chelora training cfjkfjfilkgylhoplh8y.pptx

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1. Cholera

2. What is Cholera Intestinal infection Severe diarrhea Caused by Cholera bacterium, V ibrio cholera Diarrhea – 3 or more loose stools/24 hours

3. A life-threatening secretory diarrhea induced by enterotoxin secreted by V. cholerae Water-borne illness caused by ingesting water/food contaminated

4. Transmission Contaminated food or water Inadequate sewage treatment Lack of water treatment Improperly cooked shellfish Transmitted by fecal-oral route Endemic in areas of poor sanitation

5. Con…. Transmission is usually through the fecal-oral route of contaminated food or water caused by poor sanitation.  Most cholera cases in developed countries are a result of transmission by food, while in the developing world it is more often water Food transmission can occur when people harvest seafood,

6. Symptoms Occur 2-3 days after consumption of contaminated food/water Usually mild, or no symptoms at all 75% asymptomatic 20% mild disease 2-5% severe Vomiting Cramps Watery diarrhea (1L/hour) Without treatment, death in 18 hours-several days

7. Con,,,,,,,,,, More severe symptoms Rapid loss of body fluids 6 liters/hour Rapidly lose more than 10% of bodyweight Dehydration and shock Death within 12 hours or less Death can occur within 2-3 hours

8. Consequences of Severe Dehydration Intravascular volume depletion Severe metabolic acidosis Hypokalemia Cardiac and renal failure Sunken eyes, decreased skin turgor Almost no urine production

9. History Causative Agent Discovery John Snow (1813-1858): Water borne transmission of Cholera (1855)

10. Discovery Filippo Pacini (1812-1883) 1854: Cholera reaches Florence, Italy. Pacini discovers causative agent

11. Discovery Robert Koch (1843-1910) 1884: Rediscovers Vibrio cholerae

12. Epidemiology Responsible for seven global pandemics over the past two centuries Common in India, Sub-Saharan Africa, Southern Asia Very rare in industrialized countries

13. Con,,,,

14. Diagnosis Cholera should be suspected when patients present with watery diarrhea, severe dehydration Based on clinical presentation and confirmed by isolation of vibrio cholera from stool

15. People Most at Risk People with low gastric acid levels Children: 10x more susceptible than adults Elderly

16. Period of Communicability During acute stage A few days after recovery By end of week, 70% of patients non-infectious By end of third week, 98% non-infectious

17. Incubation Ranges from a few hours to 5 days Average is 1-3 days Shorter incubation period

18. Treatment Even before identifying cause of disease, rehydration therapy must begin Immediately because death can occur within hours* Oral rehydration Intravenous rehydration Antibiotic therapy

19. Treatment: Oral Rehydration Reduces mortality rate from over 50% to less than 1% Recover within 3-6 days Should administer at least 1.5x amount of liquid lost in stools Use when less than 10% of bodyweight lost in dehydration

20. T reatment: Oral Rehydration Salts (ORS Reduces mortality from over 50% to less than 1% Packets of Oral Rehydration Salts Distributed by WHO, UNICEF Dissolve in 1 L water NaCl , KCl , NaHCO 3 , glucose

21. Treatment: Intravenous Rehydration Used when patients have lost more than 10% bodyweight from dehydration Unable to drink due to vomiting Only treatment for severe dehydration

22. Treatment: Intravenous Rehydration Ringer’s Lactate Commercial product Has necessary concentrations of electrolytes Alternative options Saline Sugar and water

23. FLUID THERAPY Ringer lactate solution is preferred over normal saline because it corrects the associated metabolic acidosis IV fluids should be restricted to patients who purge >10 ml/kg/h & for those with severe dehydration

24. Oral antibiotics Norfloxacin 400 mg PO bid for 3 days. Do not to exceed 800 mg/day. Or Erythromycin 40 mg/kg PO divided TID for 3 days. Or Co- trimoxazole 960 mg PO BID for 3 days Recommended antibiotics – taken orally Doxycyclin – Not for children - Adult: 300 mg by mouth in one dose Cirprofloxacin – not for children - Adult: 500 mg bid 3/7 Erythromycin – For Pregnant patients and children: 500 mg 4 times a day for 3 days, 48mg/kg/24 hrs tds x3/7(for children).

25. Prevention Disrupt fecal-oral transmission Water Sanitation Water treatment Health educatuion Improved environmental sanitation Improved personal hygiene

26. Con,,,,,,,, Early identification and case management. Active surveillance and prompt reporting. Water supply: Ensure a safe water supply (especially for municipal water system). Improve sanitation and sewage disposal. Making food safe for consumption by thorough cooking of high risk foods especially seafood and protecting it against flies

27. Health education through mass media: Insisting on: Importance of purifying water and cooking seafood. Washing hands after using the toilet and before food preparation. Recognition of the signs of cholera and location where treatment can be obtained to avoid delays in cases of illness

28. References Thaker V.V. Cholera. www.emedicine.com/ped/topic382.htm Last updated May 1, 2006. Todd W.T.A., Lookwood D.N.J., Nye F.J., Wilkins E.G.L and Carey P.B. infection and immune failure (cholera); Davidson’s principles and practice of medicine, 19th edition, chapter 1, page 44. Sack D.A., Sack R.B., Nair G.B and Siddique A.K. Cholera; The Lancet, January, 17, 2004. 363 (9404): 223-233. Butterton J.R. Approach to the patient with vibrio cholerae infection. www.UpToDate.com Version 13.1; Last updated: January 27, 2004. Barker D.J.P and Hall A.J. Investigation of epidemics; Practical epidemiology.4 th edition