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1-MINUTE CLINICALS: A Primer on Cholera

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January 4, 2011 - A recent outbreak of cholera that killed more than 300 people in Haiti last month has brought this deadly disease into the spotlight once again. According to the U.S. Centers for Disease Control and Prevention (CDC, 2010), the strains of cholera recently found in Haiti match strains commonly found in South Asia, where cholera is endemic and where cholera outbreaks occurred this past summer. A United Nation base in Haiti that houses peacekeepers from South Asia may be responsible for this outbreak in Haiti, since Haiti has not seen cholera in decades.

For a cholera outbreak to occur, two conditions have to be met: There must be significant breaches in the water, sanitation, and hygiene infrastructure used by groups of people, permitting large-scale exposure to food or water contaminated with Vibrio cholerae organisms; and cholera must be present in the population (CDCD, 2010).

Cholera infection is most often asymptomatic or causes a mild gastroenteritis. However, about 5 percent of infected persons develop severe, dehydrating, acute watery diarrhea. The first line of treatment for cholera is rehydration. Timely administration of oral rehydration salts and, when necessary, intravenous fluids and electrolytes with adequate volumes will reduce case-fatality rates to <1 percent  (CDC, 2010).

Severe cases of cholera should be treated with antimicrobial agents to which the circulating strain is susceptible.  Antimicrobial treatment is not recommended for mild cases of cholera and should never be used as “chemoprophylaxis” to prevent cholera on a mass scale (CDC, 2010).

As with other causes of acute watery diarrhea, the prevention and control of cholera require surveillance, heightened measures to ensure the safety of drinking water and food, and appropriate facilities and practices for disposal of feces and for handwashing. Although using vaccines to control an outbreak of cholera is complex, oral cholera vaccines are being considered for use among high-risk populations in Haiti.

For additional information, a World Health Organization (WHO) fact sheet on cholera is available at: http://www.who.int/mediacentre/factsheets/fs107/en/index.html.

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