{"id":3692,"date":"2024-11-12T07:55:49","date_gmt":"2024-11-12T07:55:49","guid":{"rendered":"https:\/\/en.codental.uobaghdad.edu.iq\/?p=3692"},"modified":"2024-11-12T07:55:49","modified_gmt":"2024-11-12T07:55:49","slug":"cholera","status":"publish","type":"post","link":"https:\/\/en.codental.uobaghdad.edu.iq\/?p=3692","title":{"rendered":"Cholera"},"content":{"rendered":"<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\"><strong>Key facts<\/strong><\/span><\/p>\n<ul style=\"text-align: justify;\">\n<li><span style=\"font-size: 18px;\">Cholera is an acute diarrhoeal disease that can kill within hours if left untreated.<\/span><\/li>\n<li><span style=\"font-size: 18px;\">Cholera is a disease of poverty affecting people with inadequate access to safe water and basic sanitation.<\/span><\/li>\n<li><span style=\"font-size: 18px;\">Conflict, unplanned urbanization and climate change all increase the risk of cholera.<\/span><\/li>\n<li><span style=\"font-size: 18px;\">Researchers have estimated that each year there are 1.3 to 4.0\u00a0million cases of cholera, and 21\u00a0000 to 143\u00a0000 deaths worldwide due to cholera\u00a0.<\/span><\/li>\n<li><span style=\"font-size: 18px;\">Most of those infected have no or mild symptoms and can be successfully treated with oral rehydration solution.<\/span><\/li>\n<li><span style=\"font-size: 18px;\">Severe cases need rapid treatment with intravenous fluids and antibiotics.<\/span><\/li>\n<li><span style=\"font-size: 18px;\">Provision of safe water and basic sanitation, and hygiene practices is critical to prevent and control the transmission of cholera and other waterborne diseases.<\/span><\/li>\n<li><span style=\"font-size: 18px;\">Oral cholera vaccines should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in areas known to be high risk for cholera.<\/span><\/li>\n<li><span style=\"font-size: 18px;\">A global strategy on cholera control,\u00a0<em>Ending cholera: a global roadmap to 2030<\/em>, with a target to reduce cholera deaths by 90% was launched in 2017.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\"><strong>Overview<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium\u00a0<em>Vibrio cholerae<\/em>. Cholera remains a global threat to public health and an indicator of inequity and lack of social development.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\"><strong>Symptoms<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Cholera is an extremely virulent disease transmitted through the ingestion of contaminated food or water. Cholera can cause severe acute watery diarrhoea and the severe forms of the disease can kill within hours if left untreated.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Most people infected with\u00a0<em>V. cholerae\u00a0<\/em>do not develop any symptoms, although the bacteria are present in their faeces for 1\u201310 days after infection and are shed back into the environment, potentially infecting other people.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Among people who develop symptoms, the majority have mild or moderate symptoms. It takes between 12 hours and 5 days for a person to show symptoms. A minority of patients develop acute watery diarrhoea with severe dehydration. This can lead to death if left untreated.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\"><strong>Epidemiology, risk factors and disease burden<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Cholera can be endemic or epidemic. A cholera-endemic area is an area where confirmed cholera cases were detected during the last 3 years with evidence of local transmission (meaning the cases are not imported from elsewhere). A cholera outbreak\/epidemic can occur in both endemic countries and in countries where cholera does not regularly occur.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities. Typical at-risk areas include peri-urban slums, as well as camps for internally displaced persons or refugees.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">The consequences of a humanitarian crisis \u2013 such as disruption of water and sanitation systems, or the displacement of populations to inadequate and overcrowded camps \u2013 can increase the risk of cholera transmission, should the bacteria be present or introduced. Uninfected dead bodies have never been reported as the source of epidemics.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">The number of cholera cases reported to WHO has continued to be high over the last few years. During 2023, 535\u00a0321 cases and 4007 deaths were reported to WHO from 45 countries. The discrepancy between these figures and the estimated burden of the disease is due to many cases not being recorded due to limitations in surveillance systems and fear of impact on trade and tourism.<strong><br \/>\n<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\"><strong>Treatment<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">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.\u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids. These patients are also given appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of\u00a0<em>V. cholerae<\/em>\u00a0excretion in their stool.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">All patients should begin to eat safely prepared, regular local food as soon as they can safely do so.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Breastfeeding should also be promoted.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Rapid access to treatment is essential during a cholera outbreak. Oral rehydration should be available in communities, including at specific oral rehydration points (ORPs), in addition to larger treatment centres that can provide intravenous fluids and 24-hour care. With early and proper treatment, the case fatality rate should remain below 1%.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Zinc is an important adjunctive therapy for children under 5, which also reduces the duration of diarrhoea and may prevent future episodes of other causes of acute watery diarrhoea.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Mass administration of antibiotics is not recommended, as it has no proven effect on the spread of cholera and may contribute to antimicrobial resistance.