Cholera Outbreak During Natural Disasters - Causes, Prevention, and Treatment

Cholera outbreaks are common after natural disasters such as floods and earthquakes due to damage to sanitation infrastructure. It  is an infectious disease that spreads through a bacteria found in water and food contaminated with a bacterium called vibrio cholerae. The Cholera bacteria causes acute diarrheal infection or acute watery diarrhea which in severe cases can lead towards death if not treated timely.

Cholera is common in regions where there is lack of access to safe drinking water and proper sanitation system. Unfortunately, Pakistan is among the countries where cholera is common. As per WHO, the disease is endemic in Pakistan. With the floods in the country, cholera along with other water borne diseases is spreading rapidly among flood affectees.

In this article we will discuss the causes of cholera, its symptoms and treatment as well as preventive measures that can be taken to avoid the cholera infection. We will also discuss cholera outbreaks during natural disaster especially floods.[MR1] 

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Causes of Cholera

Cholera is a disease that spreads through fecal-oral route which means that the disease is transmitted by fecal material passing into the mouth through contaminated or dirty water, food, and hands that are not properly washed.[MR2] 

You can get cholera if you:

  • Drink dirty water or any liquid which is contaminated with human fecal matter.
  • Eat food that is made with dirty water or which is contaminated with fecal matter brought by flies.
  • Eat vegetables or fruits that are grown with water having human waste.
  • Eat raw or undercooked fish or seafood that is caught from water contaminated with the sewage water.

Symptoms of Cholera

It takes cholera disease few hours or up to five days to show its symptoms when its germs enter the human body. Most cholera patients do not develop any symptoms or show very mild symptoms. ,The most common symptom of cholera is acute watery diarrhea accompanied by vomiting. Diarrhea and vomiting cause loss of water and electrolytes from the body, i.e., dehydration.

Dehydration is a very serious condition, if not treated immediately, it can lead to shock or death.

Symptoms of Dehydration are as follow:

  • Irritability or restlessness
  • Lethargy[MR3] 
  • Trouble in breathing
  • Sunken eyes
  • Rapid pulse
  • Thirst
  • Skin losing elasticity, i.e., when pinched, the skin does not go back to normal condition

Diagnosis

Cholera’s symptoms and signs are usually very clear, making it easy for doctors and health experts to diagnose it. However, to confirm the diagnosis and to detect cholera causing bacteria ‘stool culture test’ [MR4] is carried out. Different testing options are available in Pakistan, your doctor would recommend you a test depending on your condition.

Treatment

Cholera treatment is usually carried out in three steps,

i.              Rehydration

The first and the most important treatment for cholera is rehydration of the patient through oral hydration solution (ORS). If you have a patient at home who has diarrhea and is vomiting, give them ORS immediately. ORS can be bought from any medical store in packet form or can be made at home.

Making ORS at home[MR5] 

Making ORS at home is an easy process,

  • Boil water and cool it down,
  • Take one liter of water, 6 teaspoon of sugar, 1 teaspoon of salt and 1 lemon’s juice.
  • Mix all the ingredients together in a clean bottle, jug, or bowl.

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Recommended Amount of Oral Rehydration Therapy (ORS)

For adults and older children, 1 liter of ORS per hour is recommended till the symptoms reduce.. While for children, 20 ml/kg body weight per hour. For example, if the body weight of a kid is 8kgs, then they should be given 160ml of ORS per hour.

If the patient’s condition is not improving, they should be immediately taken to a hospital so their intravenous rehydration therapy (can be given drips) is started.

Note: It is not recommended to give diarrhea patients drinks with high sugar content like juices, soft drinks, or sherbets as they can worsen the symptoms. They should be given ORS, water, or broths.

  • Anti-Biotics

Anti-Biotics are given to patients with severe illness, along with rehydration therapy. Do not take any antibiotics without a doctor prescription.

  • Zinc Treatment

Zinc treatment is done for children with cholera. Zinc supplements should not be taken without a doctor’s recommendation.

Note: In areas with cholera endemic, governments give cholera vaccines to protect the population. If cholera is endemic in your area, check at the nearest public health facility if they are providing cholera vaccine.

