Assignment

on
Cholera

SUBMITTED TO

Mohammad Injamul Hoq

Department of Public Health
Program: Master of Public Health (Autumn 2020)
University of Creative Technology Chittagong

SUBMITTED BY

Mohammad Abdul Sukkur

ID-200722013
Program: Master of Public Health (Autumn 2020)
Department of Public Health
University of Creative Technology Chittagong

Date of Submission: 21/09/2020

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 Table of Contents

Particulars Pages
1. Introduction 03
2. Global Facts 05
3. Bangladesh Perspectives 06
4. Epidemiological Determinants 07
5. Symptom of the Diseases 08
6. Development of the Diseases 09
7. Stages 09
8. Risk Factors 10
9. Diagnosis 11
10. Control & Prevention Strategies 12
11. Management 14
12. Treatment 14
13. Conclusion 15
References 16

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1. Introduction
Cholera is an acute diarrhoeal disease that can kill within hours if left untreated. Researchers
have estimated that each year there are 1.3 million to 4.0 million cases of cholera, and 21
000 to 143 000 deaths worldwide due to cholera (1). Up to 80% of cases can be successfully
treated with oral rehydration solution (ORS). Severe cases will need rapid treatment with
intravenous fluids and antibiotics. Provision of safe water and sanitation is critical to control
the transmission of cholera and other waterborne diseases. Safe oral cholera vaccines should
be used in conjunction with improvements in water and sanitation to control cholera
outbreaks and for prevention in areas known to be high risk for cholera. A global strategy on
cholera control with a target to reduce cholera deaths by 90% was launched in 2017. Cholera
is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the
bacterium Vibrio cholerae. Cholera remains a global threat to public health and an indicator
of inequity and lack of social development. Researchers have estimated that every year, there
are roughly 1.3 to 4.0 million cases, and 21 000 to 143 000 deaths worldwide due to cholera
(1).
Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic
bacterium Vibrio cholerae serogroup O1 or O139. An estimated 2.9 million cases and 95,000
deaths occur each year around the world. The infection is often mild or without symptoms, but
can sometimes be severe. Approximately one in 10 (10%) infected persons will have severe
disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people,
rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur
within hours. The cholera bacterium is usually found in water or food sources that have been
contaminated by feces (poop) from a person infected with cholera. Cholera is most likely to
be found and spread in places with inadequate water treatment, poor sanitation, and
inadequate hygiene. The cholera bacterium may also live in the environment in brackish
rivers and coastal waters. Shellfish eaten raw have been a source of cholera, and a few
persons in the U.S. have contracted cholera after eating raw or undercooked shellfish from
the Gulf of Mexico. A person can get cholera by drinking water or eating food contaminated
with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces
of an infected person that contaminates water and/or food. The disease can spread rapidly in
areas with inadequate treatment of sewage and drinking water. The disease is not likely to
spread directly from one person to another; therefore, casual contact with an infected person is
not a risk for becoming ill.

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Cholera infection is often mild or without symptoms, but can sometimes be severe.
Approximately one in ten (10%) infected persons will have severe disease characterized by
profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids
leads to dehydration and shock. Without treatment, death can occur within hours. If you think
you or a member of your family may have cholera, seek medical attention immediately.
Dehydration can be rapid so fluid replacement is essential. If you have oral rehydration
solution (ORS), the ill person should start taking it immediately; it can save a life. He or she
should continue to drink ORS at home and during travel to get medical treatment. If you have
an infant who has watery diarrhea, continue to breastfeed. To test for cholera, doctors must
take a stool sample or a rectal swab and send it to a laboratory to look for the cholera
bacterium. Cholera can be simply and successfully treated by immediate replacement of the
fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution
(ORS), a prepackaged mixture of sugar and salts to be mixed with 1 liter of water and drunk
in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases
also require intravenous fluid replacement. With prompt appropriate rehydration, fewer than
1% of cholera patients die. Antibiotics shorten the course and diminish the severity of the
illness, but they are not as important as receiving rehydration. Persons who develop severe
diarrhea and vomiting in countries where cholera occurs should seek medical attention
promptly the risk for cholera is very low for people visiting areas with epidemic cholera.
When simple precautions are observed, contracting the disease is unlikely. All people
(visitors or residents) in areas where cholera is occurring or has occurred should observe the
following recommendations:
 Drink only bottled, boiled, or chemically treated water and bottled or canned
carbonated beverages. When using bottled drinks, make sure that the seal has not
been broken.
 To disinfect your own water: boil for 1 minute or filter the water and add 2
drops of household bleach or ½ an iodine tablet per liter of water.
 Avoid tap water, fountain drinks, and ice cubes.
 Wash your hands often with soap and clean water.
 If no water and soap are available, use an alcohol-based hand cleaner (with at least
60% alcohol).
 Clean your hands especially before you eat or prepare food and after using the
bathroom.

