Cholera is a highly contagious infection that causes diarrhoea, and can lead to severe dehydration and possible death. We are currently struggling to contain a cholera epidemic that has killed nearly 800 Nigerians in two months. About 13,000 persons have been sickened, according to reports from the Ministry of Health, and poorly funded clinics are jammed with patients. The epidemic, reportedly to be the worst in nearly two decades, has also spread to neighbouring countries, killing nearly 400 people in Cameroon and more than 40 in Chad. Cases have also been reported in Niger. Cholera is easily preventable with clean water and proper sanitation. But in Nigeria, almost half the country’s 150 million people lack access to just that, according to the World Health Organisation.

What is cholera?
Cholera is a diarrheal disease caused by infection of the intestine with the bacterium Vibrio cholerae. Children as well as adults can get infected. In developing countries, however, cholera remains a serious problem for people living without access to adequate water and sanitation systems. In most cases, infection causes only mild diarrhoea or no symptoms at all. In 5-10% of cases, however, patients develop very severe watery diarrhoea and vomiting from 6 hours to 5 days after exposure to the bacterium. In these cases, the loss of large amounts of fluids can rapidly lead to severe dehydration. In the absence of adequate treatment, death can occur within hours.

How does a person get cholera?
A person can become infected by drinking water or eating food contaminated by the bacterium. Common sources of food borne infection include raw or poorly cooked seafood, raw fruit and vegetables, and other foods contaminated during preparation or storage. Bacteria present in the faeces of an infected person are the main source of contamination. The bacterium can also live in the environment in brackish rivers and coastal waters. The disease can thus spread rapidly in areas where sewage and drinking water supplies are inadequately treated. New outbreaks can occur sporadically in any part of the world where water supplies, sanitation, food safety and hygiene are inadequate. The greatest risk occurs in overpopulated communities and displaced populations characterized by poor sanitation and unsafe drinking water.

Can cholera be prevented?
Yes. People living in high-risk areas can protect themselves by following a few simple rules of good hygiene and safe food preparation. These include scrupulous washing of hands, especially before food preparation and eating, thorough cooking of food and consumption while hot, boiling or treatment of drinking water and use of sanitary facilities.

A simple rule should be followed always: boil it, cook it, peel it, or forget it.

• Drink only water that has been boiled or disinfected. Beverages such as hot tea or coffee, wine, beer, carbonated water or soft drinks and bottled or packaged fruit juices are usually safe to drink.

• Avoid ice, unless you are sure that it is made from safe water.

• Eat food that has been thoroughly cooked and is still hot when served. Cooked food that has been held at room temperature for several hours and served without being reheated can be an important source of infection.

• Avoid raw seafood and other raw foods. The exceptions are fruits and vegetables that you have peeled or shelled yourself.
Frequently asked questions

• Ice cream from unreliable sources is frequently contaminated and can cause illness. If in    doubt, avoid it.

• Be sure that meals bought from street vendors are thoroughly cooked in your presence and do not contain any uncooked foods.

What treatments are available?
The most important treatment is rehydration, which consists of prompt replacement of the water and salts lost through severe diarrhoea and vomiting. Early rehydration can save the lives of nearly all cholera patients. Most can be rehydrated quickly and easily by drinking large quantities of a solution of oral rehydration salts. Patients who become severely dehydrated may need to receive fluid intravenously. Packets of oral rehydration salts are available from most city pharmacies and health care facilities. The World Health Organization recommends that if packets of oral rehydration salts are unavailable, they can be replaced by a home-made solution obtained by mixing half a teaspoon of salt with 6 teaspoons of sugar in one litre of water safe for human consumption.

If you have diarrhoea , especially severe diarrhoea  and are in an area where there is cholera, seek treatment immediately from a physician or other trained health care provider. Begin drinking water and other non-sweetened fluids, such as soup, on the way to getting medical treatment.

In individual cases of severe cholera, an effective antibiotic can help shorten illness, though rehydration remains the mainstay of treatment. For whole communities, however, preventive mass treatment with an antibiotic does not limit the spread of cholera and is thus not recommended. Preventive chemoprophylaxis is not recommended however. Antidiarrhoeal medicines, such as loperamide, are not recommended and should never be given.