Cholera is an easily treatable disease. Up to 80 per cent of people can be treated successfully through prompt administration of oral rehydration salts (WHO/UNICEF ORS standard sachet). Very severely dehydrated patients require administration of intravenous fluids. Such patients also require appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the duration of V. cholerae excretion. Mass administration of antibiotics is not recommended, as it has no effect on the spread of cholera and contributes to increasing antimicrobial resistance.
In order to ensure timely access to treatment, cholera treatment centres (CTCs) should be set up among the affected populations. With proper treatment, the case fatality rate should remain below one per cent.
Once an outbreak is detected, the usual intervention strategy is to reduce deaths by ensuring prompt access to treatment, and to control the spread of the disease by providing safe water, proper sanitation and health education for improved hygiene and safe food handling practices by the community.
The provision of safe water and sanitation is a formidable challenge but remains the critical factor in reducing the impact of cholera.
Oral cholera vaccines
There are two types of safe and effective oral cholera vaccines currently available on the market. Both are whole-cell killed vaccines, one with a recombinant B-sub unit, the other without. Both have sustained protection of over 50 per cent lasting for two years in endemic settings.
Both vaccines are WHO-prequalified and licensed in over 60 countries. Dukoral has been shown to provide short-term protection of 85 to 90 per cent against V. cholerae O1 among all age groups at four to six months following immunization.
The other vaccine (Shanchol) provides longer-term protection against V. cholerae O1 and O139 in children under five years of age.
Both vaccines are administered in two doses given between seven days and six weeks apart. The vaccine with the B-subunit (Dukoral) is given in 150 ml of safe water.
WHO recommends that immunization with currently available cholera vaccines be used in conjunction with the usually recommended control measures in areas where cholera is endemic as well as in areas at risk of outbreaks. Vaccines provide a short term effect while longer term activities like improving water and sanitation are put in place.
Source: Guardian News