Cholera is characterized by a sudden and overwhelming onset of diarrhea, in the form of abundant and frequent bowel movements. It is caused by the bacterium Vibrio cholera, which infects the lining of the small intestine. Cholera symptoms may occur no earlier than a few hours after exposure or up to five days later. It can last from one to two days or up to a week. Additional symptoms may include vomiting and stomach cramps. Cholera, given its potentially serious and harmful impact, is considered virulent. An extreme loss of body fluids can also lead to dehydration and shock. In the worst cases, death can occur within two days.
People are infected with cholera by coming into contact with body matter, such as vomiting and feces, which has been infected by the bacterium. The infection can also spread through contaminated food and water sources. The spread of cholera can occur wherever there is a lack of sanitation, especially when people live in close contact with one another. Extremely high risk situations include slums and refugee camps. Eighty percent of cholera victims contract the mild or moderate form of the infection. Twenty percent of those infected, meanwhile, experience cholera of the most virulent variety.
The severe dehydration associated with the most virulent cholera is what kills people, not the infection itself, which normally takes its course in a few days. If kept adequately hydrated, less than one percent of cholera victims die. The conditions that cause the spread of cholera, such as overcrowding, are also found in environments where clean water or medical care is extremely scarce. Given the appropriate conditions, cholera outbreaks can reach epidemic proportions.
In the countries of our world where cholera is endemic, mainly in sub-Saharan Africa, 1.3 billion people are likely to be infected today. Among these, children are the most vulnerable. In 2013, for example, the World Health Organization released an official count of almost 130,000 cases of cholera, which included outbreaks in Haiti and the Dominican Republic, in addition to those in Africa. This does not take into account the estimated percentage of 90 of the cases worldwide that are not reported. The estimated total incidence of cholera annually is anywhere between 1.4 and 4.0 million people. On the upside of the 100,000 deaths from cholera are reported each year, and until countries 67 have reported cholera within a reference period of one year.
Cholera can be diagnosed by laboratory tests on stool samples. However, time and access to facilities are often not available to do so in the most affected places. Alternatively, the symptoms are evaluated in consideration of the environmental conditions, as well as the particular clinical history of each patient, in order to carry out an informed diagnosis and a subsequent treatment plan for cholera patients. Cholera prevention mainly includes environmental measures and vaccination. Piped and treated water supplies, more sanitary latrines and waste disposal systems, significantly reduce the risk of exposure to the cholera bacterium.
Two vaccines are also available to prevent the onset of symptoms from the bacterium. Dukoral protects from cholera for up to six months, while Shanchol is effective at 65 percent of cases up to five years later. Mass vaccination campaigns have proven to be very successful in preventing cholera epidemics. In 2015, two million doses of the cholera vaccine were sent to high-risk regions, especially those in the midst of humanitarian crises. Post-infection treatments for cholera focus on rehydration. Patients who are able are instructed to drink large amounts of water mixed with sugar and salt to restore fluid and electrolyte balance. Rice-based solutions are preferred, as they are often the easiest to digest. The solutions are administered intravenously to patients who are too debilitated to drink alone.