‘Environmental, personal hygiene help to prevent cholera outbreak’
As the outbreak of cholera occurs in many parts of Nigeria, with over 2000 people estimated to have died from the ailment, health professionals have reiterated that the best way to prevent the disease is by observing appropriate personal and environmental hygiene.
Describing cholera as an acute epidemic infectious disease that is characterised by watery diarrhoea, extreme loss of fluid and electrolytes, as well as severe dehydration, the medical experts said it is caused by the bacterium vibrio cholera and could be fatal, if not promptly treated.
They explained that the disease could lead to death in otherwise healthy adults and children within hours, although those who recover usually have long-term immunity against re-infection.
The Director, Ports Inspection National Agency for Food and Drug Administration and Control (NAFDAC), Prof. Samson Adebayo, said people should protect themselves against cholera by visiting hospitals any time they have symptoms, drinking only boiled water or from a sealed bottle and following good hand-washing practices.
He noted that the bacteria that cause the ailment usually thrive in damp, dirty linen and moist earth. They could also be found in the stools of patients with the disease.
He said: “They can also exist as colonies of biofilms that coat the surface of water, plants, stones, shells, and similar items, just like they can live among the eggs of midges, which serve as a reservoir. Toxic strains of cholera bacteria produce a poison that triggers violent diarrhoea in humans.
“When the bacteria enter areas where humans live, they could quickly cause severe epidemics. However, weather changes, population loss, and improved sanitation can all end an outbreak. Only around one in 20 persons infected by cholera experience severe form of the ailment, while a high percentage of infected people show no symptoms. Symptoms usually appear between 12 hours and five days after exposure. They range from mild or asymptomatic to severe.”
He explained that a person with cholera could quickly lose fluids of up to 20 litres a day. So, severe dehydration and shock can occur.
Signs of dehydration include loose skin, sunken eyes, dry mouth and decreased secretion, for example, less sweating, fast heart beat, low blood pressure, dizziness or lightheadedness, rapid weight loss. Shock can lead to collapse of the circulatory system, making it a life-threatening condition and a medical emergency.
He disclosed that cholera bacteria enter the body through the mouth, often in food or water that has been contaminated with human waste, due to poor sanitation and hygiene. They can also enter by eating seafood that is raw or not completely cooked, in particular shellfish native to estuary environments, such as oysters or crabs.
He said: “Poorly cleaned vegetables irrigated by contaminated water sources are another common source of infection. In situations where sanitation is severely challenged, such as in refugee camps or communities with highly limited water resources, a single affected victim can contaminate all the water for an entire population.
“When travelling to areas where the disease is endemic, it is important to eat only fruits that can be peeled. Avoid salads, raw fish, and uncooked vegetables. Ensure that food is thoroughly cooked. Avoid street food, as this can carry cholera and other diseases.
“Travellers should learn more about cholera outbreak before visiting a states or areas where it is prevalent. Individuals should seek medical attention immediately if they experience symptoms, such as leg cramps, vomiting, and diarrhoea while in a community where the disease exists.”
He explained that NAFDAC has been in the forefront of preventing cholera in Nigeria since the outbreak by supporting organisations that are providing medications for cholera patients, which has gone a long way in preventing the disease.
Dr. Omojowolo Olubumi, former President, Association of Resident Doctors (ARD) at Lagos University Teaching Hospital, Idi-Araba, Lagos, said a doctor might suspect cholera, if a patient has severe watery diarrhoea, vomiting, and rapid dehydration, especially if they have recently travelled to a place that has a recent history of cholera, or poor sanitation, or if they have recently consumed shellfish.
He said: “A stool sample will be sent to a laboratory for testing. But if cholera is suspected, the patient must begin treatment, even before the results come back. Tthe most important treatment is to give oral hydration solution (ORS), also known as oral rehydration therapy (ORT). The treatment consists of large volumes of water mixed with a blend of sugar and salts.
“Prepackaged mixtures are commercially available, but widespread distribution in developing countries is limited by cost. So, homemade ORS recipes are often used with common household ingredients.
Severe cases of cholera require intravenous fluid replacement. An adult weighing 70 kilograms will need at least seven litres of intravenous fluids.
“Antibiotics can shorten the duration of the illness, but the World Health Organisation (WHO) does not recommend the mass use of antibiotics for cholera, because of the growing risk of bacterial resistance. Anti-diarrheal medicines are not used because they prevent the bacteria from being flushed out of the body. With proper care and treatment, the fatality rate should be around one per cent.”
He explained that people most at risk of being infected include people who work in healthcare and treat individuals with cholera, relief workers who respond to cholera outbreaks, people who are travelling in areas where cholera can still be transmitted that do not follow hygiene and food safety precautions.
He said people who are at risk of a more severe reaction to cholera than others include people with achlorydia, a condition that removes hydrochloric acid from the stomach, individuals with blood type O, people who have chronic medical conditions, as well as those without access to ORT and other medical services.