Cholera powerpoint presentation of community health nursing

1. CHOLERA
SUBMITTED TO:
SUSHMA CHARLEY
MA`AM
NSG TUTOR
CON,IGIMS
800014
SUBMITTED BY:
GEETA KUMARI
ROLL.NO.-13
BSC NSG 2
ND
YR
(2020-2024)

2. INTRODUCTION
Cholera,isaGreekword,whichmeansthe
gutteroftheroof.Itiscausedbybacteria
vibriocholerae,whichwasdiscoveredin
1883byRobertKochduringdiarrhea
outbreakinEgypt.
Vcholeraehas2majorbiotypes:classical
andElTor,whichwasfirstisolatedinEgyptin
1905.Currently,ElToristhepredominant
cholerapathogen.

3. Theorganismisacomma-shaped,gram-
negative,aerobicbacilluswhosesizevariesfrom
1-3mminlengthby0.5-0.8mmindiameter.
VIBRIO CHOLERAE
Instainedmucusflakesofcholeracases,the
vibriosarearrangedinparallelrows,describes
byKOCHasthe`FISHINSTREAM `
appearance.

4. V.CHOLERAE

5. •SIGNS AND SYMPTOMS
1.There is abrupt onset of vomiting and
purging of large amounts of rice water
stools (up to 1L/h).
2. Thirstiness
3. Sunken eyes and cheeks .
4. Tachycardia.
5.Hypotension, Oliguria, Muscular cramps,
convulsions , coma , apathy, atrophy.

6. Since1817,therehavebeen7cholera
pandemics.Thefirst6occurredfrom1817-1923
andwerecausedbyVcholerae,theclassical
biotype.ThepandemicsoriginatedinAsiawith
subsequentspreadtoothercontinents.
EPIDEMIOLOGY
TheseventhpandemicbeganinIndonesiain
1961andaffectedmorecountriesand
continentsthantheprevious6pandemics.It
wascausedbyVcholeraeElTor.

7. InOctober1992,anepidemicofcholera
emergedfromMadras,Indiaasaresultofanew
serogroup(0139).
ThisBengalstrainhasnowspreadthroughout
Bangladesh,India,andneighboringcountriesin
Asia.
Someexpertsregardthisasaneighth
pandemic.
EPIDEMIOLOGY/2

8. REPORTED CASES
The number of cholera patients worldwide is
uncertain because most cases go unreported.
Thenumberofcasesisincreasedduring
epidemics&isaffectedbyenvironmental
factors.

10. AGENT FACTORS
Resistance:-v. cholerae are killed within
30 minutes at 56 deg.C, or few sec. by
boiling
Remain in ice for 3-4 weeks or longer
Drying & sunshine will kill them in few
hours
Disinfectant kill them also

12. RESERVOIR OF INFECTION
Human is the only known reservoir of
cholera infection
The ratio of severe cases to mild ones is
shown to be 1:5 for classical type & 1:25
for EL Tor

13. TRANSMISSION
Cholera is transmitted by the fecal-oral route
through contaminated water & food.
Theinfectiousdoseofbacteriarequiredto
causeclinicaldiseasevarieswiththesource.If
ingestedwithwaterthedoseisintheorderof
10
3
-10
6
organisms.Wheningestedwithfood,
fewerorganismsarerequiredtoproduce
disease,namely10
2
-10
4
.
Person to person infection is not
so common.

14. Vcholeraeisasaltwaterorganism&itis
primaryhabitatisthemarineecosystem.
Cholerahas2mainreservoirs,man&water.
Animalsdonotplayaroleintransmissionof
disease.
Vcholeraeisunabletosurviveinanacid
medium.Therefore,anyconditionthatreduces
gastricacidproductionincreasestheriskof
acquisition.
TRANSMISSION/2

15. CLINICAL PICTURE
Incubation period is 24-48 hours.
Symptomsbeginwithsuddenonsetofwatery
diarrhea,whichmaybefollowedbyvomiting.
Feveristypicallyabsent.
Thediarrheahasfishyodorinthebeginning,
butbecamelesssmelly&like“ricewater”in
fewhours.
Inseverecasesstoolvolumeexceeds250
ml/kgleadingtoseveredehydration,shock&
deathifuntreated.

