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Primary prevention of cholera can be achieved on an individual level by appropriate personal hygiene, use of sanitary water supply, appropriate preparation of food, as well as prompt identification, isolation, and treatment of cases. Primary preventive methods may also be implemented on a community level through effective water sanitation, appropriate and broad vaccination of the community to develop [[herd immunity]] as well as early detection of an outbreak.<ref name="pmid23301693">{{cite journal| author=Waldman RJ, Mintz ED, Papowitz HE| title=The cure for cholera--improving access to safe water and sanitation. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 7 | pages= 592-4 | pmid=23301693 | doi=10.1056/NEJMp1214179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23301693  }} </ref><ref name="pmid16326125">{{cite journal| author=Sepúlveda J, Valdespino JL, García-García L| title=Cholera in Mexico: the paradoxical benefits of the last pandemic. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 1 | pages= 4-13 | pmid=16326125 | doi=10.1016/j.ijid.2005.05.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16326125  }} </ref><ref name="pmid17141709">{{cite journal| author=Sepúlveda J, Bustreo F, Tapia R, Rivera J, Lozano R, Oláiz G et al.| title=Improvement of child survival in Mexico: the diagonal approach. | journal=Lancet | year= 2006 | volume= 368 | issue= 9551 | pages= 2017-27 | pmid=17141709 | doi=10.1016/S0140-6736(06)69569-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17141709  }} </ref><ref>{{cite journal |author=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=Cochrane Database Syst Rev |volume= |issue=8 |pages=CD000974 |year=2010 |pmid=20687062 |doi=10.1002/14651858.CD000974.pub2 |url= |editor1-last=Graves |editor1-first=Patricia M}}</ref><ref name="pmid21412922">{{cite journal |author=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=Cochrane Database Syst Rev |issue=3 |pages=CD008603 |year=2011 |doi=10.1002/14651858.CD008603.pub2 |pmid=21412922}}</ref><ref>{{cite web |url=http://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=WHO |work=Health topics |year=2008 | accessdate=2010-02-01}}</ref>
Primary prevention of cholera can be achieved on an individual level by appropriate personal hygiene, use of sanitary water supply, appropriate preparation of food, as well as prompt identification, isolation, and treatment of cases. Primary preventive methods may also be implemented on a community level through effective water sanitation, appropriate and broad vaccination of the community to develop [[herd immunity]] as well as early detection of an outbreak.<ref name="pmid23301693">{{cite journal| author=Waldman RJ, Mintz ED, Papowitz HE| title=The cure for cholera--improving access to safe water and sanitation. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 7 | pages= 592-4 | pmid=23301693 | doi=10.1056/NEJMp1214179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23301693  }} </ref><ref name="pmid16326125">{{cite journal| author=Sepúlveda J, Valdespino JL, García-García L| title=Cholera in Mexico: the paradoxical benefits of the last pandemic. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 1 | pages= 4-13 | pmid=16326125 | doi=10.1016/j.ijid.2005.05.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16326125  }} </ref><ref name="pmid17141709">{{cite journal| author=Sepúlveda J, Bustreo F, Tapia R, Rivera J, Lozano R, Oláiz G et al.| title=Improvement of child survival in Mexico: the diagonal approach. | journal=Lancet | year= 2006 | volume= 368 | issue= 9551 | pages= 2017-27 | pmid=17141709 | doi=10.1016/S0140-6736(06)69569-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17141709  }} </ref><ref>{{cite journal |author=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=Cochrane Database Syst Rev |volume= |issue=8 |pages=CD000974 |year=2010 |pmid=20687062 |doi=10.1002/14651858.CD000974.pub2 |url= |editor1-last=Graves |editor1-first=Patricia M}}</ref><ref name="pmid21412922">{{cite journal |author=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=Cochrane Database Syst Rev |issue=3 |pages=CD008603 |year=2011 |doi=10.1002/14651858.CD008603.pub2 |pmid=21412922}}</ref><ref>{{cite web |url=http://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=WHO |work=Health topics |year=2008 | accessdate=2010-02-01}}</ref>


