can cause you to loose large amounts of important substance, electrolytes, fluids, sodium, and potassium, which can lead to acute dehydration and you may develop low potassium level inthe blood, low blood pressure, fast heart rate, kidney failure, shock, coma, and death in most cases. Cholera should be properly treated to avoid other health problems.
     The most important part of cholera treatment is preventing or reversing dehydration. Anyone with cholera should immediately replace the fluid and salts they have lost. The most common means of rehydrating are;
  • Oral rehydration solutions (ORS) A slightly sweetened and salty water, canbe used to recover lost fluids, and prevent further dehydration. 
  • Intravenous fluids, this canbe used in a severe case of dehydration or when the patients cannot take ORS as a result of vomiting, a health care provider may use a needle to pump fluids directly into your vein. 
Other methods are

Cholera vaccine 

There are currently three vaccines recommended by the World Health Organisation (WHO ). These are, Dukors, Shanchol, Euvichol. All three reguired two doses to full protection.

Use of antibiotics 

  Antibiotics treatment of infected individuals is also used to shorten the course of illness and the duration of shedding the bacteria inthe stool. Effective antibiotics against cholera includes, tetracycline, doxycycline, ciprofloxacin, erythromycin, and azithromycin (zithromax) etc. 

 Vaccination

   Vaccination is an important tool in outbreak control. The WHO stocks two oral cholera vaccine (Dukoral and Shanchol ) that have been used successfully in mass vaccination campaign. 

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