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  Use bottled, boiled, or chemically treated water to wash dishes, brush your teeth,
wash and prepare food, or make ice.
 Eat foods that are packaged or that are freshly cooked and served hot.
o Do not eat raw or undercooked meats and seafood, or raw or undercooked
fruits and vegetables unless they are peeled.

2. Global Facts
Cholera is an acute diarrhoeal infection caused by the bacterium Vibrio cholera of
serogroups O1 or O139. Humans are the only relevant reservoir, even though Vibrios can
survive for a long time in coastal waters contaminated by human excreta. Consumption of
contaminated water and food, especially seafood eaten under-cooked, results in infection.
After a short incubation period of less than five days, the typical symptoms might develop,
characterised by vomiting and watery diarrhoea. In most cases, though, symptoms are mild
or absent and infected individuals become carriers with no symptoms. With timely treatment
(fluid replacement and antibiotics), less than 1% of patients with symptoms die. The disease
has not been endemic in Europe for a long time, and thanks to high hygiene standards the
potential for imported cases to generate further ones is low. Current global estimates reveal
2.9 million cases of cholera each year, and 95 000 deaths occur from the disease annually. In
Bangladesh alone, there are at least 100 000 cases and approximately 4500 deaths each year.
One estimate suggests that more than 66 million people are at risk of cholera with an
incidence rate of 1.64 per 1000 . Bangladesh remains endemic for cholera with a biannual
peak in certain areas of the country . Cholera transmission increases during both floods and
droughts. Water temperature in ponds and rivers, in addition to rainfall, also has a remote
association with cholera transmission. Cholera affects all age groups; however, the majority
of fatal
cases occur in children . Children under 5 years of age bear a high burden, but adults are also
at risk. Prevention of cholera remains an important public health goal, and vaccination as
well as improving access to water, sanitation, and hygiene (WaSH) are essential factors in
preventing and controlling the disease. Therefore, a safe, effective, and affordable vaccine is
an important tool for cholera prevention and control. An oral cholera vaccine (OCV)
stockpile was established by the World Health Organization (WHO) in 2013. The number of
doses released from the stockpile in response to requests from countries in Asia, Africa, and
the Americas has approximately doubled every year since the stockpile’s creation, and the

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current supply of vaccine is currently outstripped by country demand. An international call
for ending the spread of endemic cholera is now being led by a global initiative with a plan
to make at least 20 countries free of cholera by the year 2030 (#End Cholera 2030).
Bangladesh is one of these countries. living in high-risk, densely populated environments
with poor access to safe water, sanitation, and education are most at risk. Caseloads in
Bangladesh are marked with peaks in seasonality, typically in the spring and autumn, in
areas where bimodal seasonality is observed. People living in high-risk, densely populated
environments with poor access to safe water, sanitation, and education are most susceptible.
In addition, genetic factors, including ABO and Lewis blood groups as well as malnutrition
in young children, can be predisposing factors. With an aim to control and prevent cholera in
Bangladesh, extensive efforts have been carried out over the last decade to determine
mechanisms for using OCVs to prevent the disease in Bangladesh A feasibility and
effectiveness trial of OCV to assess overall protection conferred by a 2-dose regimen of
Shanchol was conducted among 240 000 individuals in urban Bangladesh. The trial showed
that total protection of vaccinees for preventing hospitalization due to severe dehydrating
cholera was 53% in the vaccination-only group and 58% in the vaccination and behavioral
change group, which implemented hand washing and water treatment. Delivery of the
complete 2-dose regimen of the vaccine in the community, especially in emergency
situations, can be difficult. To address whether a single dose of Shanchol is protective, a
large-scale, placebo-controlled trial of Shanchol was conducted in urban Dhaka. The trial
found that a single dose conferred 65% protection against hospitalizations for severe cholera
during 2 years of follow-up; however, protection by a single dose was only seen in persons
vaccinated at 5 years of age and older. A 2-dose regimen of OCV provides less protection to
children under the age of 5, and a single dose does not work in this population. Futhermore,
maintaining a cold chain for vaccine storage in resource-poor settings presents a major
challenge to the implementation of OCV delivery. A study of Shanchol in Bangladesh found
that vaccine safety and immunogenicity were not altered when the vaccine was kept at
ambient temperature outside the cold chain . A nationwide surveillance for cholera is being
carried out in 22 sites in Bangladesh to identify hotspots of cholera and to determine areas
that need immunization with OCV. Acute watery diarrhea cases attending in sites are being
confirmed by microbiological culture ofstool for Vibrio cholerae. Another initiative is that
the technology of inactivated whole-cell OCVs has been transferred to a qualified producer
in Bangladesh. Meanwhile, 2 inactivated whole-cell vaccines have been produced, and the

