Cholera

INTRODUCTION
Cholera is an acute watery diarrheal disease caused by infection of the intestine with the gram-
negative bacteria Vibrio cholerae, either type O1 or O139. Both children and adults can be
infected. It is one of the key indicators of social development and remains a challenge to
countries where access to safe drinking water and adequate sanitation cannot be guaranteed.
Cholera is an acute diarrheal infection caused by consuming contaminated food or water

by Vibrio cholerae, which can result in rapid dehydration and death. It affects both children and
adults and can kill within hours if left untreated, though children under the age of five account
for half of all cholera deaths [1–3].
Scientific literature indicates that consuming food or water contaminated with Vibrio
cholerae can infect the majority and cause severe acute watery diarrhea between 12 hours and 5
days. Even though most people can become infected, the majority of infected individuals do not
develop symptoms. Only 20% of them will develop the signs and symptoms, and a minority
(10% to 20%) will develop acute watery diarrhea [1, 4].
Globally, in 2015 approximately 2.65 million new cases (range from 1.3 million to 4.0 million)
and approximately 82,000 deaths (range from 21,000 to 143,000) every year have been occurred
worldwide due to cholera [2].
In Africa from 15 countries; there are 120,652 cholera cases and 2436 deaths have occurred. The
most estimated number of cholera cases are in West Africa around 40% cholera cases, in East
Africa and Horn of Africa approximately 32% cholera cases, and 28% in central and middle
Africa. The most death occurs the continent was central and middle Africa (43.4%), in West
Africa approximately 37.5% of deaths occurred and the rest 19.1% occurred in East Africa and
the Horn of Africa
A different study reported from various regions about the cholera outbreak showed that the total
cases ranged between 25 to 36,154 cholera cases and around 246 deaths in Ethiopia. This burden
of the diseases was gradually increased from year to year [4, 5].
Though the infectious disease is quite serious due to rapid spread and has burdensome of death,
only limited studies have been conducted in the world and specifically in Ethiopia. On the other
hand, most of the studies conducted in Ethiopia were limited to some zones and maximum region
[5,6,7].
There are over 100 vibrio species known but only the “cholerae” species are responsible for
cholera epidemics. Vibrio cholerae species are divided into 2 serogroups: Vibrios grow easily in
saline water and alkaline media. They survive at low temperatures but do not survive in acid
media. They could be destroyed by gastric acid in the stomach, by chlorine disinfectant solutions
or boiling at least for one minute.
Cholera case Definition
Community case definition
Suspected cholera case If any person of 2 years age or more with profuse acute watery diarrhea
and vomiting.
Standard case definition
Suspected cholera case Outbreak not declared: any person aged 2 years or more presenting with
acute watery diarrhea and severe dehydration or dying from acute watery diarrhea. Outbreak
declared: any person aged 2 years or more presenting with or dying from acute watery diarrhea.
Confirmed cholera case A suspected case in which Vibrio cholera O1 or O139 has been isolated
from their stool
Mode of Transmission
Cholera is transmitted by the fecal-oral route. A dose of more than one million organisms is
usually needed to cause illness. Cholera is transmitted almost exclusively by contaminated water
or food. Transmission by contact, such as touching patients is rare. Water may be contaminated
at its source. Surface water and water from shallow wells are common sources of infection.
Vibrio cholerae can live for years in certain aquatic environments. Water is frequently
contaminated at home when inadequately washed hands come in contact with stored water.
Bathing or washing cooking utensils in contaminated water can also transmit cholera. Moist
grains, such as rice, millet, or sorghum, when served at room temperature or lightly warmed, are
common vehicles for cholera transmission. Moist foods lightly contaminated
Risk Factors
■ Poor social and economic environment, precarious (risky) living conditions associated with:
■ Insufficient water supply (quantity and quality)
■ Inappropriate and poor sanitation and hygiene practices
■ Inadequate food and safety - this includes cultural influences on food preparation and storage
at home, poor food safety during preparation and storage, inadequate/lack of food safety in
markets and restaurants and by street vendors.
■ High population density: camps, slum populations, internally displaced people (IDP) are
highly vulnerable.
■ Conflict/War affected areas (due to distraction of WASH infrastructures, poor food safety) are
very high risk for cholera outbreak/Epidemic
■ Underlying diseases such as malnutrition, chronic diseases and AIDS are thought to increase
susceptibility to cholera, but this has not been proven.
■ Unimmunized people
■ Environmental and seasonal factors: Cholera epidemics often start at the end of the dry season
or at the beginning of the rainy season, when water sources are limited
Human susceptibility
Human susceptibility
A variety of host factors influence human susceptibility to cho-lera. Gastric hypoacidity has been
associated with the risk of cholera, an observation not unexpected in view of the well-known
acid sensitivity of V. cholerae [39]. Less well understood from a mecha- nistic point of view is
the observation that the risk of severe cholera is influenced by ABO blood group. Studies have
shown that individuals with group O are at highest risk, those with group AB are at intermediate
risk, and those with groups A or B are at lowest risk. Recently, in vitro studies have
demonstrated a more potent effect of cholera toxin in inducing cAMP in enteric cells of humans
with blood group O than in those of humans with blood group A [40]. Interestingly, these
relationships apply to the risk of El Tor biotype cholera but not classical biotype cholera [41,42].
Based on these observations, and the additional observation that the population prevalence of
blood group O in the Ganges delta is among the lowest in the world, it has been proposed that
cholera has acted to influence natural selection in human evolution in this region

Cholera

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INTRODUCTION

Cholera is an acute diarrheal infection caused by consuming contaminated food or water

Cholera case Definition

Community case definition

Standard case definition

■ Insufficient water supply (quantity and quality)

■ Inappropriate and poor sanitation and hygiene practices

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