Cholera ppts

Cholera disease

1. INTRODUCTION Cholera is an acute diarrheal illness caused by infection of the intestine with the bacteria Vibrio cholerae. Cholera  is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated.

2. INCIDENCE Cholera has become an increasing public health concern around the world. It kills an estimated 95,000 people each year and infects 2.9 million more

3. DEFINITION Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium  Vibrio cholerae. It is spread by ingestion of contaminated food or water. The infection is often mild or without symptoms, but sometimes it can be severe and life threatening.

4. INCIDENCE

5. AGENT V cholerae is comma-shaped, gram-negative aerobic or facultative anaerobic bacillus bacillus that varies in size from 1-3 µm in length by 0.5- 0.8 µm in diameter

6. Its antigenic structure consists of flagellar H antigen somatic O antigen Bacteria are easily destroyed by coal tar disinfectants such as cresol and bleaching powder.

7. The vibrios multiply in the lumen of the small intestine and produce an exotoxin (enterotoxin).

8. HOST FACTORS Age: Children: 10x more susceptible than adults, And Elderly also higher susceptible. Sex: Equal in both male and female. Immunity: Less immune higher risk. People with low gastric acid levels Blood types O>> B > A > AB.

9. Highest in the lower socioeconomic groups. Movement of population(pilgrimages, marriages, fairs and festivals) results in increased risk of exposure to infection.

10. ENVIRONMENTAL FACTORS Contaminated water and food. Certain human habit favoring water and soil pollution. Low standard of personal hygiene. Lack of education and poor quality of life.

11. INFCTIVE MATERIAL The immediate source of infection are the stools and vomit of cases & carriers.

12. INCUBATION PERIOD From a few hours up to 5 days, but commonly 1-2 days.

13. MODE OF TRANSMISSION Feacally contaminated water. Contaminated food and drinks Direct contact.

14. Rare in developed countries Common in Asia, Africa, & Latin America Poor sanitary conditions Contaminated seafood, even in developed countries. Especially shellfish. People with low levels of stomach acid Such as children, older adults, and some medications. Reasons aren't entirely clear Twice more likely Raw or undercooked food Hypochlorhydria Type O blood RISK FACTORS

15. VIRULENCE &PATHOGENICITY Ingestion of V. cholerae Resistant to gastric acid Colonize small intestine Virulence of Non-toxigenic V. cholera O1 strain not well understood

16. Enterotoxin binds to intestinal cells Chloride channels activated Release Large quantities of electrolytes & bicarbonates Fluid hypersecretion Diarrhea D e h y d r ation Secrete enterotoxin

17. CLINICAL MENIFESTATIONS Cholera is an extremely virulent disease that can cause severe acute watery diarrhea. It takes between 12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water  . 90 % of ER tor Cholera cases are mild.

18. Usually mild, or no symptoms at all 75% asymptomatic 20% mild disease 2-5% severe Vomiting Cramps – profuse, painless diarrhea and vomiting of clear fluid. "rice water" (1L/hour) >20 mL/kg during a 4-hour observation period Without treatment, death in 18 hours-several days

19. TYPICAL RICE WATER DIARRHOEA

20. CHOLERA SICCA Cholera sicca is an old term describing a rare, severe form of cholera that occurs in epidemic cholera. This form of cholera manifests as ileus and abdominal distention from massive outpouring of fluid and electrolytes into dilated intestinal loops .

21. Mortality is high, with death resulting from toxemia before the onset of diarrhea and vomiting. The mortality in this condition is high: Because of the unusual presentation, failure to recognize the condition as a form of cholera is common

22. 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 & need to be excluded.

23. CONSEQUENCES OF SEVERE DEHYDRATION Intravascular volume depletion Severe metabolic acidosis Hypokalemia →cardiac arrest low blood sugar (hypoglycemia) Seizures coma , especially in the young Cardiac and renal failure Sunken eyes, decreased skin turgor Almost no urine production

24. DIAGNOSIS EVALUATION Stool specimen. Confirm presence of cholera toxin by culture Cholera Rapid Test Dipsticks. Additional tests

25. STOOL SPECIMEN

26. OTHER LAB FINDINGS Dehydration leads to high blood urea & serum creatinine. Hematocrit & WBC will also be high due to hemoconcentration. Dehydration & bicarbonate loss in stool leads to metabolic acidosis with wide-anion gap. Total body potassium is depleted, but serum level may be normal due to effect of acidosis.

