Cholera Ravaging Africa - What is Cholera?

The numbers are astounding, tens of thousands of victims in Zimbabwe in 2008 alone with totals reaching approximately 100,000 and over 4000 fatalities. And it's not just Zimbabwe, Mozambique, Malawi, South Africa, Nigeria and the list goes on and on. Most recently the nation of Cameroon reported over 400 cases in the northern area of the country since September including 65 deaths. The epidemic in Africa has been going on for decades and shows no sign of slowing.

Recent history shows during the 19th century, cholera spread repeatedly from its original reservoir or source in the Ganges delta in India to the rest of the world, before receding to South Asia. Six pandemics were recorded that killed millions of people across Europe, Africa and the Americas. The seventh pandemic, which is still ongoing, started in 1961 in South Asia, reached Africa in 1971 and the Americas in 1991. The disease is now considered to be endemic in many countries and the pathogen causing cholera cannot currently be eliminated from the environment. (from the World Health Organization website).

In the United States cases are sporadic usually due to consumption of seafood.

Cholera is an acute bacterial intestinal disease characterized by sudden onset, profuse watery stools (given the appearance as rice water stools because of flecks of mucus in water) due to a very potent enterotoxin. The enterotoxin leads to an extreme loss of fluid and electrolytes in the production of diarrhea. It has been noted that an untreated patient can lose his bodyweight in fluids in hours resulting in shock and death.

It is caused by the bacterium, Vibrio cholerae. Serogroups O1 and O139 are the types associated with the epidemiological characteristics of cholera (outbreaks).

The bacteria are acquired through ingestion of contaminated water or food through a number of mechanisms. Water is usually contaminated by the feces of infected individuals. Drinking water can be contaminated at the source, during transport or during storage at home. Food can get contaminated by soiled hands, during preparation or while eating.

Beverages and ice prepared with contaminated water and fruits and vegetables washed with this water are other examples. Some outbreaks are linked to raw or undercooked seafood.

The incubation for cholera can be from a few hours to 5 days. As long as the stools are positive, the person is infective. Some patients may become carriers of the organism which can last for months.

Cholera is diagnosed by growing the bacteria in culture. Treatment consists of replacement of fluids lost, intravenous replacement in severe cases. Doxycycline or tetracycline antibiotic therapy can shorten the course of severe disease.

There is an oral vaccine available in some countries but it is not available in the U.S.

Cholera prevention is the same as in other causes of traveler's diarrhea.