Cholera is characterized by a sudden and overwhelming onset of diarrhea, in the form of profuse and frequent watery bowel movements. It is caused by the bacterium Vibrio cholera, which infects the lining of the small intestine. Symptoms of cholera can appear as soon as within a few hours of exposure, or up to five days later. It can last for one to two days or up to a week. Additional symptoms can include vomiting and stomach cramps. Cholera, given its potentially severe and harmful impact, is considered virulent. An extreme loss of bodily fluids can lead to dehydration and shock as well. In the worst cases, death can occur within two days.
People become infected with cholera by coming into contact with body matter, like vomit and feces, that has been infected with the bacterium. The infection can also spread through food and water sources that are contaminated. The rampant spread of cholera can occur anywhere there is a lack of sanitation, especially when people live in close quarters to one another. Extremely high risk settings 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 runs its course within a few days. If kept properly hydrated, less than one percent of cholera victims die. The conditions that give rise to the spread of cholera, like overcrowding, are also seen in settings where clean water or medical care are in extremely short supply. Given the proper conditions, Cholera outbreaks can grow to epidemic proportions.
In the countries of our world where cholera is endemic, primarily those in sub-Saharan Africa, 1.3 billion people are at risk of being infected today. Among them, children are the most vulnerable. In 2013, for example, the World Health Organization issued an official count of almost 130,000 cases of cholera, which included outbreaks in Haiti and the Dominican Republic, as well as those in Africa. This does not take into account the estimated 90 percent of cases worldwide that are not reported. The total estimated incidence of cholera annually is anywhere between 1.4 and 4.0 million people. Upwards of 100,000 deaths from cholera are reported annually, and as many as 67 countries have reported cholera within a single year’s reporting period.
Cholera can be diagnosed by way of laboratory testing of stool samples. However, time and access to facilities is often not available to do this in the places most affected. Alternatively, symptoms are assessed in consideration of the environmental conditions, as well as each patient’s particular medical history, in order to make an informed diagnosis and subsequent treatment plan for cholera patients. Cholera prevention foremost includes environmental measures and vaccination. Piped and treated water supplies, and more sanitary latrines and waste disposal systems, all 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 against cholera for up to six months, while Shanchol is effective in 65 percent of cases for up to five years thereafter. Mass vaccination campaigns have proven to be highly successful in preventing cholera outbreaks. In 2015, two million doses of the cholera vaccine were shipped 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 quantities 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. Solutions are fed intravenously to patients too debilitated to drink on their own. Antibiotics are sometimes administered as an extra measure to fight the infection as well.