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\"><strong>Oral cholera vaccines<\/strong><\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Currently there are 3 WHO pre-qualified oral cholera vaccines (OCV): Dukoral\u00ae, Shanchol\u2122, and Euvichol-Plus\u00ae. All 3 vaccines require 2 doses for full protection\u00a0<em>(4)<\/em>. \u00a0<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Dukoral\u00ae is administered with a buffer solution that, for adults, requires 150 ml of clean water. Dukoral can be given to all individuals over the age of 2 years. There must be a minimum of 7 days, and no more than 6 weeks, delay between each dose.\u00a0 Children aged 2\u20135 years require a third dose. Dukoral\u00ae is mainly used for travellers. Two doses of Dukoral\u00ae provide protection against cholera for 2 years.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Shanchol\u2122 and Euvichol-Plus\u00ae have the same vaccine formula, produced by 2 different manufacturers. They do not require a buffer solution for administration.\u00a0 They are given to all individuals over the age of 1 year. There must be a minimum of 2 weeks delay between each dose of these 2 vaccines. Two doses of Shanchol\u2122 and Euvichol-Plus\u00ae provide protection against cholera for at least 3 years, while 1 dose provides short term protection.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Shanchol\u2122 is prequalified to be used in a controlled temperature chain, an innovative approach to vaccine management allowing vaccines to be kept at temperatures outside of the traditional cold chain of +2\u00b0C to +8\u00b0C for a limited period of time under monitored and controlled conditions.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Shanchol\u2122 and Euvichol-Plus\u00ae are the vaccines currently available for mass vaccination campaigns through the Global OCV Stockpile with the support of Gavi, the Vaccine Alliance.<\/span><\/p>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">Based on the available evidence, the<a href=\"https:\/\/www.who.int\/publications\/i\/item\/who-wer9234-477-500\">\u00a0<\/a><a href=\"https:\/\/www.who.int\/publications\/i\/item\/who-wer9234-477-500\">August 2017 WHO position paper on vaccines against cholera<\/a>\u00a0states that:<\/span><\/p>\n<ul style=\"text-align: justify;\">\n<li><span style=\"font-size: 18px;\">OCV should be used in areas with endemic cholera, in humanitarian crises with high risk of cholera, and during cholera outbreaks; always in conjunction with other cholera prevention and control strategies;<\/span><\/li>\n<li><span style=\"font-size: 18px;\">vaccination should not disrupt the provision of other high priority health interventions to control or prevent cholera outbreaks; and<\/span><\/li>\n<li><span style=\"font-size: 18px;\">more than 145 million doses of OCV have been used in mass vaccination campaigns since the creation of the stockpile. The campaigns have been implemented in areas experiencing an outbreak, in areas at heightened vulnerability during humanitarian crises, and among populations living in highly endemic areas, known as hotspots.<\/span><\/li>\n<\/ul>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\"><strong>\u00a0<\/strong><\/span><span style=\"font-size: 18px;\"><strong>References<\/strong><\/span><\/p>\n<ol style=\"text-align: justify;\">\n<li><span style=\"font-size: 18px;\">Updated global burden of cholera in endemic countries.Ali M, Nelson AR, Lopez AL, Sack D. (2015). PLoS Negl Trop Dis 9(6): e0003832. doi:10.1371\/journal.pntd.0003832.\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4455997\/\">https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4455997\/<\/a><\/span><\/li>\n<li><span style=\"font-size: 18px;\">The incubation period of cholera: a systematic review. Azman AS, Rudolph KE, Cummings DA, Lessler J. J Infect. 2013;66(5):432-8. doi: 10.1016\/j.jinf.2012.11.013. PubMed PMID: 23201968; PubMed Central PMCID: PMC3677557.\u00a0https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23201968<\/span><\/li>\n<li><span style=\"font-size: 18px;\">Cholera Annual Report 2023. Weekly Epidemiological Record, 9 September 2024, Vol 99 (36), (pp 481- 496). \u00a0<\/span><\/li>\n<li><span style=\"font-size: 18px;\">Cholera vaccines: WHO position paper \u2013 August 2017. Weekly Epidemiological Record 25 August 2017, No 34, 2017, 92, 477\u2013500.\u00a0<a href=\"http:\/\/apps.who.int\/iris\/bitstream\/10665\/258764\/1\/WER9234-477-498.pdf\">http:\/\/apps.who.int\/iris\/bitstream\/10665\/258764\/1\/WER9234-477-498.pdf<\/a><\/span><\/li>\n<\/ol>\n<p style=\"text-align: justify;\"><span style=\"font-size: 18px;\">5.<a href=\"https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cholera?gad_source=1&amp;gclid=Cj0KCQiA88a5BhDPARIsAFj595i2DSMd1A3UitPAiU84fZVC4ArTcSmzATDzYI4EBVm6ah0fiMfy-HMaAr6iEALw_wcB\">https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cholera?gad_source=1&amp;gclid=Cj0KCQiA88a5BhDPARIsAFj595i2DSMd1A3UitPAiU84fZVC4ArTcSmzATDzYI4EBVm6ah0fiMfy-HMaAr6iEALw_wcB<\/a><\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 20px;\">Asst Prof Dr Noor R. Al-Hasani<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 20px;\">The head of electronic health unit<\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 20px;\">12-11-2024<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key facts Cholera is an acute diarrhoeal disease that can kill within hours if left untreated. Cholera is a disease <a class=\"cz_readmore\" href=\"https:\/\/en.codental.uobaghdad.edu.iq\/?p=3692\"><i class=\"fa fa-angle-left\" aria-hidden=\"true\"><\/i><span>More<\/span><\/a><\/p>\n","protected":false},"author":11,"featured_media":3693,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[24],"tags":[],"class_list":["post-3692","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-e-health"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Cholera - College of Dentistry<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/en.codental.uobaghdad.edu.iq\/?p=3692\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Cholera - College of Dentistry\" \/>\n<meta property=\"og:description\" content=\"Key facts Cholera is an acute diarrhoeal disease that can kill within hours if left untreated. 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