CHOLERA UP DATE :

Dr Sospatro Elisha Ngallaba – CUHAS Dr Andrew Luhanga - BMC PRESENTERS Dr Sospatro Elisha Ngallaba – CUHAS Dr Andrew Luhanga - BMC Dr Pastory Mondea - BMC

WHAT IS CHOLERA??? Is an acute disease characterized by watery diarrhea that is caused by bacterium called Vibrio cholerae. It is a gram negative aerobic bacillus or rod shaped bacteria It has two major biotypes Classic and Eltor Eltor is the most notorious cause of cholera outbreak

INTRODUCTION Cholera is an acute enteric infection characterized by profuse vomiting and acute watery diarrhoea caused by ingestion of a bacterium Vibrio cholerae The infection can lead to severe dehydration or even death within few hours of contamination.

ct If left untreated- The case- fatality rate can range up to 50% With timely and adequate treatment, the rate can be contained below 1%. 80% of reported patients recover when treated only with oral rehydration salts While 10% to 20% may need administration of intravenous fluids for rehydration

Mode of transmission Agent: Vibrio cholerae In order for a disease to occur three factors must interact the Agent, Host, Environment. So the agent must have the ability to cause the disease, (pathogenicity) (and the dose)

Undesirable behaviors such as, poor hygiene Genetic composition HOST :ie human There are factors which facilitate the host to get the disease (risk factors) Undesirable behaviors such as, poor hygiene Genetic composition Poor nutritional status Low immunity

ct Host factors which protect against cholera include immunity due to previous infection with Vibrio cholerae and, when the host has been living in endemic area, where he or she has acquired immunity Medications -antacids

Environment Environmental factors include: physical factors such climate, biologic factors such as insects that transmit the agent, and socioeconomic factors such as crowding, sanitation, and the availability of health services.

REFUGE

MAGNITUDE OF THE PROBLEM GLOBALLY Cholera is endemic to the Indian subcontinent, especially a long the river Ganges which serve as a contamination reservoir. Since 1800, cholera has spread throughout the world, but with development it has been controlled in many parts of developed countries

MAGNITUDE OF THE PROBLEM IN AFRICA In Africa, the first major outbreak of cholera occurred in 1970 affecting East, North, and West Africa simultaneously. This epidemic moved rapidly throughout the region, and by the end of 1971, 25 African countries had reported cholera outbreak with Case fatality rate 16-35%

AFRICA

MAGNITUDE OF CHOLERA IN TANZANIA The first epidemic -1974 in which 10 cases were reported with no deaths. Later after this phenomenon, there were several epidemics reported in various regions in the country. The first major epidemic - 1992 with 18,526 cases and 2,173 deaths with Case fatality Rate 11.7%. Due to Integrated Disease Surveillance and Response (IDSR) strategy in the country between 1998 and 2010, ( 88,235 cases and 2,416 deaths reported with a case fatality rate of 2.7%.)

ct 2015 – Burundi refugee crisis Majority of refugees fleeing to Tanzania Overcrowded camp conditions -> cholera outbreak

TANZANIA Current outbreaks started in Dar es Salaam and then to Morogoro (August 2015). By 24th Feb 2016 most regions (except Njombe, Ruvuma and Mtwara) reported to have cholera outbreak. A total of 14,608 patients reported and 228 patients died.

MWANZA CHOLERA UP DATE 03/02/2016

MWANZA CHOLERA UPDATE

Common causes of cholera outbreak in Tanzania Inadequate safe water supply Areas without safe water supply are at high risk of encountering cholera epidemics; these include municipal areas with inadequately chlorinated piped water and rural areas without safe water

ct It has also been noted that most people in the areas affected by cholera epidemics do not have habits of boiling water or treating by to killing the bacteria and hence making water safe for drinking and other domestic uses. Leaking water pipes can also be easily infiltrated by dirty water from sewerage effluents and can contaminate water sources.

WATER CAN BE SOURCE OF INFECTION

Poor environmental sanitation and hygiene practices: Inadequate Latrines use Areas which have either insufficient number of latrines or with latrines that are not used or those who have overflowing latrines, contribute to the persistence of cholera epidemics in many areas. Improper waste Disposal Heaps of garbage, especially in urban areas, form a breeding ground for flies which contaminate food and thereby spread cholera and other infectious diseases.

FEACAL CONTAMINATION OF ENVIRONMENT

Ct: ENVIRONMENTAL SANITATION AND HYGIENE Poor personal hygiene Improper personal hygiene practices : improper washing hands with soap after visiting the toilet, before preparing foods, and before eating can contribute to the spread of the disease. Poor disposal of children’s excretion Handling children’s excreta without washing hands with soap predisposes to cholera epidemics

WASH HANDS BEFORE PREPARING FOOD

FLIES CAN TRANSFER VIBRIO CHOLERAE

CONTAMINATED FOOD

CHOLERA DEAD BODY TO BE BURRIED UNDER SUPERVISION OF H/O

S/S of Cholera Moderate Dehydration Loss of 5-10% body weight Normal BP Normal or rapid pulse Sunken eyes Dry mouth and tongue Increased thirst Drinks eagerly Skin goes back slowly after skin pinch Decreased tears

Severe Dehydration Cases Loss of more than 10% body weight Shock Low blood pressure Minimal or no urine Weak and rapid pulse Mouth and tongue very dry Sunken eyes Clouded mental status

Are we prepared for the cholera outbreak?