• The return of killer diease
By Doris Obinna
The rainy season is that time of the year when the annual rainfall occurs. The rainy season comes with many diseases. One among these diseases is cholera outbreak recently witnesed across the states in Nigeria.
Cholera is an acute diarrhoeal infection caused by eating or drinking food or water that is contaminated with the bacterium vibrio cholerae. Cholera remains a global threat to public health and is an indicator of inequity and lack of social development.
Researchers estimate that, every year, there are 1.3 to 4.0 million cases of cholera, and 21,000 to 143,000 deaths worldwide due to the infection.
Experts have explained that cholera is an extremely serious disease that can cause severe acute watery diarrhoea with severe dehydration. “It takes between 12 hours and five days for a person to show symptoms after consuming contaminated food or water. Cholera affects both children and adults and can kill within hours, if untreated.
“Most people infected with vibrio cholerae do not develop any symptoms, although the bacteria are present in their faeces for 1-10 days after infection. This means the bacteria are shed back into the environment, potentially infecting other people.
“Cholera is often predictable and preventable. It can ultimately be eliminated where access to clean water and sanitation facilities, as well as good hygiene practices, are ensured and sustained for the whole population.”
The World Health Organisation (WHO), cholera in children is an infectious disease caused by bacteria: “Your child can get cholera they eat food or drink water that is contaminated with the bacteria. Cholera is a health problem in many developing countries. It’s mainly found in Africa, south Asia, and Latin America.
“The acids in your stomach and digestive tract can kill small amounts of the cholera bacteria. Because of this, most infected people will not have any symptoms. But the bacteria are still in their stool for seven to 14 days. During that time, they can infect other people. This is especially true if they have poor hygiene habits.”
Lagos State Commissioner for Health, Prof Akin Abayomi, explained: “Cholera is a highly contagious disease that causes severe diarrhea and can be life-threatening. It poses a significant health burden in areas with poor water treatment and sanitation.”
A new oral vaccine for cholera received prequalification by the WHO on April 12, 2024. The inactivated oral vaccine Euvichol-S has a similar efficacy to existing vaccines but a simplified formulation, allowing opportunities to rapidly increase production capacity.
“The new vaccine is the third product of the same family of vaccines we have for cholera in our WHO prequalification list. The new prequalification is hoped to enable a rapid increase in production and supply which many communities battling with cholera outbreaks urgently need,” said Director, WHO Department for Regulation and Prequalification, Dr Rogerio Gaspar.
WHO prequalification list already includes Euvichol and Euvichol-Plus inactivated oral cholera vaccines produced by EuBiologicals Co., Ltd, Republic of Korea, which also produces the new vaccine Euvichol-S.
WHO revealed: “Vaccines provide the fastest intervention to prevent, limit and control cholera outbreaks but supplies have been at the lowest point amidst countries facing dire shortcomings in other areas of cholera prevention and management such as safe water, hygiene and sanitation.
“Currently, 23 countries are reporting cholera outbreaks with most severe impacts seen in the Comoros, Democratic Republic of the Congo, Ethiopia, Mozambique, Somalia, Zambia and Zimbabwe.”
Fatality cases in Nigeria
The Nigerian Centre for Disease Control and Prevention (NCDC) said, 1,141 suspected and 65 confirmed cases of cholera with 30 deaths were reported from 96 LGAs in 30 states between January 1 and June 11, 2024.
It listed the 10 states that contributed 90 per to the burden of cholera to include Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa and Lagos.
Lagos State, on June 15, 2024, revealed that 350 suspected cases of cholera were reported in 29 wards across multiple LGAs with 17 confirmed cases and 15 deaths so far.
Health hazard alert on beverages
NCDC highlighting the risk posed by unhygienic water sources warned that beverages prepared with unclean water could spread cholera. It cautioned that cholera can spread through beverages, ice, and drinks made with contaminated water. The warning highlights the risk posed by unhygienic water sources, impacting public health across the nation.
Director-general of NCDC, Dr. Jide Idris, said: “Cholera caused by vibrio cholerae bacteria in tainted water and food, manifests with symptoms such as sudden onset of severe diarrhoea, vomiting, and fever, emphasised that severe cases can lead to death within hours due to dehydration.
“This disease is endemic in Nigeria, peaking during the rainy season in areas with poor sanitation. Currently, 96 local government areas in 30 states have reported cholera cases in 2024.”
While advising Nigerians to avoid consuming food or drinks prepared with unreliable water sources to curb the outbreak, he urged improved access to safe drinking water, proper sanitation, and hygiene practices. “Ensure water is from safe sources, boiled before use, and stored properly, improving access to safe drinking water, proper sanitation, and hygiene practices.”
Signs and symptoms
NCDC said: “Nausea and vomiting. Vomiting occurs, especially in the early stages of cholera, and can last for hours. Watery diarrhea, sometimes described as rice-water stools because they are milky white, vomiting, leg cramps and restlessness or irritability.
“Symptoms usually appear 2-3 days after someone drinks or eats something containing cholera bacteria. Symptoms can show up within a few hours or up to five days. Also, later symptoms include: Losing body fluids quickly from diarrhea and vomiting can cause dehydration. Patients with severe cholera may have lost more than 10 per cent of body weight by the time they seek medical care.
“If untreated, severe dehydration can lead to kidney failure, shock, coma, and death. While symptoms of dehydration include: rapid heart rate, loss of elasticity in the skin, dry mucous membranes, low blood pressure. With early and proper treatment, even people with severe cholera can survive. During a cholera outbreak, people with acute watery diarrhea (three or more loose stools a day) should seek care.”
Treatment
NCDC continued: “Cholera can cause dehydration, which can lead to death in just a few hours. The most important treatment is rehydration therapy, which includes oral rehydration solution (ORS), intravenous fluids, and electrolytes. With timely rehydration therapy, more than 99 per cent of cholera patients survive.
“If you don’t have ORS, you can consider other fluids like drink safe water, broth. Do not drink fluids with high sugar content like juice, soft drinks, or sports drinks. Sugary drinks can make diarrhea worse. Babies with watery diarrhea should continue to be fed breast milk or formula to help them stay hydrated.
“In addition to rehydration therapy, antibiotics may be recommended for severely ill patients and others depending on their symptoms and medical conditions. Antibiotics can help decrease how long someone is sick. However, antibiotics should be used along with aggressive rehydration.
“When available, children ages six months to five years with suspected cholera should be started on zinc supplementation immediately.
“If you think you or a family member might have cholera, start drinking ORS and get medical attention immediately. With early and proper treatment, even people with severe cholera can survive.”
What you must do
Abayomi urged all to support the State Government’s efforts by adhering strictly to precautionary measures, cooperating with health authorities, and participating in community-wide sanitation activities to mitigate the spread of cholera.
He advised that drinking safe water, cooking food thoroughly, maintaining personal hygiene, washing hands regularly, the use of sanitiser, and avoiding over crowded places would reduce risk of transmission.
“Reporting symptoms like watery diarrhoea or vomiting immediately is also crucial to save lives and prevent transmission to other members of the community. Treatment for suspected cholera is provided free of charge at all government facilities as part of governments standard public health response.”
