Download 04 Feb 2016 - Cholera Up date

CHOLERA UP DATE
:
PRESENTERS
• Dr Sospatro Elisha Ngallaba –
CUHAS
• Dr Andrew Luhanga - BMC
• Dr Pastory Mondea - BMC
WHAT IS CHOLERA???
• Is an acute disease characterized
by watery diarrhea that is caused
by bacterium called Vibrio
cholerae.
• It is a gram negative aerobic
bacillus or rod shaped bacteria
• It has two major biotypes
Classic and Eltor
 Eltor is the most notorious cause
of cholera outbreak
INTRODUCTION
• Cholera is an acute enteric infection
characterized by profuse vomiting and
acute watery diarrhoea caused by
ingestion of a bacterium Vibrio
cholerae
• The infection can lead to severe
dehydration or even death within few
hours of contamination.
ct
• If left untreated- The case- fatality
rate can range up to 50%
• With timely and adequate treatment,
the rate can be contained below 1%.
• 80% of reported patients recover
when treated only with oral
rehydration salts
• While 10% to 20% may need
administration of intravenous fluids
for rehydration
Mode of transmission
Agent: Vibrio cholerae
•In order for a disease to occur
three factors must interact the
Agent, Host, Environment.
•So the agent must have the
ability to cause the disease,
(pathogenicity) (and the dose)
HOST :ie human
There are factors which
facilitate the host to get the
disease (risk factors)
• Undesirable behaviors
such as, poor hygiene
• Genetic composition
• Poor nutritional status
• Low immunity
ct
• Host factors which protect
against cholera include immunity
due to previous infection with
Vibrio cholerae and, when the
host has been living in endemic
area, where he or she has
acquired immunity
• Medications -antacids
Environment
• Environmental factors include:
physical factors such climate,
biologic factors such as insects
that transmit the agent, and
socioeconomic factors such as
crowding, sanitation, and the
availability of health services.
REFUGE
MAGNITUDE OF THE PROBLEM
GLOBALLY
• Cholera is endemic to the Indian
subcontinent, especially a long the
river Ganges which serve as a
contamination reservoir.
• Since 1800, cholera has spread
throughout the world, but with
development it has been controlled in
many parts of developed countries
MAGNITUDE OF THE PROBLEM IN
AFRICA
• In Africa, the first major outbreak of
cholera occurred in 1970 affecting East,
North, and West Africa simultaneously.
• This epidemic moved rapidly throughout
the region, and by the end of 1971, 25
African countries had reported cholera
outbreak with Case fatality rate 16-35%
AFRICA
MAGNITUDE OF CHOLERA IN
TANZANIA
• The first epidemic -1974 in which 10 cases
were reported with no deaths.
• Later after this phenomenon, there were
several epidemics reported in various regions
in the country.
• The first major epidemic - 1992 with 18,526
cases and 2,173 deaths with Case fatality Rate
11.7%.
• Due to Integrated Disease Surveillance and
Response (IDSR) strategy in the country
between 1998 and 2010, ( 88,235 cases and
2,416 deaths reported with a case fatality rate
of 2.7%.)
ct
·2015 – Burundi refugee crisis
• Majority of refugees fleeing to
Tanzania
 Overcrowded camp conditions
-> cholera outbreak
TANZANIA
Current outbreaks
started
in Dar es Salaam
and then to
Morogoro
(August 2015).
By 24th Feb 2016
most regions
(except Njombe,
Ruvuma and
Mtwara) reported
to have cholera
outbreak. A total of
14,608 patients
reported and 228
patients died.
MWANZA CHOLERA UP DATE
03/02/2016
DISTRICS
Cu Cases Cu death Bed state
Ilemela
327
2
Nyamagana
147
3
Ukerewe
386
15
Misungwi
2
0
Magu
86
0
Sengerema
272
7
Kwimba
12
0
Buchosa
11
0
1243
27
1
2
3
0
0
0
0
1
7
MWANZA CHOLERA UPDATE
Cu Cases
1% 1%
22%
7%
26%
12%
31%
Ilemela
Nyamagana
Ukerewe
Misungwi
Magu
Sengerema
Kwimba
Buchosa
Common causes of cholera
outbreak in Tanzania
Inadequate safe water supply
• Areas without safe water supply are at
high risk of encountering cholera
epidemics; these include municipal
areas with inadequately chlorinated
piped water and rural areas without
safe water
ct
• It has also been noted that most
people in the areas affected by cholera
epidemics do not have habits of boiling
water or treating by to killing the
bacteria and hence making water safe
for drinking and other domestic uses.
• Leaking water pipes can also be easily
infiltrated by dirty water from sewerage
effluents and can contaminate water
sources.
WATER CAN BE SOURCE OF INFECTION
Poor environmental sanitation and
hygiene practices:
• Inadequate Latrines use
Areas which have either insufficient number
of latrines or with latrines that are not used
or those who have overflowing latrines,
contribute to the persistence of cholera
epidemics in many areas.
• Improper waste Disposal
Heaps of garbage, especially in urban areas,
form a breeding ground for flies which
contaminate food and thereby spread
cholera and other infectious diseases.
FEACAL CONTAMINATION OF
ENVIRONMENT
Ct: ENVIRONMENTAL SANITATION AND
HYGIENE
• Poor personal hygiene
Improper personal hygiene practices :
improper washing hands with soap after
visiting the toilet, before preparing foods,
and before eating can contribute to the
spread of the disease.
• Poor disposal of children’s excretion
Handling children’s excreta without washing
hands with soap predisposes to cholera
epidemics
WASH HANDS BEFORE PREPARING
FOOD
FLIES CAN TRANSFER VIBRIO
CHOLERAE
CONTAMINATED FOOD
CHOLERA DEAD BODY TO BE BURRIED
UNDER SUPERVISION OF H/O
S/S of Cholera
Moderate Dehydration
o Loss of 5-10% body weight
o Normal BP
o Normal or rapid pulse
o Sunken eyes
o Dry mouth and tongue
o Increased thirst
o Drinks eagerly
o Skin goes back slowly after skin
pinch
o Decreased tears
Severe Dehydration Cases
o Loss of more than 10% body weight
o Shock
o Low blood pressure
o Minimal or no urine
o Weak and rapid pulse
o Mouth and tongue very dry
o Sunken eyes
o Clouded mental status
Are we prepared for the
cholera outbreak?