16. CHOLERA IN CHILDREN
Breast-fed infants are protected.
Symptoms are severe & fever is frequent.
Shock, drowsiness & coma are common.
Hypoglycemia is a recognized complication,
which may lead to convulsions.
Rotavirus infection may give similar picture.

17. Management
The primary goal of therapy is to replenish
fluid losses caused by diarrhea & vomiting.
Fluid therapy is accomplished in 2 phases:
rehydration and maintenance.
Rehydrationshouldbecompletedin4
hours&maintenancefluidswillreplace
ongoinglosses&providedailyrequirement.

19. FLUID THERAPY
Ringerlactatesolutionispreferredover
normalsalinebecauseitcorrectstheassociated
metabolicacidosis.

20. DRUG THERAPY
Thegoalsofdrugtherapyaretoeradicate
infection,reducemorbidityandprevent
complications.
Thedrugsusedforadultsinclude
tetracycline,doxycycline,cotrimoxazole&
ciprofloxacin.
Forchildrenerythromycin,cotrimoxazole
andfurazolidonearethedrugsofchoice.

21. DRUG THERAPY/2
Drugtherapyreducesvolumeofstool&
shortensperiodofhospitalization.Itisonly
neededforfewdays(3-5days).
Drugresistancehasbeendescribedinsome
areas&thechoiceofantibioticshouldbe
guidedbytheseresistancepatterns.
Antibioticshouldbestartedwhencholerais
suspectedwithoutwaitingforlabconfirmation.

22. PREVENTION
Education on hygienic practices.
Provision of safe, uncontaminated water to
the population.
Antibiotic prophylaxis to house-hold
contacts.
Vaccination against cholera.

23. PREVENTIVE MEASURES

25. CHOLERA VACCINES
Theoldkilledinjectablevaccineisobsolete
nowbecauseitisnoteffective.
Two new oral vaccines became available in
1997. A Killed & a live attenuated types.
Both provoke a local immune response in
the gut & a blood immune response.
Cholera vaccination is no more required
for international travelers coz risk is small.

26. Currently there are three WHO pre-qualified
oral cholera vaccines (OCV): Dukoral®,
Shanchol™, and Euvichol-Plus®. All three
vaccines require two doses for full protection.
Dukoral®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.
Children aged 2 -5 require a third dose.
Shanchol™and Euvichol-Plus®have the
same vaccine formula, produced by two
different manufacturers. They do not require
a buffer solution for administration. They are
given to all individuals over the age of one
year. There must be a minimum of two
weeks delay between each dose of these
two vaccines

27. WHO Guidelines
Step (1) : Assess degree of dehydration
Step (2) : Rehydrate the patient &
monitor signs frequently
Step (3): Maintain hydration
Step (4): Administer oral antibiotics to
patient with severe dehydration
Step (5): Feed the patient
:-

28. CONTROL MEASURES

29. Steps of epidemic control
Verification of the diagnosis
Early case finding & tracing source of
infection.
Establishment of treatment centers
Notification of the case to MOH & WHO.
Isolation & barrier nursing is indicated

30. PROGRAMMES
1.Theregionalcholeraplatformunitesthemain
regionalWASH(water,sanitationandhygiene)
andhealthactorsinvolvingthefightagaint
cholera.
2.The“shieldandsword”concept,acommon
languageforaproactive,cross-orderand
multi-disciplinarystrategytopreventthespread
ofcholera.
3.Choleradayiscelebratedon23rdSeptember.

31. KEY MESSAGE
Achieving national commitment from
water, sanitation and hygiene
(WASH) and health stakeholders to
strongly engage in comprehensive
strategies to eliminate cholera.

32. SUMMARY
Introduction
Sign and symptoms
Epidemiology
Distribution
Factors
Reservoir of infection
Transmission
Management
Preventive measures
WHO guidelines
Control measures
Programs and Key message

33. BIBLIOGRAPHY
BT Basavanthappa
Shyama D mala
I Clement
www.wikipedia.org
www.who int
scholar.google co.in

34. THANKS FOR
YOUR
ATTENTION
roe