Chapter 1-Introduction to Cholera D.pptx

Chapter 1-Introduction to Cholera D

1. Introduction to Cholera Disease Ethiopian Public Health Institute Public Health Emergency Management Bacterial Diseases Surveillance and Response Dr.Balkew (EPHI) April 23/ 2023 Adama, Ethiopia

2. Activity 1.1. Self-reflection 15 minutes Instruction: Read the following summary of cholera report in Ethiopia and answer the following questions (on your participant manual page) Question: 1.What comes in your mind when you hear cholera? 2.Why do you think the frequent occurrence of cholera outbreak in Ethiopia?

3. Outline What is Cholera? Etiology Reservoir Mode of transmission Risk factor Clinical characteristics

4. Enabling Objective After completing this chapter, the training participants will be able to: 1)Describe cholera disease, etiologic agent, and reservoir. 2)Describe mode of transmission. 3)Identify risk factors and clinical features of cholera disease.

5. Epidemiology of Cholera in Ethiopia Since 2015 Ethiopia was affected by cholera outbreaks every year. The first epidemic of this period started in late 2015 (in Oromia and Somali Regions) and spread throughout the country in 2016. In 2016, a total of 30,718 suspected cases were reported across all regions except Gambela. This epidemic continued into 2017 with a total of 47,540 suspected cases, of which 75% of suspected cases were reported from Somali Region.

6. Cont.. Following the massive epidemic in 2017, case numbers drastically decreased, with 3,024 cases reported in 2018 (mostly in Afar and Tigray Regions) and 2,535 cases in 2019 (primarily in Oromia and Afar Regions).

7. Cont.. Case numbers again increased in 2020, with 14,612 cases reported that year (77% of cases were reported from SNNP Region). In 2021, a total of 983 suspected cases were reported, with nearly all cases reported from either Oromia or SNNP Regions.

8. Current Situation Totally 40 woredas from Oromia,Somali and SNNP have been affected by the current outbreak since August 27,2022 . Currently there is an active cholera outbreak in 33 woredas ( 18 from Oromia , 2 from Somali and 5 SNNPR ) .

9. As of April 21,2023 A Total of 4790 cases(AR of 118.6/100,000 Oromia region & Somali region) with 73 total death with CFR of 1.7%. Totally 35 CTCs have been established in Oromia (24) & Somali (4) & SNNP (7) and 5 CTUs are established. ORPs at HFs are functional at all affected woredas.

10. Cholera affected woreda since August 2022

11. Cholera Cholera is an acute diarrheal disease caused by ingestion of food or water contaminated with the bacterium vibrio cholera. Cholera remains a global threat to public health and an indicator of inequality and lack of social Development.

12. Cholera.. Etiology : There are over 100 vibrio species known but only the “cholerae” species are responsible for cholera epidemics. Vibrio cholerae species are divided into 2 serogroups Vibrio cholerae O1 & Vibrio cholerae O139 Both biotypes subdivided into Classical and El Tor biotypes

13. Cholera

14. cholera The three serotypes can co-exist during an outbreak This does not affect the epidemic pattern: Clinical features are similar, whatever the strain Regardless of the strain, the response is the same. Vibrios grow easily in saline water and alkaline media. Survive at low temperatures but do not survive in acid media

15. Cholera Reservoir: Humans are the main reservoir of vibrio cholerae Water V. Cholerae can live for years in some aquatic environments Some molluscs fish and Aquatic plants

16. Cholera Transmission Cholera is transmitted by the fecal-oral route Contaminated water or food Corpses of cholera patients Cholera treatment centers can become main sources of contamination if hygiene and isolation measures are insufficient Fruit and vegetables grown at or near ground level and fertilized with night soil (human excreta) and then eaten raw!

