Friday, March 23, 2018

Cholera Epidemic in Nepal

Introduction

ü Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae.
ü An estimated 3-5 million cases and over 100,000 deaths occur each year around the world.
ü The infection is often mild or without symptoms, but can sometimes be severe.
ü Approximately one in 10 (5-10%) infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

Sign and symtoms

Pic: Symptoms of Cholera


How to diagnose

      Isolation and identification of Vibrio cholerae serogroup O1 or O139 by culture of a stool specimen remains the gold standard for the laboratory diagnosis of cholera.
      Cary Blair media is ideal for transport, and the selective thiosulfate–citrate–bile salts agar (TCBS) is ideal for isolation and identification.
      In areas with limited to no laboratory testing, the Crystal VC® dipstick Rapid testcan provide an early warning to public health officials that an outbreak of cholera is occurring. However, the sensitivity and specificity of this test is not optimal. Therefore, it is recommended that fecal specimens that test positive for V. cholerae O1 and/or O139 by the Crystal VC® dipstick be confirmed using traditional culture-based methods suitable for the isolation and identification of V. cholerae.


Vibrio cholera culture



In Nepal

      The first recorded cholera epidemic took place in 1823, followed by a series of epidemics occurring in the Kathmandu Valley in 1831, 1843, 1856, 1862, and 1887.
      The first scientific report on cholera in Nepal was published in May of 1886.
      Most of the laboratory-based surveillance or outbreak reports indicated that V. cholerae 01 El Tor Ogawa is endemic in Nepal.
      The studies also describe the seasonal nature of cholera in the country with most cases reported during the rainy, or monsoon season, which starts in June and usually ends by October.
      More recently, during the 2014 monsoon, a cholera outbreak was reported in Rautahat. The outbreak, during which more than 600 people were affected, was laboratory confirmed to be cholera
      It has been estimated that nearly 20% of the population of Nepal is at risk for infection by V. cholerae  
       It is critical that Nepal improves its outbreak preparedness by strengthening its early warning and response system, expanding health education, increasing its case management readiness, ensuring the adequate distribution of rehydration supplies, and giving consideration to the provision of the oral cholera vaccine in high risk communities.  


Treatment

      Cholera is an easily treatable disease. The majority of people can be treated successfully through prompt administration of oral rehydration solution (ORS). The WHO/UNICEF ORS standard sachet is dissolved in 1 litre (L) of clean water. Adult patients may require up to 6 L of ORS to treat moderate dehydration on the first day
Most common ORS Name among Nepalese


Prevention and Control

      The recent establishment of an antimicrobial sentinel surveillance systemacross the country that includes the identification of cholera, along with plans for use of the WHO stockpile cholera vaccine, are significant steps in the development of a cholera response system.
      In a country which can only spend 2% of its domestic GDP on public health, however, there is a need for external support to fully develop an effective cholera prevention and control program.
      Creating an integrated and efficient response to cholera outbreaks in Nepal will involve the engagement and commitment of policy decision-makers, public health administrators and managers, and health care professionals.
      The control of cholera is eminently possible with the tools and knowledge available today, and the growing interest among health officials in introducing the oral cholera vaccine and expanding water and sanitation education.  
      Keeping hands clean through improved hand hygiene is one of the most important steps we can take to avoid getting sick and spreading germs to others.



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Hi, I’m Chakra, the man behind GITAB | Knowledge Hub, from Lumbini (Born place of Lord Buddha) Nepal. I am a student of Microbiology. Feel free to say hello via Fb, Twitter & Chakra's Blog.

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