3. Everyone must know how one becomes infected with Cholera
Cholera is contracted by ingesting the cholera bacterium. The cholera bacterium must be swallowed either with water or food contaminated with vomit or stool of cholera victims. Anything contaminated with the cholera bacterium, including dirty hands, that goes into the mouth must pass through the stomach to infect the small intestine.
4. Everyone should know how to stay alive and save lives during a cholera epidemic
The treatment of cholera is extraordinarily simple. Treatment should be started without or before confirming the diagnosis. The water and salt lost in the cholera stool must be replaced, ounce for ounce, in comparable amount and concentration. Except in most severe cases, the replacement can be accomplished by allowing the patient to drink fluid. The earlier the treatment begins, the better the prognosis and the less chance for complications; this means that one should never stop giving fluid to the affected individual at home, while on the way to the hospital or clinic and while waiting to be seen in the waiting area of the hospital or clinic. Every household should have a regimen of salts to mix with water to enable them to initiate treatment as soon as it becomes apparent that someone contracted cholera, and the diarrhea is of sufficient severity to be life threatening.
Initiating treatment does not require a physician, a nurse or health worker of any sort. It demands that a person who may be at risk, as is the case for every Haitian living in Haiti, have sufficient knowledge to do the appropriate thing. If the regimen of salt is not available, table salt and sugar may be added to the water and used for treatment. Except for the “full blown” cases, most cholera victims can be managed with treatment with this fluid alone.
Intravenous treatment is needed when a cholera victim is unconscious, muscle cramps exist, or for a patient who has been rapidly purging. This exists when volume of stools output exceed 100ml/Kg/24 hours or 7 liters per day in a 70 Kg person.
When the initial hydration is successful, the fluid loss must match. In Haiti, administration of Tetracycline, Ciproflaxin, and Kanamycin will reduce fluid loss. Pregnant women should use other safer antibiotics.
The most important life-threatening complications of cholera to recognize is hypoglycemia (low blood sugar). Any alteration in the state of consciousness particularly in small children or babies must be presumed to be due to hypoglycemia and must be treated immediately.
Electrolyte abnormalities, the next common problems, usually manifest as alteration in the state of consciousness or as convulsions, especially when the plasma sodium is low. When kidney failure exists, it should be treated conservatively. Dialysis is rarely necessary.
5. Everyone should understand that it is not essential to confirm Cholera with laboratory test to start treatment
It is not necessary to confirm the diagnosis of cholera with laboratory tests to initiate treatment of cholera. Diagnosis of cholera must rest on the history of symptoms that present as acute, and the presence of watery stool in the absence of fever or belly pain. Treatment is based solely on estimating the degree of dehydration.
6. Everyone should understand how Cholera spreads
It is essential for every one to understand how cholera spreads. Cholera epidemics are characterized by multiple outbreaks. During the periods between outbreaks, which could last many months, there is no evidence of the bacterium in water or food. Although flies can carry the bacterium from stool to food and water, there are no animal carriers or vectors known.
During outbreaks, there are many individuals purging large volume of the cholera bacterium in their stool, which usually finds its way on the soil and in the water that is used for washing, swimming, cooking or drinking. Food such as shellfish is often implicated in the epidemic, but it is often through the use of contaminated water. Shellfish have played a role in outbreaks in the Philippines, Thailand, and Italy.
Humans that carry the El Tor bacterium can shed the cholera bacteria for at least two weeks in their stools. People with no symptoms and those with mild illness shed the bacterium in their stool; those in convalescence also continue to shed the bacterium as well. They are all important contributors of the epidemic spread of cholera.