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later was used in Phase I/II clinical trials (NCT02742558, NCT02823899). It is important to
document the effectiveness of OCV, WaSH interventions, and clinical management, and this
should be a multisectoral approach for long-term control of cholera.
3. Bangladesh Perspectives
Cholera, an ancient diarrheal disease, continues to be a public health threat even to this day
in over 47 countries where communities are exposed to large quantities of fecal material and
face problems in accessing to safe drinking water and basic hygiene.
Current global estimates reveal 2.9 million cases of cholera each year, and 95000 deaths
occur from the disease annually. In Bangladesh alone, there are at least 100000 cases and
approximately 4500 deaths each year. One estimate suggests that more than 66 million
people are at risk of cholera with an incidence rate of 1.64 per 1000. Bangladesh remains
endemic for cholera with a biannual peak in certain areas of the country. Cholera
transmission increases during both floods and droughts. Water temperature in ponds and
rivers, in addition to rainfall, also has a remote association with cholera transmission.
Cholera affects all age groups; however, the majority of fatal cases occur in children.
Children under 5 years of age bear a high burden, but adults are also at risk. Prevention of
cholera remains an important public health goal, and vaccination as well as improving access
to water, sanitation, and hygiene (WaSH) are essential factors in preventing and controlling
the disease. Therefore, a safe, effective, and affordable vaccine is an important tool for
cholera prevention and control.
An oral cholera vaccine (OCV) stockpile was established by the World Health Organization
(WHO) in 2013. The number of doses released from the stockpile in response to requests
from countries in Asia, Africa, and the Americas has approximately doubled every year since
the stockpile’s creation, and the current supply of vaccine is currently outstripped by country
demand. An international call for ending the spread of endemic cholera is now being led by a
global initiative with a plan to make at least 20 countries free of cholera by the year 2030
(#End Cholera 2030). Bangladesh is one of these countries. People living in high-risk,
densely populated environments with poor access to safe water, sanitation, and education are
most at risk. Caseloads in Bangladesh are marked with peaks in seasonality, typically in the
spring and autumn, in areas where bimodal seasonality is observed. People living in high-
risk, densely populated environments with poor access to safe water, sanitation, and
education are most susceptible. In addition, genetic factors, including ABO and Lewis blood
groups as well as malnutrition in young children, can be predisposing factors. With an aim to

7
control and prevent cholera in Bangladesh, extensive efforts have been carried out over the
last decade to determine mechanisms for using OCVs to prevent the disease in Bangladesh.
A feasibility and effectiveness trial of OCV to assess overall protection conferred by a 2-
dose regimen of Shanchol was conducted among 240000 individuals in urban Bangladesh.
4. Epidemiological Determinants
Cholera can be endemic or epidemic. A cholera-endemic area is an area where confirmed
cholera cases were detected during the last 3 years with evidence of local transmission
(meaning the cases are not imported from elsewhere). A cholera outbreak/epidemic can
occur in both endemic countries and in countries where cholera does not regularly occur.
In cholera endemic countries an outbreak can be seasonal or sporadic and represents a
greater than expected number of cases. In a country where cholera does not regularly occur,
an outbreak is defined by the occurrence of at least 1 confirmed case of cholera with
evidence of local transmission in an area where there is not usually cholera. Cholera
transmission is closely linked to inadequate access to clean water and sanitation facilities.
Typical at-risk areas include peri-urban slums, and camps for internally displaced persons or
refugees, where minimum requirements of clean water and sanitation are not been met. The
consequences of a humanitarian crisis – such as disruption of water and sanitation systems,
or the displacement of populations to inadequate and overcrowded camps – can increase the
risk of cholera transmission, should the bacteria be present or introduced. Uninfected dead
bodies have never been reported as the source of epidemics. The number of cholera cases
reported to WHO has continued to be high over the last few years. During 2017,1 227 391
cases were notified from 34 countries, including 5654 deaths (3). The discrepancy between
these figures and the estimated burden of the disease is since many cases are not recorded
due to limitations in surveillance systems and fear of impact on trade and tourism.
5. Symptom of the Diseases