17. Feco -oral rout

18. Cholera Common source_ Water Contaminated at its source Shallow wells, surface water Contaminated in the home / after storage When inadequately washed hands come in contact with stored water If wash utensils in contaminated water If bathe in contaminated water

19. Cholera Common source_ food Moist grains served at room temperature or lightly heated Moist food is excellent environment for growth of V. Cholerae Acidifying foods inhibits growth of V. Cholerae with lemons, tomatoes, yogurt or fermented milk

20. Cholera Risk Factors Poor social and economic environment, precarious (risky) living conditions associated with: Insufficient water supply (quantity and quality) Inappropriate and poor sanitation and hygiene practices Inadequate food safety (from preparation to table) - High population density: camps, slum populations, internally displaced people (IDP) are highly vulnerable. - Conflict/War affected areas

21. Cholera Risk factor Inadequate quantity and/or quality of water Inadequate personal hygiene Poor washing facilities Inappropriate or poor sanitation Inappropriate funeral services for cholera corpus

22. Activity 1.3 Think Pair –Share(10m) Instruction: Think and discuss the following questions with your neighboring trainee for 5 minutes and share your ideas within 5 minute. Question: The incubation period of cholera? Describe the sign and symptoms of cholera patient?

23. Cholera Clinical Features_ Pathogenesis: The large majority of ingested bacteria are destroyed by stomach acidity surviving bacteria colonize intestinal cells, where they multiply and produce a very powerful enterotoxin That causes profuse watery diarrhea by a secretion mechanism. The toxin adheres to intestinal cells and causes an excretion of isotonic fluid in the intestinal lumen: it is the enterotoxin that causes fluid loss and diarrhea.

24. Cholera Incubation Period and Period of Infectivity The incubation period is usually 1 to3 days but can range from several hours to 5 days. Symptoms usually last 2 to 3days, although in some patients they can continue up to 5 days. Infected persons whether they are symptomatic or not, can carry and transmit vibrios during 1 to 4 weeks Antibiotic therapy can decrease the duration of symptoms and the period of infectivity.

25. Cholera Signs and Symptoms Of the people infected with cholera Around 75% have no symptoms Around 20% have mild or moderate diarrhea (which can produce dehydration) Around 5% have severe diarrhea, vomiting, and severe dehydration

26. Cholera The case-fatality rate in untreated cases may reach 30–50% if there is not prompt treatment. Treatment is straightforward (basically rehydration) If treatment is applied appropriately the case-fatality rate can be minimized to below 1%.

27. Cholera Symptomatic cholera: Acute watery diarrhea(AWD) Profuse, "rice water" stools No fever, no abdominal cramps Vomiting and leg cramps common It is usually odorless or has a mild fishy smell. People with a severe case of cholera can pass one liter of stool per hour or more, and leads to dehydration.

28. Dehydration Can lose up to 10% of body weight Fluid losses up to 1 liter / hour Must replace fluids and electrolytes to avoid hypovolemic shock, renal failure and death.

29. Figure 1. Signs of severe dehydration Sunken eyes, lethargy and slow recall of skin

30. Cholera “Rice water" stool

31. Cholera Key cholera prevention and control measure Surveillance: Early detection and containment of cases Risk factor identification .. Proper case management: Reduce CFR Establish CTC/CTU as soon as possible in affected community Conduct OCV camping : helps in controlling the outbreak

32. Cholera Water and sanitation improvements Construct latrines Construct above-ground sewage tanks (e.g., in urban areas) Distribute safe water (e.g., water delivery by truck) Distribute point-of-use water purification tools (e.g., AquaTabs ) Improved water storage containers (e.g., containers with narrow mouths or spigots) Flocculation-disinfectant powder sachets Filtered water using cloth Monitor Free chlorin residual (FCR) at point of consumption

33. Cholera Use community leaders, teachers, broadcast and print media to tell messages: Hand washing with soap after defecation or cleaning an infant’s bottom Hand washing with soap before handling food, eating, or breastfeeding Boiling water before drinking or using it in cooking Safe food preparation and storage practices Breastfeeding infants