27. CHOLERA RAPID TEST In areas with limited or no laboratory testing, the  Crystal ®  VC  dipstick rapid test can provide an early warning to public health officials that an outbreak of cholera is occurring. However, the sensitivity and specificity of this test is not optimal. Therefore, it is recommended that fecal specimens that test positive for  V. cholerae  O1 and/or O139 by the Crystal ®  VC dipstick always be confirmed using traditional culture-based methods suitable for the isolation and identification of  V. cholerae.

28. SE ROLOGICAL TESTS Slide agglutination test : Picking up suspected colonies and make suspension in 0.85 % sterile saline . Add one drop of polyvalent anti-cholera diagnostic serum. If agglutinin is positive , the test is repeated with Inaba and Ogawa antisera.

29. NOTIFICATION Cholera is a notifiable disease locally and nationally. Since 2005 cholera notification is no longer mandatory internationally. Cholera is notifiable to the WHO within 24 hours of its occurrence by the national government . The number of cases and deaths are also to be reported daily and weekly till the area is declared free of cholera.

30. TREATMENT

31. REHYDRATION

32. REHYDRATION PHASE The goal of the rehydration phase is to restore normal hydration status, which should take no more than 4 hours. Set the rate of intravenous infusion in severely dehydrated patients at 50-100 mL /kg/hr . Lactated Ringer solution is preferred over isotonic sodium chloride solution because saline does not correct metabolic acidosis

33. MAINTAINENCE PHASE The goal of maintenance phase is maintain normal hydration status by replacing ongoing losses. The oral route is preferred , the use of ORS at a rate of 500-1000 ml/hr. Fluids should never be restricted.

34. SIGN OF DEHYDRATION No dehydration (<5 percent) Some dehydration (5-10 percent) 2 or more of the following signs? sunken eyes absence of tears dry mouth and tongue thirsty and drinks eagerly Goes back slowly(< 2 sec) Oral Rehydration If NO If YES 2 or more of the following signs? lethargic, unconscious or floppy unable to drink radial pulse is weak Goes back very slowly(>2 sec) If YES Severe dehydration (>10 percent) If NO Age Amount After Loose Stool < 24 mo 50-100 mL 2-9 y 100-200 mL >10 y As much as is wanted Age < 4 mo 4-11 mo 12-23 mo 2-4 y 5-14 y >15 y Weight < 5 kg 5-7.9 kg 8-10.9 kg 11-15.9 kg 16-29.9 kg >30 kg ORS solution in mL 200-400 400-600 600-800 800-1200 1200-2200 2200-4000 ORS solution to give in the first 4 hours If improv e

35. Treat Severe dehydration in cholera younger than 1 year 100 mL/kg IV in 6 hours older than 1 year + adult 30 mL/kg in the first hour then 70 mL/kg in the next 5 hours. 30 mL/kg as rapidly as possible (within 30 min) then 70 mL/kg in the next 2 hours. Fluids should never be restricted . maintained intravenously with RL Total amount per day RL+ORS = 200 ml/kg during the first 24 hours + Administer ORS solution (about 5 mL/kg/h) as soon as the patient can drink, in addition to IV fluid. Continue to reassess at least every 4 hours; radial pulse should be strong and Bld pressur should be normal. goal of the rehydration phase is to restore normal hydration status, must be less than 4 hours The goal of maintenance phase is to maintain normal hydration by replacing ongoing losses . 100 mL/kg IV in 6 hours Conti n ue monitor

36. CRITERIA FOR HOSPITAL DISCHARGE After receiving therapy of adequate hydration, patients that fulfill these three criteria can be discharged of the hospital: Adequate oral intake Normal urinary flow (40-50 cc by hour) Maximum diarrhea flow of 400 cc per hour

37. ANTIBIOTIC TREATMENT Antimicrobial therapy is useful for prompt eradication of the Vibrio diminish the duration of diarrhea decrease the fluid loss. Antibiotics should be administered to moderate or severe cases

38. ZINK THERAPY

39. ISOLATION Case should be quickly removed from homely environment . Local schools, community buildings, mobile hospital under tents are the places to be converted into temporary treatment centers. Isolation is necessary till the patient is no longer infectious.

