Where Does Cholera Commonly Occur?

What is cholera?

Cholera is any of the several acute infectious diseases occurring in humans and domestic animals that are caused by the bacterium vibrio cholerae. Cholera is caused by taking in water or food that has been contaminated by the vibrio cholerae bacteria.

Cholera is characterized by several gastrointestinal symptoms, thus affects the stomach and intestines. It is potentially fatal. Vibrio cholerae secretes toxins that cause large amounts of watery diarrhea that result in dehydration, oliguria and even circulatory collapse. Cholera can result in death in a matter of hours if untreated. 

Symptoms

You can identify the infection by looking for the following symptoms:

• Severe and watery diarrhea, which occurs more often than normal
• Cramps of the stomach
• Dehydration, which occurs very rapidly and may result to death if not quickly treated
• Nausea and vomiting in adults, which occurs as a reflex action to get rid of harmful substances from the stomach
• Painful swelling in the gut where feces are formed

The pain starts in the middle of the abdomen and comes on sporadically, and after some hours it moves to the lower right side near the appendix. The pain will become severe and constant. Coughing, walking and putting pressure on the area will only worsen the pain. If you are worried about your vomiting it is advisable to go for a check up to ascertain it is not serious, especially if the vomiting is continuous for two consecutive days and you are experiencing signs of severe dehydration.

Transmission

The infection is basically transmitted through contaminated water or foods, especially seafood. Vibrio cholerae is a type of bacillus bacteria that is aerobic and produces enterotoxins, which are proteins that cause hyper-secretion of an isotonic electrolyte solution from the mucus of the small intestines. Their appearance in nature is short, curved and motile.

Cholera is caused by the ingestion of food and/or water that has been contaminated by the vibrio cholerae bacteria. There are a number of reasons as to why water may be contaminated with the bacteria. In locations where there is poor sanitation, such as under-developed or developing countries, water is often contaminated by feces due to ineffective sewage systems. If the water was contaminated with the feces of an infected person and you drink the water, you too will contract the cholera infection. The bacteria can also be present in stagnant water. If you eat street foods in an area where there is a cholera outbreak, it is likely that you will get it too. You can also get the disease from eating seafood, raw fruits and vegetables that have been exposed to the vibrio cholerae bacteria.    

Risk factors; where to expect cholera

Hygiene is key in staying away from cholera. This is largely due to the fact that cholera is a water-borne disease.

• Households: In households, sharing is a common occurrence. Household contact with patients experiencing cholera makes for a high risk of the infection being transmitted through the shared items such as sources of water and food.

• Epidemiology: In approximately 50 countries, cholera is endemic and can potentially emerge in dramatic epidemics. Most cases, however, go unreported. Vibrio cholerae 01 is endemic in much of Africa, South Asia and Southeast Asia, whereas vibrio cholerae 0139 is localized in a few areas of Asia. After a huge earthquake hit the capital of Haiti and the surrounding areas, a large cholera outbreak began in Haiti barely ten months later. A lack of proper sanitation and sewage processing facilities also contribute to the ongoing cases in these regions.

• Travel areas: Travelers to and from endemic countries or where there is an active epidemic are at high risk of infection. Haiti remains a primary source of cholera in travel-associated cases. The risk is heightened for those drinking water that is not treated, eating poorly cooked or raw food especially fish, and practice poor hygiene ignoring proper hygiene recommendations in endemic area or zones. Travelers following tourist itineraries and consuming only safe food and water recommended are virtually at no risk of acquiring cholera. Time of travel also plays a vital role in that there is an increased cholera transmission risk during heavy rainfalls for instance.

• Peri-urban slums: Since transmission is basically due to inadequate access to clean water and sanitation facilities, it is predominant in slums. The infrastructure here is lacking and also there is refugee camps for the internally displaced. In such instances, minimum requirements for clean water and sanitation are more often not met. Humanitarian crises for example, water and sanitation system disruption and overcrowding in camps, increases the risk of cholera transmission if the bacteria is present or is somehow introduced.

• Environmental and seasonal factors: Cholera epidemics most commonly kick in at the end of dry season or in the setting in of the rainy season. This is basically when the sources of water become scarce and highly polluted, and the scarcity of water sources forces people to dwell in the few available water sources thereby increasing the risk of contamination and transmission. Cholera outbreaks are also triggered by heavy rainfall when accidents occur such as over-flooding of sewage systems, cross-contaminate of septic tanks and shallow wells, land leaking pipes.

• Convergence zones or seasons: Areas of intensive trading activities are highly at risk of contracting cholera because of the large population of people converging at a limited area. Some of the traders may be ailing and spread the disease to healthy traders. This is highly possible since the areas characteristically have poor sanitation and access to safe clean water is limited by the large population. Trade routes often face the same challenges.

• Previous existence of cholera: If an area is known to have no prior reported cases of cholera, the population is not immune and there is a high risk of contracting the disease. Displacement of people who are carriers may result to some of them settling in an area and causing another outbreak to occur. Carriers often do not show any signs of cholera. People displaced from non-endemic areas to endemic ones are more prone to infection.

• Restricted access to treatment centers: In some places, geographical barriers hinder access to health facilities for treatment. Security constrains also hinder the access, hence delayed treatment and further spreading of the disease.

Preventive Measures

Despite its contagious nature, cholera is preventable. The following recommended eating and drinking habits act as key preventive measures:

• Raw foods, especially those associated with fresh produce or salads, should be avoided.
• Boiling your drinking water. Treating the water using a disinfectant chemical or treatment with ultraviolet light is also recommended.
• Eat hot-served foods that are well cooked.
• Wash thoroughly with clean water, and peel raw vegetables. Prepare foods by yourself if you can. 
• When taking drinks, ask for them ice-free as the ice cubes may have been contaminated.
• Brush your teach with clean and uninfected water.

The Bottom Line

Cholera is an infection that should be taken seriously. Use preventive measures in areas where the infection commonly occurs. The symptoms may last for only a few hours or may develop within a few days of infection. If untreated, the combination of diarrhea and vomiting result in dehydration, a huge drop in blood pressure, and even in severe cases could result in death.