Prevention of Cholera:

Cholera can be prevented by taking the following measures,

  • Drinking Safe Water

Cholera is mainly transmitted through contaminated water and food. To protect your family and yourself from cholera either boil water before drinking, filter water or use water purification tablets.

  • Eat Clean Food

You can take the following steps to ensure that the food you are taking is safe and would not make you sick

  • Avoid food whose source is unknown
  • Wash hands before preparing and eating food
  • Use clean water for preparing food
  • Wash fruits and vegetables properly with clean water
  • Peel fruits and vegetables before eating
  • Do not consume raw or undercooked fish or seafood
  • Avoid raw or undercooked meat
  • Do not drink unpasteurized milk
  • Eat freshly cooked and hot food
  • Cover cooked food properly to save them from flies
  • Follow Hand Hygiene

Wash your hands properly with soap after using the washroom or before every meal. Ensure that the water you are using for washing your hands is clean.

  • Follow General Hygiene

Following general hygiene is also extremely important to protect yourself from catching cholera. You can take following steps to ensure your and your family’s safety,

  • Wash your hands and face,
  • Brush your teeth regularly,
  • Cut your nails and clean them regularly,
  • Keep your surroundings clean.
  • Keep your house and surroundings clean

Keeping your house and surroundings clean is extremely important to prevent cholera and numerous other diseases,

  • Make sure your washroom is properly cleaned and disinfected regularly,
  • During spring and monsoon intensity of flies is high. They carry fecal matter that can cause cholera, make sure to properly insulate your house so flies cannot enter.

Cholera Outbreak After Floods - Safety and Precautions

Cholera and other disease outbreaks in the aftermath of floods or other natural disasters are commonplace. The reason for these outbreaks is lack of clean and safe drinking water, inadequate sanitation systems at camps, [MR6] and a lack of resources.

If you live in an area which is affected by flood, you can take the following measures to avoid cholera and other water-borne diseases.

 

 

Water Safety

  • Make sure to consume water only after boiling it properly or filtering it. If you do not have the resources to boil or filter water, request water purification tablets from the relief organizations working in your area.

Hand and personal hygiene

  • Wash your hands properly and regularly with soap and water, especially after using the toilet and before having any meal.

Use toilets and washrooms

  • If you have toilets available at your camp, keep them clean for your use and other people’s use.
  • Make sure that your toilets are set up away from freshwater resources and human waste does not mix with fresh or drinking water.
  • Do not defecate in open or near freshwater reservoirs, only use toilets if they are available.
  • If you are in a camp, bathe and wash clothes or diapers at least 100 feet away from drinking water sources to avoid contamination.

Food Safety

  • Do not eat food that has come in contact with flood water.
  • Do not consume food that is not fresh or has any kind of smell that indicates that it might be rotten.
  • Avoid raw or undercooked food, especially meat, chicken, or fish.
  • Wash fruits and vegetables with clean water and peel their skins before consumption,
  • Cover your food properly so flies cannot sit over it.

Get vaccinated

  • If your camp administrator or local authorities are offering cholera vaccine, do not hesitate and get vaccinated immediately.

Seek Medical Attention

If you have diarrhea or loose motions, start taking ORS immediately. If your diarrhea persists and you feel weaker, seek medical attention immediately. If medical staff is unavailable, keep taking ORS until you get the necessary help.

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 [MR1]Would that be good to keep the intro a bit short keeping some main info like why its important to know about Cholera after natural disaster, specially focusing on the recent flood?

 [MR2]Would it possible to simplify the language a bit? For example, anyone can get Cholera by drinking water or eating foods contaminated with Cholera bacteria? Some terminologies seem hard to ‘grasp like –facal-oral route,’.

 [MR3]Is ‘Tiredness’ more common than Lethergay ?

 [MR4]If we mention specific test name, do you think there is a possibility that the patient might only do the test rather going to doctor?

 [MR5]Any thought on how long the home made ORS can be preserved ?

 [MR6]Does it mean refugee camps?