Cholera is an extremely virulent disease that can cause severe acute watery diarrhoea. It
takes between 12 hours and 5 days for a person to show symptoms after ingesting

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contaminated food or water (2). Cholera affects both children and adults and can kill within
hours if untreated.
Most people infected with V. cholerae do not develop any symptoms, although the bacteria
are present in their faeces for 1-10 days after infection and are shed back into the
environment, potentially infecting other people.
Among people who develop symptoms, the majority have mild or moderate symptoms,
while a minority develop acute watery diarrhoea with severe dehydration. This can lead to
death if left untreated.
Symptoms of cholera can begin as soon as a few hours or as long as five days after infection.
Often, symptoms are mild. But sometimes they are very serious. About one in 20 people
infected have severe watery diarrhea accompanied by vomiting, which can quickly lead to
dehydration. Although many infected people may have minimal or no symptoms, they can
still contribute to spread of the infection.
Signs and symptoms of dehydration include:
 Rapid heart rate
 Loss of skin elasticity (the ability to return to original position quickly if pinched)
 Dry mucous membranes, including the inside of the mouth, throat, nose, and eyelids
 Low blood pressure
 Thirst
 Muscle cramps

6. Development of the Diseases

Cholera is an acute intestinal infection caused by ingestion of food or water contaminated
with the bacterium Vibrio cholerae. It has a short incubation period and produces an
enterotoxin that causes a copious, painless, watery diarrhoea that can quickly lead to severe
dehydration and death if treatment is not promptly given. Vomiting also occurs in most
patients.
Most persons infected with V. cholerae do not become ill, although the bacterium is present
in their faeces for 7-14 days. When illness does occur, about 80-90% of episodes are of mild
or moderate severity and are difficult to distinguish clinically from other types of acute
diarrhoea. Less than 20% of ill persons develop typical cholera with signs of moderate or
severe dehydration.
Cholera remains a global threat and is one of the key indicators of social development. While
the disease no longer poses a threat to countries with minimum standards of hygiene, it
remains a challenge to countries where access to safe drinking water and adequate sanitation

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cannot be guaranteed. Almost every developing country faces cholera outbreaks or the threat
of a cholera epidemic.
7. Stages
Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium
Vibrio cholerae and is spread by ingestion of contaminated food or water. The infection is
often mild or without symptoms, but sometimes it can be severe and life threatening.
A physician checking a patient for dehydration
Approximately one in ten (5-10%) of infected persons will have severe cholera which in the
early stages includes:
 profuse watery diarrhea, sometimes described as “rice-water stools,”
 vomiting
 rapid heart rate
 loss of skin elasticity
 dry mucous membranes
 low blood pressure
 thirst
 muscle cramps
 restlessness or irritability
Persons with severe cholera can develop acute renal failure, severe electrolyte imbalances
and coma. If untreated, severe dehydration can rapidly lead to shock and death in hours.
Profuse diarrhea produced by cholera patients contains large amounts of infectious Vibrio
cholerae bacteria that can infect others if ingested, and when these bacteria contaminate
water or food will lead to additional infections. Dispose of human waste appropriately to
prevent the spread of cholera.
Persons caring for cholera patients can avoid acquiring illness by washing their hands after
touching anything that might be contaminated and properly disposing of contaminated items
and human waste.
Person washing hands over a bucket of water.
Infected persons, when treated rapidly, can recover quickly, and there are typically no long
term consequences. Persons with cholera do not become carriers of the disease after they
recover, but can be reinfected if exposed again.
8. Risk Factors

