BENEFITING: Partners In Health
Help health workers to take the necessary measures to contain an outbreak of cholera in Haiti.
cholera: epidemiology, Transmission, prevention and treatment.
Cholera has been confined to the Indian subcontinent until 1817. This date marks the beginning of the first cholera pandemic that has invaded Asia, the Middle East, and parts of Africa. Other pandemics have succeeded, having all of Asia as a starting point, reaching all continents and progressing more rapidly with the improvement of means of transport. We are currently in the 7th pandemic, part of Indonesia in 1961, invaded Asia (1962), then the Middle East and parts of Europe (1965), and then extended 1970 in Africa, and in 1991 in Latin America.
It is in Africa that the situation is more worrying now. The conflicts and mass movements of refugees promote epidemics: cholera are estimated to have killed 23,800 people in a few weeks in the camps of Rwandan refugees in Goma in July 1994 in the Congo. Many countries are regularly hit by devastating outbreaks of this disease, as now Zimbabwe.
Until 1992, Vibrio cholerae O1 was the only known agent of cholera. That year, a strain belonging to a new serogroup - O139 - occurred in India and Bangladesh. This vibrio is now responsible for outbreaks in several Asian countries and could be the cause of an eighth cholera pandemic.
The bacterium Vibrio cholerae is a highly mobile, modest nutritional requirements,which the man is the main reservoir. The disease results from the absorption of waterby mouth or contaminated food. Once in the intestine, the vibrios secrete includingcholera toxin, primarily responsible for the significant dehydration characteristic of infection: the loss of water and electrolytes can reach 15 liters per day. The man playsboth the role of culture medium and means of transportation for vibrio cholerae.Diarrheal stools released in large amounts are responsible for the spread of bacilli inthe environment and the fecal-oral transmission. In addition, the incubation periodenables the transport of vibrio over longer or shorter distances.
The main factors favoring the spread of infection are the socio-economic and living conditions of populations. High concentrations of population associated with poor hygiene play an important role in the onset and development of a cholera epidemic
The treatment is mainly to balance the digestive losses of water and electrolytes. Theimprovement that followed rehydration is noticeable after a few hours and recovery,without sequelae, is obtained in a few days.
Antibiotics may be helpful in severe cases, but the emergence of multidrug-resistantstrains of cholera vibrios to antibiotics limit the indication.
The general hygiene measures are essential in the fight against cholera, involving areal mobilization health outbreak and development of health education in countrieswhere cholera occurs regularly. But it is likely that this increased level of hygiene will not be realized for several decades in countries affected by cholera. It is thereforeabsolutely necessary to have a vaccine effective, safe and offer long lasting protection.