Knowing more about Cholera

By Peter Ngulube, Immunology student

Much as we celebrate the advent of rains, especially for a country that relies on rain-fed agriculture as Malawi is, we also need to be cautious of the negative effects that come with the rains, including floods and a number of water borne diseases. Cholera is one such diseases that wreak havoc during this time. Already, cholera outbreaks have been confirmed in several areas in Malawi, including the cities of Blantyre and Lilongwe. But what is Cholera? Well, Cholera is a disease that causes a lot of watery diarrhea and vomiting. It is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholera. Cholera stool/ feaces look like rice water.

Malawi and choleraRecently, from April 2019 confirmed cases of cholera were registered in Tengani areas in Nsanje (one case), two cases in Mchinji, and another two in Mwanza. There is confirmed evidence of cross-border transmission with Mozambique. The Mwanza cases had history of travel from Moatize, Tete Province in Mozambique where they experienced symptoms. The outbreak was first detected on March 30, 2019 but the index case started having signs of watery diarrhoea and vomiting on March 29 on their way back to Malawi from Moatize. Following investigations, the index case was confirmed positive. The second case from Moatize turned positive by cholera RDT at Mwanza District Hospital on April 12. This was a 20-year old Malawian national (female) who lives with her husband in Mozambique and she developed symptoms on April 9, 2019, before she left for Malawi. This case also tested positive for Vibrio cholerae by culture.As we have seen in the cases above, cholera germs are found in the feaces (poop) of infected people. The disease is thus spread when feaces (poop) from an infected person gets into the water people drink or the food people eat. Cholera is not likely to spread directly from one person to another.

Signs and SymptomsCholera infected individuals usually present the following signs and symptoms: watery diarrhea, rice-water stools, fishy odor to stools, vomiting, rapid heart rate, loss of skin elasticity, dry mucous membranes, low blood pressure, thirst, muscle cramps (leg cramps, for example), restlessness or irritability (especially in children), and unusual sleepiness or tiredness.Whenever our relatives, friends or neighbors show these signs, we need to act fast by, among others, immediately giving them oral rehydration solution

(ORS), rush them to the nearest health facility, continue to give them ORS at home and as you go for medical attention, and if breastfeeding babies, continue to breastfeed them

Preventioni) Drink and use safe water-Bottled water with unbroken seals and canned/bottled carbonated beverages are safe to drink and use.-Use safe water to brush your teeth, wash and prepare food, and to make ice.-Clean food preparation areas and kitchenware with soap and safe water and let dry completely before reuse.-To be use water is safe to drink and use-Boil it or treat it with a chlorine product or household bleach.If boiling, bring your water to a complete boil for at least 1 minute.-To treat your water with chlorine, use one of the locally available treatment products and follow the instructions.-Always store your treated water in a clean, covered container.* Piped water sources, drinks sold in cups or bags, or ice may not be safe and should be boiled or treated with chlorine.ii) Wash your hands regularly with soap and safe water-Before you eat or prepare food.-Before feeding your children.-After using the latrine or toilet.-After cleaning your child’s bottom.-After taking care of someone ill with diarrhea.* If no soap is available, scrub hands often with ash or sand and rinse with safe water.iii) Use latrines or bury your feaces-Use latrines or other sanitation systems, like chemical toilets, to dispose of feces.-Wash hands with soap and safe water after defecating.-Clean latrines and surfaces contaminated with feaces using a solution of 10 percent household bleach and 90 percent water.For those without latrines or chemical toilets, the following will help:-Defecate at least 30 meters away from any body of water and then bury your feces.Dispose of plastic bags containing feces in latrines, at collection points if available, or bury it in the ground. -Do not put plastic bags in chemical toilets.-Dig new latrines or temporary pit toilets at least a half-meter (1.6 feet) deep and at least 30 meters away from any body of water.

iv) Cook food well, keep it covered, eat it hot, and peel fruits and vegetables -Boil it, cook it, peel it, or leave it.-Be sure to cook seafood, especially shellfish, until it is very hot all the way through. * Avoid raw foods other than fruits and vegetables you have peeled yourself.v) Clean up safely—in the kitchen and in places where the family bathes and washes clothes• Wash yourself, your children, diapers, and clothes, 30 meters away from drinking water sources

References1, World Health Organization, Cholera Report, 20192, Debasish S, LaRocque RC, Cholera and other Vibrios. In McGill A, Ryan E, Hill D, Solomon T, Eds, Hunter’s Tropical Medicine and Emerging Infectious Diseases. 9th Edition. New York: Saunders Elsevier; 2013: 448-453.3, Public Health Agency of Canada: Canadian Immunization Guide, Cholera Vaccine4, World Health Organization: International Travel and Health, Vaccine, Preventable Diseases and Vaccines