1. What are the potential causes?
October
Doctor reports 4 cases of acute watery diarrhoea with severe dehydration in last 24 hours
Gradual increase in admissions with watery diarrhoea in last 5 days
Abrupt onset profuse watery diarrhoea with vomiting and fever
Is this an outbreak?
What are the potential causes?

2. October 25
Health cluster meeting: 2 other districts report 40 deaths form diarrhoea since 20 October
Case definition?
How will you confirm cause of the outbreak?
What outbreak control measures are needed?

4. What outbreak control measures are needed?
Case management
Logistics
Infection Prevention and Control
Health education

5. Case management

7. Case management Cholera treatment centre
Cholera cots – plastic sheeting – buckets
Fluids
Treatment:
Oral IV
Antibiotics
Train health workers

8. Logistics
Supplies
IV fluids
Giving sets
Specimen containers

9. Infection Prevention and Control
Soap and water
Handwashing stations
Chlorination of piped and tankered water
Latrines

10. Health education
Handwashing
Safe food
Safe water
Funerals

11. a high case fatality rate?
8 November
9971 cases reported
643 deaths
Actual number of cases could be much higher
Why is there such
a high case fatality rate?

12. High Case Fatality Rate
Lack of knowledge: public, healthcare staff
Delays in accessing health care
Large numbers of cases
High infective dose with rapid onset
Poorly trained staff
Inappropriate treatment
Poor triage mechanisms
Lack of supplies

13. What are the potential sources?
Importation from cholera endemic area
International staff
Imported food:
?seafood

14. UN military base Battalion of Nepalese soldiers arrived early October
Raw sewage discharged to river
Water used downstream for cooking, drinking, bathing
90% of cases in first 5 days along bank of river
No reported cases among UN military

15. Kathmandu 23 September 2010: Cholera outbreak reported
DNA fingerprinting and genotyping

17. Spread to Dominican Republic, USA, Mexico, Venezuela, Cuba