EPIDEMIC DISEASE

“Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae.By the start of the 20th century, there had been six major cholera pandemics. The world is now fighting its seventh, caused by a new strain of the Vibrio cholerae bacterium, El Tor.”-Wikipedia

Causes of cholera: Cholera is mainly caused by a toxin produced by the bacterium Vibrio cholerae. The bacterium is part of the flora of brackish water and estuaries - it's when this water gets into the drinking supply that an outbreak can start. It causes severe diarrhoea and vomiting, and patients, particularly children and the elderly, are vulnerable to dangerous dehydration as a result. An outbreak of cholera can spread quickly in areas where there is poor sanitation and where water supplies can be tainted. It's a common problem in disaster areas where water supplies are disrupted. Most people infected with cholera don't actually get ill. Despite this, they are contributing to the problem because the bacteria remain in their faeces for up to a fortnight. It's only rarely spread by person-to-person contact.

Treatment of cholera: Treating the condition, or rather alleviating the severe life-threatening effects, requires only simple measures. Normally, rehydration salts (mixed with clean water into a drink) are the only treatment given, although severely dehydrated patients may need intravenous fluids. However, the clean water and rehydration salts required are often in short supply in areas where they are needed most. Antibiotics can reduce the amount of diarrhoea. There are two oral cholera vaccines, but these are mainly aimed at travellers rather than wider use in a community stricken by the illness. Control of an epidemic is difficult in a community unless clean water supplies can be restored. Systems for hygienic disposal of human waste also need to be brought in. Cooking practices need to be made as safe as possible - where practicable, food needs to be cooked thoroughly and eaten while hot, and raw fruit and vegetables avoided unless they are peeled first. Hand-washing after going to the toilet and before preparing food is a vital measure to prevent the spread of the disease. Oral cholera vaccines are safe and effective but must not be considered as a substitute for basic preventative measures such as clean water and sanitation

Our country has nearly 30 National programs to eradicate many epidemic.There are certain guidelines given by WHO for control,they are as follows

Verification of diagnosis. Medical personnel first need to confirm the outbreak, take the necessary culture test ,find strain i.e prescence of the bacteria. Health communities identifies and notify cases and should inform local health authority.Early case findings makes treatment  easier rather than aggressive case. Establishment of treatment centers is necessary, especially in a country like India where more than 50% of the population is below the poverty line and cannot afford medical expense .Once cholera occurs rapid treatment is necessary because metabolic status gets altered.In case of mild dehydration oral dehydration fluid is sufficient. In case of high dehydration IV fluids are required.

My views:Epidemiological investigation is necessary.The most effective measure in fighting against cholera would be in taking sanitation measures as soon as outbreak occurs.Water control and usage of clean water is a necessity. Excreta disposal must be done to prevent spreading of bacteria and prevent multiplication. As food could also serve as a source of infection food sanitation is also necessary. But in all these preventive measures health education tops the list as only an educated mind would understand the complexity of the issue and take necessary action.
(Reference : Swathi Balasubramaniam, 3rd year M.B.B.S, Chettinad Medical College)