Update on local outbreak
What is Cholera?
Cholera is an acute diarrheal illness resulting from an infection of the intestines by Vibrio cholerae. While some individuals may have mild or no symptoms; and can be treated with oral rehydration solutions (ORS), others may present with a severe watery diarrhea leading to dehydration and shock. Symptoms can appear within twelve hours or up to five days after ingesting contaminated food or water.
Cholera affects individuals of all ages and can be fatal if left untreated. (1)
Is South Africa facing a local outbreak?
The World Health Organisation (WHO) defines a cholera outbreak as the occurrence of at least one confirmed cholera case with evidence of local transmission in an area where cholera is not regularly found (1). As of 28 February 2023, the National Institute for Commutable Diseases (NICD) confirmed
six cases of cholera (including one death) in Gauteng province. The cases are all adults aged between 19 and 44 years old. Of the six cases, two were locally acquired, two were infected in Malawi, one case had direct contact with a Malawi case and one case is still under investigation. All cases were identified
as toxigenic Vibrio cholerae 01 serotype Ogawa that is susceptible to ciprofloxacin. (2) (3) According to the Gauteng Department of Health (DoH), the current outbreak is not linked to tap water, and they maintain that the water is safe to drink. (4)
How does it spread?
Cholera spread through ingesting food or water contaminated with Vibrio cholerae bacteria. The disease can spread rapidly in places with poor sanitations and inadequate treatment of drinking water. (5)
What are the complications of Cholera?
Cholera can cause complications especially if it is left untreated. Complications that arise from cholera include severe dehydration, electrolyte imbalances, kidney failure accompanied by shock and even death. Prompt diagnosis and treatment of cholera can help prevent complications and improve outcomes; it is important to seek medical attention if cholera is suspected. (6)
How is it treated?
Cholera can be effectively treated by administering ORS dissolved in one liter of clean water. While adults may need up to six liters of ORS, severely dehydrated patients may require intravenous (IV) fluids and appropriate antibiotics. Supplementation with zinc is also recommended for children. The use of antibiotics can shorten the duration of the disease. However, it is important to note that mass administration of antibiotics is not recommended as there is no evidence to suggest that it can prevent the spread of cholera. When treated promptly and properly, the fatality rate can be reduced to less than 1%. (1)
How can Cholera be prevented
Cholera is a deadly disease that requires a comprehensive approach to prevention and reduction of deaths. This includes measures such as surveillance, clean water, proper sanitation, hygiene, community engagement, treatment, and vaccination with oral cholera vaccines. Countries affected by cholera are urged to improve their disease surveillance and national readiness to quickly detect and respond to outbreaks. There are currently three WHO prequalified oral cholera vaccines available, but only one of them (Dukoral®) is registered in South Africa. (1) Dukoral® is used for the prevention of cholera for travelers (from two years of age) that are visiting high-risk areas. This medication requires a prescription and should be completed at least one week prior going to potential exposure. (7) In case of uncertainty about the safety of water, there are several methods to disinfect it but some of these methods need to be used with caution.
These include boiling, using filters, adding chlorine tablets, or using household bleach to ensure proper disinfection. When using bleach, two drops of household
bleach should be added for every liter of water, and one should wait for 30 minutes before drinking the water. Proper hygiene practices such as washing hands with soap and water after using the bathroom, before eating and when preparing food are essential to prevent cholera. If clean water and soap are not available, it is advisable to use an alcohol-based hand sanitizer with at least 60% alcohol. Lastly, it is recommended to avoid consuming raw or undercooked food to minimise the risk of cholera infection.(8)
Other countries facing an Outbreak
African countries that are currently experiencing an outbreak are Burundi, Zambia, Kenya, Malawi, Cameroon, Ethiopia, Mozambique, Democratic Republic of the Congo, and Nigeria. There are also some North American countries that are facing an outbreak, and these are Haiti and Dominican Republic. (9)
Key points to note
- Wash hands with soap and water
- Cook food thoroughly
- Drink safe and clean water
- Use safe sanitation facilities and safely dispose nappies
- Clean up safely and wash clothes separate from drinking water sources
If you have symptoms of cholera regardless of your travel history, it is important to visit the nearest health facility right away for screening and testing, early detection is crucial for successful treatment, in case the test results are positive. (10)
Healthcare workers and laboratorians across the country are encouraged to assess for cholera in people with acute watery diarrhea. (2)
References
- World Health Organization. Cholera [Internet]. Who.int. World Health Organization: WHO; 2022. Available from:
https://www.who.int/news-room/fact-sheets/detail/cholera. - Update | Outbreak of Cholera in South Africa (1 March 2023) [Internet]. NICD. 2023 [cited 2023 Mar 2]. Available from:
https://www.nicd.ac.za/update-outbreak-of-cholera-in-south-africa-1-march-2023/. - Health confirms sixth Cholera case | South African Government [Internet]. www.gov.za. [cited 2023 Mar 3]. Available
from: https://www.gov.za/st/speeches/health-confirms-sixth-cholera-case-2-mar-2023-0000. - Ellis E. INFECTIOUS DISEASE FLARE-UP: Cholera outbreak declared in Gauteng as sixth case identified [Internet].
Daily Maverick. 2023 [cited 2023 Mar 3]. Available from: https://www.dailymaverick.co.za/article/2023-03-01-choleraoutbreak-declared-in-gauten. - General Information | Cholera | CDC [Internet]. www.cdc.gov. 2020. Available from:
https://www.cdc.gov/cholera/general/#one.
MEDSCHEME HEALTH POLICY UNIT- CONTACT EMAIL (INTERNAL): HPUdrugs@medscheme.co.za
- CONTACT EMAIL (EXTERNAL): medschemedrugsubmissions@medscheme.co.za
- Mayo Clinic. Cholera – Symptoms and Causes [Internet]. Mayo Clinic. 2022. Available from:
https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-20355287. - Cholera Vaccine, Inactivated , Whole Cell. Available on https: //emguidance.page.link/NjFM.
- CDC. Five Basic Cholera Prevention Steps [Internet]. CDC. 2019. Available from:
https://www.cdc.gov/cholera/preventionsteps.html. - Cholera – Global situation [Internet]. www.who.int. Available from: https://www.who.int/emergencies/diseaseoutbreak-news/item/2023-DON437.
- MEDIA STATEMENT. Health Minister announces first Cholera death, as more cases detected in South Africa.
Departments of Health, Thursday, 23 February 2023.
Written by LifeAssist