==Primary Prevention==l
==Primary Prevention==
===Individual Prevention===
===Individual Prevention===
Effective methods for individuaprimary prevention of cholera include:<ref name="pmid23301693">{{cite journal| author=Waldman RJ, Mintz ED, Papowitz HE| title=The cure for cholera--improving access to safe water and sanitation. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 7 | pages= 592-4 | pmid=23301693 | doi=10.1056/NEJMp1214179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23301693  }} </ref><ref name="pmid16326125">{{cite journal| author=Sepúlveda J, Valdespino JL, García-García L| title=Cholera in Mexico: the paradoxical benefits of the last pandemic. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 1 | pages= 4-13 | pmid=16326125 | doi=10.1016/j.ijid.2005.05.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16326125  }} </ref><ref name="pmid17141709">{{cite journal| author=Sepúlveda J, Bustreo F, Tapia R, Rivera J, Lozano R, Oláiz G et al.| title=Improvement of child survival in Mexico: the diagonal approach. | journal=Lancet | year= 2006 | volume= 368 | issue= 9551 | pages= 2017-27 | pmid=17141709 | doi=10.1016/S0140-6736(06)69569-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17141709  }} </ref>
Effective methods for individuaprimary prevention of cholera include:<ref name="pmid23301693">{{cite journal| author=Waldman RJ, Mintz ED, Papowitz HE| title=The cure for cholera--improving access to safe water and sanitation. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 7 | pages= 592-4 | pmid=23301693 | doi=10.1056/NEJMp1214179 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23301693  }} </ref><ref name="pmid16326125">{{cite journal| author=Sepúlveda J, Valdespino JL, García-García L| title=Cholera in Mexico: the paradoxical benefits of the last pandemic. | journal=Int J Infect Dis | year= 2006 | volume= 10 | issue= 1 | pages= 4-13 | pmid=16326125 | doi=10.1016/j.ijid.2005.05.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16326125  }} </ref><ref name="pmid17141709">{{cite journal| author=Sepúlveda J, Bustreo F, Tapia R, Rivera J, Lozano R, Oláiz G et al.| title=Improvement of child survival in Mexico: the diagonal approach. | journal=Lancet | year= 2006 | volume= 368 | issue= 9551 | pages= 2017-27 | pmid=17141709 | doi=10.1016/S0140-6736(06)69569-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17141709  }} </ref>
Line 16: Line 16:


===Prevention in the Community===
===Prevention in the Community===
There are several points along the transmission path at which the spread may be halted:
Primary prevention of cholera in the community include:
* Broad vaccination of the community for [[her immunity]]
* Sickbed: Isolate the severe cases. Proper disposal and treatment of the germ infected fecal waste (and all clothing and bedding that come in contact with it) produced by cholera victims is of primary importance as stool and vomit are highly contagious
* Sickbed: Isolate the severe cases. Proper disposal and treatment of the germ infected fecal waste (and all clothing and bedding that come in contact with it) produced by cholera victims is of primary importance as stool and vomit are highly contagious
* Sewage: Treatment of general sewage before it enters the waterways or underground water supplies prevent possible undetected patients from spreading the disease.
* Sewage: Treatment of general sewage before it enters the waterways or underground water supplies prevent possible undetected patients from spreading the disease.
* Sources: Warnings about cholera contamination posted around contaminated water sources through simple messages with directions on how to decontaminate the water.
* Education: Warnings about cholera contamination posted around contaminated water sources through simple messages with directions on how to decontaminate the water.
 
===Primary Prevention in Healthcare settings===
Primary Prevention in a health care setting includes appropriate sanitation of potentially infected surfaces and equipment as follows:
*2% chlorine
**Made by mixing 3 parts water and 2 parts bleach
**Used for disinfecting vomit, feces, and corpses
*0.5% chlorine
**Made by mixing 9 parts water and 1 part bleach
**Used for foot baths, cleaning floors, bedding, latrines
*0.05% chlorine
**Made by mixing 9 parts water and 1 part 0.5% chlorine solution
**Used for bathing soiled patients, handwashing, rinsing dishes, laundry
===Vaccine===
A number of safe and effective oral vaccines for cholera are available.<ref name="pmid21412922">{{cite journal |author=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=Cochrane Database Syst Rev |issue=3 |pages=CD008603 |year=2011 |doi=10.1002/14651858.CD008603.pub2 |pmid=21412922}}</ref> Dukoral, an orally administered, inactivated whole cell vaccine, has an overall efficacy of about 52% during the first year after being given and 62% in the second year, with minimal side effects.<ref name="pmid21412922"/> It is available in over 60 countries. However, it is not currently recommended by the [[Centers for Disease Control and Prevention]] (CDC) for most people traveling from the United States to endemic countries.<ref name="CDC_Vacc">{{cite web| title=Is a vaccine available to prevent cholera? | work=CDC disease info: Cholera| url=http://www.cdc.gov/cholera/general/#vaccine| date=2010-10-22| accessdate=2010-10-24}}</ref> ShanChol is another oral vaccination which is based on the O1 and O139 serotypes.<ref name="who"> World Health Organization Cholera Epidemiological Report. http://www.who.int/wer/2012/wer8731_32.pdf. Accessed on October 7th, 2016</ref>. An injectable vaccine was found to be effective for two to three years. The protective efficacy was 28% lower in children less than 5 years old.<ref>{{cite journal |author=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=Cochrane Database Syst Rev |volume= |issue=8 |pages=CD000974 |year=2010 |pmid=20687062 |doi=10.1002/14651858.CD000974.pub2 |url= |editor1-last=Graves |editor1-first=Patricia M}}</ref> However, as of 2010, it has limited availability. Work is under way to investigate the role of mass vaccination.<ref>{{cite web |url=http://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=WHO |work=Health topics |year=2008 | accessdate=2010-02-01}}</ref> The World Health Organization (WHO) recommends immunization of high risk groups, such as children and people with [[HIV]], in countries where this disease is [[Endemism|endemic]]. If people are immunized broadly, [[herd immunity]] results, with a decrease in the amount of contamination in the environment.


