HESSEQUA LIFESTYLE NEWS - Cholera is an acute diarrhoea disease caused by the bacterium Vibrio cholera.

There are approximately 206 serogroups of V. cholera that have been identified to date, but only serogroups O1 and O139 are associated with disease and have pandemic potential. 

There are two biotypes of V. cholera O1 namely, Classic and El Tor. At present, V. cholera O1 El Tor is responsible for the majority of cholera cases and outbreaks worldwide (including Africa). Persons most at risk of contracting cholera are those who do not have access to safe water and adequate, proper sanitation in areas where cholera is endemic, or during an outbreak.

Is cholera common in South Africa (SA)?
South Africa experienced an outbreak of cholera which affected all nine provinces and lasted for several months from November 2008 to June 2009. There have been reports of cholera in neighbouring countries (including Zimbabwe and Mozambique) where cholera is endemic. The risk of imported cholera-causing outbreaks is ever-present. V. cholera lives in aquatic environments– typically salt water such as in river estuaries. 

From the aquatic environment, V. cholera is introduced to humans through contamination of water sources and food. Once humans are infected, very high attack rates may occur, especially in previously non-exposed populations. Person-to-person transmission is less likely because a large inoculum is necessary to transmit the disease.

What are the signs and symptoms of cholera?
The incubation period of cholera ranges from a few hours to 5 days (usually 2 - 3 days). Most cholera infections are asymptomatic (up to 75%) or mild, but severe and life-threatening disease can occur (cholera gravis). 

The organism produces ‘cholera toxin’ which leads to a massive outpouring of fluid and electrolytes into the bowel. Cholera typically presents as follows: Sudden onset of profuse, painless and watery diarrhoea, with flecks of mucus in the stool, with the appearance of ‘rice water’; Vomiting may occur, usually early in the illness; A majority of patients (95%) are afebrile, although children are more often febrile than adults; Life-threatening dehydration occurring within a matter of hours is associated with ‘cholera gravis’, with up to 1000 ml/hour of diarrhoea. 

Complications secondary to the loss of fluids and electrolytes in stool lead to muscle cramps, acidosis renal and circulatory failure. Arrhythmias and death may occur if treatment, specifically rehydration is not given.

What is the recommended public health response in SA to a case of cholera?
Cholera is a notifiable disease. All suspected cases should be notified immediately to the local Department of Health to be investigated. Every case of cholera reported to the department is investigated to assess for possible sources of infection and epidemiologically linked cases. Prevention of spread in the community requires the provision of potable, safe water and adequate sanitation. 

Hand washing is vital in all community and health facility settings. Attention should be given to sanitary human waste disposal and particularly the protection of water sources from faecal contamination. 

Communities should be advised to chlorinate or boil water and store it in clean containers. Attention to food safety is an essential preventive measure in order to prevent faecal contamination of food by food handlers. 

Street vendors and communal food sources will require particular attention through health education, since they pose a special risk.

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