Signs and Symptoms
Signs and symptoms: usually start immediately (1-5 days after the ingestion of the bacterium). Dehydration and
electrolyte imbalance can start within a few hours of the onset of profuse diarrhea and vomiting if not aggressively
treated.
• profuse watery diarrhea and vomiting (large amounts of ‘rice water’ diarrhea)
• dehydration (caused by other symptoms)
• electrolyte imbalance (also caused by diarrhea and vomiting)
Transmission/Cause
Cholera is a bacterial infection caused by the bacterium Vibrio cholera (serogroup O1 or O139). The toxins of the bacterium
cause and infection of the small intestine which leads to the disease. Young children or those who already have
a weakened immune system are more susceptible.
Mechanism of the Disease
When the living bacteria are ingested, the few that make it through the stomach and to the small intestine will attach
to the intestinal walls and start producing a toxin. The toxin is what causes the symptoms of watery watery diarrhea
which then carries multiplying bacteria out of the individual making it available to contaminate other water sources
and lead to further cases if proper sanitation is not in place. The secreted toxin will, through mechanisms too in depth
to explain here, cause Chloride and Sodium ions to be pumped into and accumulate in the small intestine, creating a
salt-water environment in the intestines. This will, through osmosis, cause large amounts of water to be pulled into
the intestines, leading to profuse diarrhea. The host can become rapidly dehydrated if an appropriate mixture of dilute
salt water and sugar is not taken to replace the blood’s water and salts lost in the diarrhea (explained more in
depth below).
Prevention
With proper sanitation methods, Cholera is extremely preventable. The main reason why cholera is so prevalent in
many developing countries is due to their lack of sanitation, which is often due to a lack of education and training of
the people. Cholera epidemics can easily be stopped if proper sanitation procedure are known and followed. Some
methods of prevention are…
•Sterilization: All fecal matter and anything that contacts it should be disposed of or washed in hot water using chlorine
bleach. Any person who handles a contaminated person should thoroughly wash their hands with chlorinated
water (or any other anti-microbial agent).
•Awareness: People in the area should be warned of possible cholera contamination of water sources and informed
how to decontaminate water before consumption (boiling or chlorination, etc.)
•Sewage: Sewage should be treated with anti-microbial treatment (chlorine, ozone, UV light, etc.) before it enters into
contact with possible water sources.
•Water Purification: All water used for drinking, washing, or cooking should be sterilized by either boiling, chlorination,
ozone water treatment, ultra violet light sterilization (e.g. by solar water disinfection), or anti-microbial filtration
in any area where cholera may be present. Chlorination and boiling are often the least expensive and most effective
means of halting transmission. Cloth filters, though very basic, have significantly reduced the occurrence of cholera
when used in poor villages that rely on untreated surface water. Better anti-microbial filters like those present in advance
individual water treatment hiking kits are most effective. To be even more careful, bottled water may be consumed
instead.
•Educate: Public health education and adherence to appropriate sanitation practices are of primary importance to
help prevent and control transmission of cholera and other diseases. This includes good hand washing practices, and
washing hands often, especially after working with ids who may not wash hands well after defecating, etc. It is a
good practice to wash with some sort of anti-microbial after washing hands with soap well. Also, it is best to keep
hands out of your mouth to prevent possible contaminants from being ingested.
•Water: Shower/bath water and other water sources (lake, rivers, ocean, etc). Any water that comes into contact with
your body has to potential to be contaminated. It is important to keep your mouth should and avoid any water from
being ingested. Small amounts should not cause infection in a healthy adult, but it is best to attempt not to ingest any
questionable water. Flood water should be avoided if possible as it will often carry runoff waste and is more likely to
be contaminated.
•Vaccines: There are a few vaccines to help prevent Cholera, however none of them are currently recommended for
otherwise healthy adults by the Center of Disease Control (CDC) or Passport Health (a medial agency that specializes
in world travel).
Treatment
•Oral Rehydration Therapy: ORT is extremely effective in treat Cholera and is easy to administer. The main reason
why this is not used in many developing countries is that there is a lack of education about ORT and therefore they
do not do it. ORT helps treat dehydration. Commercially produces oral rehydration solution may be used, but if not
available, they can be easily made. Most recipes also add in a mashed banana to ass flavor and help replenish potassium
which may decrease as rehydration occurs. You may need to administer up to 10% the person’s body weight in
fluid within the first 2 to 4 hours, and continued large amounts will need to be given until diarrhea has subsided. The
salt and sugar in the solution will help equalize the salt and sugar which have been pulled into the intestines and will
therefore help prevent water from being re-absorbed into the intestines to be excreted, allowing for better rehydration
that simply drinking water.
•Antibiotics: Antibiotics can (and should if possible) be administered for the first 1 to 3 days to shorten the course of
the disease and decrease the severity of the symptoms, however, with proper hydration, the individual should recover
without them, Possible antibiotics that have been shown to be effective are: Doxycycline (most common for the
first line of defense), cotrimoxazole, erythromycin, tetracycline, chloramphenicol, and furazolidone.
Prognosis
If treated quickly and properly, the mortality rate is less than 1%; however, if not treated, the mortality rate rises 50-
60%.
How does this apply to your trip?
While there is a fairly significant outbreak of cholera in Haiti currently, it should not be a reason to keep Americans
our of the country. The outbreak is largely due to the fact that there is not sufficient water sources for many of the
Haitians to get drinking water. Because they cannot afford any other water and do not have access to it, many Haitian,
especially in the more rural villagers are having to resort to the only water that they have, the contaminated water.
Many of the villages do not have any sort of filtration system and their sanitation practices are habitually very
poor. One of the main reasons why there has been such a large spread of the disease is the fact that, when a case is
discovered, many people in the village are leaving and going to where other relatives live, bringing the bacteria along
with them, and further contaminating the water sources of near-by villages.
However, our teams will be exposed to much less danger of cholera. Recently, a well has been dug providing our
own personal source of water for the camp a surrounding village. Furthermore, the camp has also gotten a filtration
system which provides sanitation to the water. Therefore, you will have clean drinking water. However the showers
don’t get the same kind of filtration and so it would be good to prevent swallowing water if possible.
Pack plenty of anti-microbial hand sanitizer to use on a regular basis to ensure no contamination of hands which
could potentially contaminate food that enters the mouth. It is extremely important to keep your hands as clean a
possible. All the food will be prepared by specific Haitians that the Vlacins know and have trained to prepare sanitary
food. It is recommend that seafood be avoided as it can actually have come from contaminated water and therefore,
be contaminated.
While these practices should prevent any cases of Cholera, if for some reason you feel like you are starting to get any
of the symptoms, it is vital that you tell one of the trip leaders. With early notice, we can treat the symptoms and
hopefully prevent other on the team from getting it too.
Sources
Center for Disease Control (CDC)
World Health Organization (WHO)
Passport Health
Wikipedia: http://en.wikipedia.org/wiki/Cholera
