Cholera primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Although cholera can be life-threatening, it is nearly always easily prevented, in principle, if proper sanitation practices are followed. In the United States and Western Europe, because of advanced water treatment and sanitation systems, cholera is no longer a major threat. The last major outbreak of cholera in the United States was in 1911. However, everyone, especially travelers, should be aware of how the disease is transmitted and what can be done to prevent it. Good sanitation practices, if instituted in time, are usually sufficient to stop an epidemic.
Primary prevention
Steps to take in case of suspected cholera outbreak
- Inform and ask for help (supervisor, other centers)
- Treat patients promptly specially patients presenting as some or severe cholera symptoms (as they may deteriorate frequently)
- Protect the community (prevent spread to others)
Checklist for medical professional in case of suspected outbreak
In case of suspected cholera in community medical professionals and hospitals should check the supplies to treat the patients.
- IV fluids (Ringer Lactate is the best, in case of nonavailability of ringer lactate cholera saline or normal saline)
- Oral Rehydration Salt (ORS)
- Antibiotics (doxycycline, erythromycin, tetracycline)
- Drips
- Nasogastric tubes
- Soap
- Chlorine or bleaching powder
- Rectal swabs and transport medium (Cary Blair or TCBS) for stool samples
- Safe water is needed to rehydrate patients and to wash clothes and instruments
Steps to protect the community
- Disinfect water sources with chlorine
- Promote water disinfection at home using chlorine
- Stool and vomit are highly contagious
- Wash your hands with soap after using toilets and latrines, before preparing food, before eating
- Boil or disinfect the water with chlorine solution
- Only eat freshly cooked food
- Do not defecate near the water sources
- Use latrines and keep them clean
- Isolate the severe cases
- Provide information on how to avoid cholera through simple messages on the outbreak
Precautions for funerals
- Disinfect corpses with chlorine solution (2%)
- Fill mouth and anus with cotton wool soaked with chlorine solution
- Wash hands with soap after touching the corpse
- Disinfect the clothing and bedding of the deceased by stirring them in boiling water or by drying them thoroughly in the sun
There are several points along the transmission path at which the spread may be halted:
- Sickbed: 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.
- 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 with directions on how to decontaminate the water.
- Sterilization: Boiling, filtering, and chlorination of water kill the bacteria produced by cholera patients and prevent infections, when they do occur, from spreading. All materials (clothing, bedding, etc.) that come in contact with cholera patients should be sterilized in hot water using (if possible) chlorine bleach. Hands, etc. that touch cholera patients or their clothing etc. should be thoroughly cleaned and sterilized. All water used for drinking, washing or cooking should be sterilized by boiling or chlorination in any area where cholera may be present. Water filtration, chlorination and boiling are by far the most effective means of halting transmission. Cloth filters, though very basic, have greatly reduced the occurrence of cholera when used in poor villages in Bangladesh that rely on untreated surface water. In general, public health education and good sanitation practices are the limiting factors in preventing transmission.