Cholera - Q & A - Fact Sheet

Report
from UN Children's Fund
Published on 23 Oct 2019

Simon Lawson WCARO Cholera Consultant - nomadsimonuk@gmail.com

About cholera

1. What is cholera?
Basic: Cholera is an acute diarrheal disease that can, in severe cases, rapidly lead to dehydration – a loss of water from the body - and death if appropriate treatment – Oral Rehydration Therapy - is not provided immediately. It affects both children and adults and can kill within hours.

Detail: Cholera is caused by the bacterium Vibrio cholerae, which colonizes the small intestine and produces a toxin that leads to massive secretion of water and salts. This huge amount of fluid from the intestinal cells is much more than the intestine can reabsorb and so the fluid comes pouring out as watery diarrhoea. The loss of fluids is so great that the patient can quickly become severely dehydrated, go into shock, and die within a few hours. The diarrhoea fluid is teeming with huge numbers of the bacteria and these can rapidly spread to others, leading to epidemics.

How common is cholera?
According to WHO - there are an estimated 1.3 million to 4.0 million cases of cholera, and 21,000 to 143,000 deaths worldwide annually due to cholera.

2. Signs and Symptoms - What are the signs of cholera – what happens to you?
Symptoms can range from mild to very severe diarrhoea, sometimes with vomiting.

In severe cases, diarrhoea is copious - like rice-water - and very frequent and can cause dehydration, shock and death within a few hours – if left untreated.

This is usually without fever.

It takes between 12 hours and 5 days for a person to show symptoms after consuming contaminated food or water

Cholera can kill quickly through dehydration but rapid re-hydration treatment saves lives.

3. Does everyone infected with cholera show symptoms?
No, most people infected with cholera (about 75% or 3 out of 4) do not develop any symptoms, although the bacteria are present in their faeces and are shed (excreted) back into the environment, potentially infecting other people.

Among people who develop symptoms, the majority have mild or moderate symptoms, while a minority develop acute watery diarrhoea with severe dehydration. This can lead to death if left untreated.

4. Who is most susceptible?
Anyone can be infected with cholera - through drinking water or eating food contaminated with the cholera bacteria (germs) from the faeces (or vomit) of infected people.

Household contacts of cholera patients are at increased risk of developing the disease.

In areas where cholera is common, children aged <5 years have the highest rates of infection, but all age groups are at risk.

People with low immunity – such as malnourished children or people living with HIV – are at a greater risk of death if infected.

5. Why does cholera cause such rapid de-hydration?
Severe symptoms of cholera cause a rapid loss of body fluids through – copious and frequent diarrhoea with or without vomiting. The loss of fluids can be as much as 1 litre per hour leading to dehydration. These fluids contain minerals and salts needed for the body to function. (2.5% the fluid content of an adult man’s body / hour – a 5% loss can cause fatigue and dizziness - dehydration)

6. Why does Cholera kill so quickly?
The loss of minerals, salts and other vital chemicals through dehydration – stops the body functioning correctly.

Human beings need water for survival. Without water major body functions like circulation, excretion and respiration cannot take place. It is therefore critical that the water must be replaced quickly.

7. Why does Cholera kill so quickly, even in Health Centres?
If patients are very de-hydrated when they reach the Health Centre then it can be difficult to save them. Hence need for rapid re-hydration and treatment seeking.