What Is Cholera?

                                        CHOLERA

1. What is Cholera?

Cholera is an acute diarrheal illness, caused by infection of the intestine with the bacterium Vibrio cholerae. The infection is generally mild and asymptomatic. However, symptoms when occur, may appear as profuse watery diarrhea, vomiting and leg cramps. In the infected people, rapid loss of fluid leads to dehydration, shock and if left untreated, may even lead to death. [Cholera - Vibrio cholerae infection (2014, November 6). Retrieved September 13, 2016, from http://www.cdc.gov/cholera/general/index.html].

Among the Vibrio cholera, two toxigenic serogroups O1 and O139 are regarded as the etiologic serogroups causing the disease. [Sack, D. A., Sack, R. B., & Chaignat, C. (2006). Getting Serious about Cholera. New England Journal of Medicine. 355(7), 649-651. doi:10.1056/nejmp068144]

According to the research, it is estimated that approximately 1.4 to 4.3 million cases of cholera are discovered each year and out of which 28,000 to 142,000 deaths occur annually due to cholera. [Ali, M., Lopez, A. L., You, Y. A., Kim, Y. E., Sah, B., Maskery, B., & Clemens, J. (2012). The global burden of cholera. Bulletin of the World Health Organization. 90(3), 209-218. doi:10.2471/blt.11.093427]

1. Who are affected by the Cholera?

Everyone is susceptible to cholera except breastfeeding infant. Usually those people living in places with inadequate water treatment, poor sanitation, and inadequate hygiene are at a greater risk for cholera. Risk factors for cholera include:

1. Poor sanitary conditions: Cholera is more likely to flourish in situations where a sanitary environment — including a safe water supply — is difficult to maintain. Such conditions are common to refugee camps, impoverished countries, and areas devastated by famine, war or natural disasters.
2. Reduced or nonexistent stomach acid (hypochlorhydria or achlorhydria): Cholera bacteria can't survive in an acidic environment, and ordinary stomach acid often serves as a first-line defense against infection. But people with low levels of stomach acid — such as children, older adults, and people who take antacids, H-2 blockers or proton pump inhibitors — lack this protection, so they're at greater risk of cholera.
3. Household exposure:  People are at significantly increased risk of cholera if they live with someone who has the disease.
4. Raw or undercooked shellfish: Although large-scale cholera outbreaks no longer occur in industrialized nations, eating shellfish from waters known to harbor the bacteria greatly increases risk.

[Ferri, F. F. (2014). Ferri's clinical advisor 2014: 5 books in 1. Philadelphia, PA: Elsevier/Mosby.]

1. Where are the population affected by the Cholera?

Cholera still remains a major health problem in many parts of the world mainly developing countries.

A recent survey of 2014 demonstrates that a total of 190,549 cholera cases with 2231 deaths reported to the WHO by 42 countries which is 47% increase than the previous year.

Most of the populations affected were from developing countries than the industrialized countries. However, 5 countries – Afghanistan, Democratic Republic of Congo (DRC), Ghana, Haiti and Nigeria – together reported 84% of all cases. Statistically 55% of reported cases originated from Africa, 30% from Asia and 15% from Hispaniola.

A total of 28,456 cholera cases with 307 deaths were reported from 7 countries in American countries. Imported cases were found in Canada, Chile and USA.

During 2014, 56,787 cases, including 42 deaths were reported by 11 countries in Asia.

In 2014, 19 countries in the African continent reported 105,287 cases of cholera, including 1882 deaths.

Europe and Australia reported negligible imported cases of cholera in 2014.

[The Weekly Epidemiological Record (WER). (2015, October 2). Retrieved September 13, 2016, from http://www.who.int/wer/en/]

1. When are the population affected by the Cholera?

Cholera can occur in both endemic and epidemic patterns. It is endemic in many areas of Asia and Africa.

In Asia, cholera occurs seasonally before and after the monsoon rains. The incidence is highest in children and the disease can occur in neonates.