40. PREVENTION & CONTROL Ending Cholera: The Global Roadmap to 2030 Five Basic Cholera Prevention Steps How Family Members Can Prevent Infection Infection Control for Cholera in Health Care Settings Chemoprophylaxis. Vaccines

41. ENDING CHOLERA: THE GLOBAL ROADMAP TO 2030 Ending Cholera—A Global Roadmap to 2030  operationalises the new global strategy for cholera control at the country level and provides a concrete path toward a world in which cholera is no longer a threat to public health. By implementing the strategy between now and 2030, the Global Task Force on Cholera Control (GTFCC) partners will support countries to reduce cholera deaths by 90 percent. With the commitment of cholera-affected countries, technical partners, and donors, as many as 20 countries could eliminate disease transmission by 2030.

42. FIVE BASIC CHOLERA PREVENTION STEPS Drink and use safe water. Wash hands often with soap and safe water.  Use latrines or bury feces (poop); do not defecate in any body of water.  Cook food well (especially seafood), keep it covered, eat it hot, and peel fruits and vegetables. . Clean up safely—in the kitchen and in places where the family bathes and washes clothes

43. HOW FAMILY MEMBERS CAN PREVENT INFECTION Drink and use safe water Cook food thoroughly Wash hands with soap and safe water after caring for the patients, and especially after handling fecal matter Remove and wash any bedding or clothing that may have had contact with diarrheal stool, preferably in a washing machine, in warm or hot water. Usual machine detergents are sufficient; bleach is not necessary. Use a flush toilet or approved septic system; double bag soiled materials when discarding in trash. bathroom, bedpan, as soon as possible after being soiled.

44. When possible, use rubber gloves when cleaning any room or surface that may have had contact with the patient’s fecal matter. Patients with cholera should not swim while ill with diarrhea or for 2 weeks after resolution of symptoms. If a household member develops acute, watery diarrhea, administer oral rehydration solution (ORS) and seek healthcare immediately

45. Use any household disinfectant or a 1:10 dilution of bleach solution (1 part bleach to 9 parts water) to clean any area that may have contact with fecal matter, including the patient’s. While caring for persons who are ill with cholera, do not serve food or drink to persons who are not household members Visitors can be allowed if the ill person wants company; visitors should also observe hand hygiene recommendations

46. INFECTION CONTROL FOR CHOLERA IN HEALTH CARE SETTINGS Healthcare providers should take precautions to prevent the spread of cholera in clinical setting. Hand washing with soap and clean water. If no water and soap are available, use an alcohol-based hand cleaner. Several chlorine solutions can be used for disinfection such as 2% chlorine, 0.2% chlorine, 0.05% chlorine.

47. VACCINATION(ORAL VACCINE)

48. DUKORAL cholera and travellers' diarrhea vaccine (oral, inactivated). 3 ml single dose vials. works by introducing very small amounts of dead cholera bacteria and nontoxic components of cholera toxin into the body. This allows the body to make antibodies against the bacteria. Not licensed for Childeren aged < 2 years.

49. SANCHOL It is bivalent cholera vaccine. Vaccine should be administered orally in 2 liquid doses 14 days for individuals aged >1 year. Booster dose is recommended after 2 years.

50. VAXCHORA VAXCHORA is a vaccine indicated for active immunization against disease caused by Vibrio cholerae serogroup O1 . VAXCHORA is approved for use in adults 18 through 64 years of age traveling to cholera-affected areas. The safety and effectiveness of VAXCHORA have not been established in immunocompromised persons.

51. CHOMEOPROPHYLAXIS It is advised only for household contacts or of a closed community in which cholera has occurred. Tetracycline is the drug of choice . 3 day period in BD of 500 mg for adults, 125 mg for children aged 4-13 years, 50 mg for age0-3 years.