1. CHOLERA UP DATE :

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

3. 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

4. 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.

5. 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

6. 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)

7. 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

8. 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

9. 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.

10. REFUGE

11. 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

12. 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%

13. AFRICA

14. MAGNITUDE OF CHOLERA IN TANZANIA
The first epidemic 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 with 18,526 cases and 2,173 deaths with Case fatality Rate %.
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%.)

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

16. 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.

17. MWANZA CHOLERA UP DATE 03/02/2016

18. MWANZA CHOLERA UPDATE

19. 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

20. 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.

21. WATER CAN BE SOURCE OF INFECTION

23. 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.

24. FEACAL CONTAMINATION OF ENVIRONMENT

26. 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

27. WASH HANDS BEFORE PREPARING FOOD

28. FLIES CAN TRANSFER VIBRIO CHOLERAE

29. CONTAMINATED FOOD

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

31. 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

32. 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

33. Are we prepared for the cholera outbreak?