Opeyemi defemi
A professor of Public Health, Ernest Achalu, discusses the causes, prevention and treatment of cholera in this interview with OPEYEMI ADEFEMI
How best can Cholera be described?
Cholera is an acute diarrhoeal disease caused by Vibrio cholerae bacteria. It is passed on from faeces through contaminated food, drinks and unhygienic environments, and it causes severe dehydration. This is caused by ingesting food or water that is contaminated with cholera bacteria, which causes profuse watery diarrhoea, vomiting, circulatory collapse, shock and even death. Cholera is widespread in areas with poor environmental sanitation, unsafe drinking water, poor sewage disposal and some other conditions that increase the risk of contracting cholera in the environment. Cholera is a very serious problem in a developing country like Nigeria.
How is it transmitted?
Cholera is transmitted by the consumption of contaminated food, water, vegetables and so on.
How easily can the transmission occur?
This disease can be easily transmitted. Consuming contaminated food without washing them will definitely lead to transmission. Also, when people don’t wash their hands after visiting the toilet and they go ahead to eat with that hand, they can get infected with cholera.
What are the symptoms of cholera?
The most important symptoms are profuse diarrhoea, the water-like kind of diarrhoea, vomiting, and cramps. It is important to note that not everyone with cholera comes down with severe symptoms; some of them are mild. The most serious symptom is shock, which results from the loss of water and salt from the body. If untreated, it can lead to the eventual death of the patient
Is it true that a cholera patient can fall into a coma?
Yes, it can happen because of the loss of excessive salt and water from the body.
What are the risk factors for cholera?
Living in areas characterised by poor sanitation, poor personal hygiene, lack of safe water, and poor treatment of sewage. Health workers taking care of cholera patients are also at risk, travellers who go visit areas where there is a cholera outbreak, Internally Displaced Persons, are all at risk. Generally, everyone, both adults and children, is at risk once exposed. Living in slums promotes cholera too. This is because regular water supply and toilet facilities are not available.
Will it be correct to describe cholera as a medical emergency?
Yes, it is a medical emergency. It can kill within hours if treatment is not given to the patient.
The incubation period simply means the time between infection and the appearance of symptoms. The incubation takes about two to three days after the actual infection. In some cases, it can range from a few hours to about five days before the manifestation of symptoms.
What is the prevalence rate in Nigeria?
We lack data on specific cholera prevalence in Nigeria. It spreads to various parts of the country.
How is cholera diagnosed?
It’s a single test of submitting one’s stool at the medical laboratory. A test will be done on the stool sample to check for the presence of Cholera bacterium.
How is cholera treated?
The treatment requires immediate replacement of water and salt that has been lost as a result of the diarrhoea. This is done by giving the patient what is called oral rehydration solution. This solution is usually a mixture of packaged salt and water, which can be diluted with one litre of water. That is part of the immediate treatment to replace lost water. This might require intravenous fluid replacement in the hospital or clinic. Also, cholera can be treated with antibiotics. It can be used to shorten the effect of the disease or the severity of the ailment.
Is cholera peculiar to people within a certain age bracket?
No, cholera is not age-bound. Everyone is susceptible to it. Both the old and young people. You know in any disease, younger people might be more vulnerable because of the lower resistance as well as older people. Generally, it affects everybody without regard to age, gender or even social status.
What happens if the patient does not seek treatment in time?
It might lead to shock and circulatory collapse and eventually death because the person might have lost too much water and salt, which are necessary for the functioning of the human body.
Is it possible to recover from the shock?
Yes, provided the patient gets immediate treatment by rehydrating the body of the patient with the use of antibiotics. Immediate response is very important.
What are the other complications of cholera?
Just like I have mentioned, vomiting, diarrhoea, and cramps. These are the major effects. Others include loss of water, shock and eventual death of the patient if left untreated or not attended to on time. It can also lead to circulatory collapse because of the volume of water lost. There are no other effects.
Once one gets infected and is nursed back to life, does it mean that the body is now immune to it?
There is no ultimate immunity to cholera. One can always get it as long as the person ingests anything contaminated with cholera. It’s possible for the immune system to do something when infected again because of previous sensitisation but there is no total immunity to it. However, there is the oral cholera vaccine that can be used to prevent a cholera outbreak.
Are there any side effects of the treatment options?
Not exactly but there could be because of the individual body’s response to treatment. There are no known side effects of the treatment.
What are the types of cholera vaccines that are available?
There are different types. There is the one called the oral cholera vaccine used to prevent cholera.
After being vaccinated, is there a need to take precautions or is one fully covered?
It doesn’t work that way. You must take the necessary precautions even after being vaccinated. One stands the chance of getting infected if one eats contaminated food. The vaccine does not confer permanent immunity. It is a temporary thing that requires a booster. Any reasonable person won’t do things that will increase the risk of getting infected.
How can an outbreak be contained?
Through surveillance. If there are reported cases it is good to take action immediately. There is a need to know to which extent the disease has spread, the cause and the source of the problem, especially at the community level. Chances should not be taken once there is an outbreak. It could be from water or poor environmental hygiene from farmers or individuals by not taking the necessary precautions, not washing their hands, not cooking their food properly and the like. Other practices that help prevent this infection are making sure one drinks safe water, getting water from hygienic sources, boiling water before drinking; avoiding tap water without boiling them.
What are the common misconceptions or superstitions about cholera?
At some level, people do not understand how the disease is transmitted so they can always attribute the symptoms to something else. You know that between the locals when there is a disease they feel like someone next door who was with them a few hours ago just suddenly started vomiting or stooling. They now feel like that uncle that visited them last week is the cause. If someone is healthy and after a few hours he just dies people will not think it’s caused by something physical. It is just a poor understanding of the disease.
Do you think that people are adequately informed about this disease?
I don’t think so because the government is not doing much at the grass-roots level. There is a need to help people health-wise, including creating awareness about epidemic diseases. The government is not doing much at the grassroots in terms of education. Cholera has been described as a disease of poverty because social risk factors play significant roles in its transmission.
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