===Signals of an Outbreak===
===Signals of an Outbreak===
Line 28: Line 43:
* Sharing the same water source
* Sharing the same water source
* Outbreak in the neighboring community
* Outbreak in the neighboring community
===Vaccine===
A number of safe and effective oral vaccines for cholera are available.<ref name="pmid21412922">{{cite journal |author=Sinclair D, Abba K, Zaman K, Qadri F, Graves PM |title=Oral vaccines for preventing cholera |journal=Cochrane Database Syst Rev |issue=3 |pages=CD008603 |year=2011 |doi=10.1002/14651858.CD008603.pub2 |pmid=21412922}}</ref> Dukoral, an orally administered, inactivated whole cell vaccine, has an overall efficacy of about 52% during the first year after being given and 62% in the second year, with minimal side effects.<ref name="pmid21412922"/> It is available in over 60 countries. However, it is not currently recommended by the [[Centers for Disease Control and Prevention]] (CDC) for most people traveling from the United States to endemic countries.<ref name="CDC_Vacc">{{cite web| title=Is a vaccine available to prevent cholera? | work=CDC disease info: Cholera| url=http://www.cdc.gov/cholera/general/#vaccine| date=2010-10-22| accessdate=2010-10-24}}</ref> ShanChol is another oral vaccination which is based on the O1 and O139 serotypes.<ref name="who"> World Health Organization Cholera Epidemiological Report. http://www.who.int/wer/2012/wer8731_32.pdf. Accessed on October 7th, 2016</ref>. An injectable vaccine was found to be effective for two to three years. The protective efficacy was 28% lower in children less than 5 years old.<ref>{{cite journal |author=Graves PM, Deeks JJ, Demicheli V, Jefferson T |title=Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected) |journal=Cochrane Database Syst Rev |volume= |issue=8 |pages=CD000974 |year=2010 |pmid=20687062 |doi=10.1002/14651858.CD000974.pub2 |url= |editor1-last=Graves |editor1-first=Patricia M}}</ref> However, as of 2010, it has limited availability. Work is under way to investigate the role of mass vaccination.<ref>{{cite web |url=http://www.who.int/topics/cholera/vaccines/en/index.html |title=Cholera vaccines |publisher=WHO |work=Health topics |year=2008 | accessdate=2010-02-01}}</ref> The World Health Organization (WHO) recommends immunization of high risk groups, such as children and people with [[HIV]], in countries where this disease is [[Endemism|endemic]]. If people are immunized broadly, [[herd immunity]] results, with a decrease in the amount of contamination in the environment.
===Infection Control in Healthcare settings===
2% chlorine
Made by mixing 3 parts water and 2 parts bleach
Used for disinfecting vomit, feces, and corpses
0.5% chlorine
Made by mixing 9 parts water and 1 part bleach
Used for foot baths, cleaning floors, bedding, latrines
0.05% chlorine
Made by mixing 9 parts water and 1 part 0.5% chlorine solution
Used for bathing soiled patients, handwashing, rinsing dishes, laundry


==References==
==References==

Revision as of 12:06, 7 October 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]

Overview

Primary prevention of cholera can be achieved on an individual level by appropriate personal hygiene, use of sanitary water supply, appropriate preparation of food, as well as prompt identification, isolation, and treatment of cases. Primary preventive methods may also be implemented on a community level through effective water sanitation, appropriate and broad vaccination of the community to develop herd immunity as well as early detection of an outbreak.[1][2][3][4][5][6]

Primary Prevention

Individual Prevention

Effective methods for individuaprimary prevention of cholera include:[1][2][3]

  • Appropriate hand washing and personal hygiene
  • Avoid defecation in bodies of water
  • Appropriate preparation and cooking of food (Seafood)
  • Peeling of fruits and vegetables
  • Use of sanitary water supply

Prevention in the Community

Primary prevention of cholera in the community include:

  • Broad vaccination of the community for her immunity
  • Sickbed: Isolate the severe cases. Proper disposal and treatment of the germ infected fecal waste (and all clothing and bedding that come in contact with it) produced by cholera victims is of primary importance as stool and vomit are highly contagious
  • Sewage: Treatment of general sewage before it enters the waterways or underground water supplies prevent possible undetected patients from spreading the disease.
  • Education: Warnings about cholera contamination posted around contaminated water sources through simple messages with directions on how to decontaminate the water.

