Cholera primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editors-In-Chief: Priyamvada Singh, MBBS [2]
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
Effective methods for primary prevention of cholera include[1][2][3]:
- Development of water and sewage treatment
- Appropriate hand washing
- Avoid defecation in bodies of water
- Appropriate preparation and cooking of food (Seafood)
- Peeling of fruits and vegetables
Signals of an Outbreak
- Increase number of acute diarrheal 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
Steps to Protect the Community
There are several points along the transmission path at which the spread may be halted:
- 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.
- Sources: Warnings about cholera contamination posted around contaminated water sources through simple messages 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. Wash your hands with soap after using toilets and latrines, before preparing food, before eating
- Only eat freshly cooked food
- Do not defecate near the water sources
- Use latrines and keep them clean
Vaccine
A number of safe and effective oral vaccines for cholera are available.[4] 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.[4] 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.[5] ShanChol is another oral vaccination which is based on the O1 and O139 serotypes.[6]. 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.[7] However, as of 2010, it has limited availability. Work is under way to investigate the role of mass vaccination.[8] 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.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 4.0 4.1 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.
- ↑ "Is a vaccine available to prevent cholera?". CDC disease info: Cholera. 2010-10-22. Retrieved 2010-10-24.
- ↑ World Health Organization Cholera Epidemiological Report. http://www.who.int/wer/2012/wer8731_32.pdf. Accessed on October 7th, 2016
- ↑ 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.
- ↑ "Cholera vaccines". Health topics. WHO. 2008. Retrieved 2010-02-01.