Cholera

Cholera is an acute bacterial infection caused by the toxin-producing bacterium, Vibrio cholerae, and is transmitted by consumption of contaminated water. Infection usually progresses without symptoms, but can occasionally lead to severe diarrhoea, dehydration and death.

What is cholera?

Vibrio cholerae is a toxin-producing bacterium that causes cholera and affects all age groups. More than 2 serogroups have been described, but only 2 serogroups, O1 and O139, cause the cholera associated with the production of the cholera toxin. These 2 serogroups are responsible for the majority of epidemic flare-ups. The other serogroups are collectively called Vibrio cholerae non-O1, non-O139 or non-cholera vibrio and are rarely responsible for epidemics.

Symptoms

When infected by Vibrio cholerae O1 or O139, the infected person usually shows no symptoms (75% to 90% of cases) or mild diarrhoea. The disease can also take severe forms with profuse watery diarrhoea, vomiting and abdominal cramps resulting in severe dehydration and shock.

Vibrio cholerae non-O1 and non-O139 can be responsible for moderate forms of intestinal inflammation (gastroenteritis) but can also cause blood poisoning (sepsis) and wound infections.

Symptoms appear 12 hours to 5 days after infection.

Transmission

The biggest reservoir for the bacteria is man, as well as aquatic environments, such as seas, estuaries and brackish water. Infections with Vibrio cholerae occur via the fecal-oral route and usually result from the handling or consumption of contaminated seafood (raw or inadequately cooked), as well as direct exposure to contaminated water from the sea, an estuary or brackish water.

Prevention 

The infection is transmitted primarily through contaminated water and food. To prevent transmission, hygiene regulations must be strictly followed.

  • Wash and clean your hands:
    • after going to the toilet to prevent spreading
    • before cooking.
  • Cook  in a proper manner:
    • heat adequately, cook your food thoroughly
    • do not consume insufficiently cooked or raw seafood.
  • Use clean water and sanitation facilities. If these are not available, as may be the case when you are on holiday, for example, drink only water that you know has been boiled/disinfected first or bottled/canned soft drinks. Beware of ice cubes.

Diagnosis

The doctor takes a sample of the patient’s stool and sends it to a laboratory for culture (coproculture). If Vibrio cholerae is isolated in the stool, the diagnosis of cholera is confirmed.

Risk groups

Anyone can get cholera, but some vulnerable or weak people are at higher risk of the disease progressing severely due to dehydration. These are:

  • pregnant women
  • young and malnourished children
  • the elderly
  • immunocompromised people.

Treatment

Treatment of cholera initially consists of rehydration. Severe dehydration sometimes requires aggressive rehydration. Thereafter, maintaining an adequate fluid intake is important. In addition to hydration, the patient is also treated with antibiotics to shorten the duration of the disease and infectious phase.

Sciensano contributes to the epidemiological surveillance of cholera in Belgium. This is done in cooperation with laboratories and regional authorities.

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