Primary Prevention in Healthcare settings

Primary Prevention in a health care setting includes appropriate sanitation of potentially infected surfaces and equipment as follows:

  • 2% chlorine
    • Made by mixing 3 parts water and 2 parts bleach
    • Used for disinfecting vomit, feces, and corpses
  • 0.5% chlorine
    • Made by mixing 9 parts water and 1 part bleach
    • Used for foot baths, cleaning floors, bedding, latrines
  • 0.05% chlorine
    • Made by mixing 9 parts water and 1 part 0.5% chlorine solution
    • Used for bathing soiled patients, handwashing, rinsing dishes, laundry

Vaccine

A number of safe and effective oral vaccines for cholera are available.[5] Dukoral, an orally administered, inactivated whole cell vaccine, has an overall efficacy of about 52% during the first year after being given and 62% in the second year, with minimal side effects.[5] It is available in over 60 countries. However, it is not currently recommended by the Centers for Disease Control and Prevention (CDC) for most people traveling from the United States to endemic countries.[7] ShanChol is another oral vaccination which is based on the O1 and O139 serotypes.[8]. An injectable vaccine was found to be effective for two to three years. The protective efficacy was 28% lower in children less than 5 years old.[9] However, as of 2010, it has limited availability. Work is under way to investigate the role of mass vaccination.[10] The World Health Organization (WHO) recommends immunization of high risk groups, such as children and people with HIV, in countries where this disease is endemic. If people are immunized broadly, herd immunity results, with a decrease in the amount of contamination in the environment.

Signals of an Outbreak

Increase number of acute diarrhea cases and patients having common symptoms-

  • Watery diarrhea, dehydration and vomiting
  • Cases from same area or location
  • Eaten the same food (for e.g. at a burial ceremony)
  • Sharing the same water source
  • Outbreak in the neighboring community

References

  1. ↑ 1.0 1.1 Waldman RJ, Mintz ED, Papowitz HE (2013). "The cure for cholera--improving access to safe water and sanitation". N Engl J Med. 368 (7): 592–4. doi:10.1056/NEJMp1214179. PMID 23301693.
  2. ↑ 2.0 2.1 Sepúlveda J, Valdespino JL, García-García L (2006). "Cholera in Mexico: the paradoxical benefits of the last pandemic". Int J Infect Dis. 10 (1): 4–13. doi:10.1016/j.ijid.2005.05.005. PMID 16326125.
  3. ↑ 3.0 3.1 Sepúlveda J, Bustreo F, Tapia R, Rivera J, Lozano R, Oláiz G; et al. (2006). "Improvement of child survival in Mexico: the diagonal approach". Lancet. 368 (9551): 2017–27. doi:10.1016/S0140-6736(06)69569-X. PMID 17141709.
  4. ↑ Graves PM, Deeks JJ, Demicheli V, Jefferson T (2010). Graves, Patricia M, ed. "Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected)". Cochrane Database Syst Rev (8): CD000974. doi:10.1002/14651858.CD000974.pub2. PMID 20687062.
  5. ↑ 5.0 5.1 5.2 Sinclair D, Abba K, Zaman K, Qadri F, Graves PM (2011). "Oral vaccines for preventing cholera". Cochrane Database Syst Rev (3): CD008603. doi:10.1002/14651858.CD008603.pub2. PMID 21412922.
  6. ↑ "Cholera vaccines". Health topics. WHO. 2008. Retrieved 2010-02-01.
  7. ↑ "Is a vaccine available to prevent cholera?". CDC disease info: Cholera. 2010-10-22. Retrieved 2010-10-24.
  8. ↑ World Health Organization Cholera Epidemiological Report. http://www.who.int/wer/2012/wer8731_32.pdf. Accessed on October 7th, 2016
  9. ↑ Graves PM, Deeks JJ, Demicheli V, Jefferson T (2010). Graves, Patricia M, ed. "Vaccines for preventing cholera: killed whole cell or other subunit vaccines (injected)". Cochrane Database Syst Rev (8): CD000974. doi:10.1002/14651858.CD000974.pub2. PMID 20687062.
  10. ↑ "Cholera vaccines". Health topics. WHO. 2008. Retrieved 2010-02-01.

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