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Everyone is susceptible to cholera, with the exception of infants who get immunity from
nursing mothers who have previously had cholera. Still, certain factors can make you more
vulnerable to the disease or more likely to have severe signs and symptoms.
Risk factors for cholera include:
 Poor sanitary conditions. Cholera is more likely to flourish in situations where a
sanitary environment — including a safe water supply — is difficult to maintain.
Such conditions are common to refugee camps, impoverished countries, and areas
afflicted by famine, war or natural disasters.
 Reduced or nonexistent stomach acid. Cholera bacteria can't survive in an acidic
environment, and ordinary stomach acid often serves as a defense against infection.
But people with low levels of stomach acid — such as children, older adults, and
people who take antacids, H-2 blockers or proton pump inhibitors — lack this
protection, so they're at greater risk of cholera.
 Household exposure. You're at increased risk of cholera if you live with someone
who has the disease.
 Type O blood. For reasons that aren't entirely clear, people with type O blood are
twice as likely to develop cholera compared with people with other blood types.
 Raw or undercooked shellfish. Although industrialized nations no longer have
large-scale cholera outbreaks, eating shellfish from waters known to harbor the
bacteria greatly increases your risk.
 Cholera transmission is closely linked to inadequate environmental management.
Typical atrisk areas include peri-urban slums, where basic infrastructure is not
available, as well as camps for internally displaced people or refugees, where
minimum requirements of clean water and sanitation are not met.
 The consequences of a disaster – such as disruption of water and sanitation systems,
or the displacement of populations to inadequate and overcrowded camps – can
increase the risk of cholera transmission should the bacteria be present or introduced.
Epidemics have never arisen from dead bodies.
 Cholera remains a global threat to public health and a key indicator of lack of social
 development. Recently, the re-emergence of cholera has been noted in parallel with
the ever-increasing size of vulnerable populations living in unsanitary conditions.
 The number of cholera cases reported to WHO continues to rise. For 2011 alone, a
total of 589 854 cases were notified from 58 countries, including 7816 deaths. Many

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 more cases were unaccounted for due to limitations in surveillance systems and fear
of trade and travel sanctions. The true burden of the disease is estimated to be 3–5
million cases and 100 000–120 000 deaths annually.
9. Diagnosis
Isolation and identification of Vibrio cholerae serogroup O1 or O139 by culture of a stool
specimen remains the gold standard for the laboratory diagnosis of cholera.
Cary Blair media is ideal for transport, and the selective thiosulfate–citrate–bile salts agar
(TCBS) is ideal for isolation and identification. Reagents for serogrouping Vibrio cholerae
isolates are available in all state health department laboratories in the U.S. Commercially
available rapid test kits are useful in epidemic settings but do not yield an isolate for
antimicrobial susceptibility testing and subtyping, and should not be used for routine
diagnosis.
In many countries where cholera is not uncommon, but access to diagnostic laboratory
testing is difficult, WHO recommends the following clinical definition be used for suspected
cholera cases.
Suspected cholera case
 In areas where a cholera outbreak has not been declared: Any patient 2 years old or
older presenting with acute watery diarrhea and severe dehydration or dying from
acute watery diarrhea.
 In areas where a cholera outbreak is declared: any person presenting with or dying
from acute watery diarrhea.
WHO also recommends the following definition for confirmed cholera cases.
Confirmed cholera case
A suspected case with Vibrio cholerae O1 or O139 confirmed by culture or PCR and, in
countries where cholera is not present or has been eliminated, the Vibrio cholerae O1 or
O139 strain is demonstrated to be toxigenic.
10. Control & Prevention Strategies
Among people developing symptoms, 80% of episodes are of mild or moderate severity. The
remaining 10%-20% of cases develop severe watery diarrhoea with signs of dehydration.
Once an outbreak is detected, the usual intervention strategy aims to reduce mortality -
ideally below 1% - by ensuring access to treatment and controlling the spread of disease. To
achieve this, all partners involved should be properly coordinated and those in charge of
water and sanitation must be included in the response strategy. Recommended control

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methods, including standardized case management, have proven effective in reducing the
case-fatality rate.
The main tools for cholera control are:
 proper and timely case management in cholera treatment centres;
 specific training for proper case management, including avoidance of nosocomial
infections;
 sufficient pre-positioned medical supplies for case management (e.g. diarrhoeal
disease kits);
 improved access to water, effective sanitation, proper waste management and vector
control;
 enhanced hygiene and food safety practices;
 improved communication and public information
A multidisciplinary approach based on prevention, preparedness and response, along with an
efficient surveillance system, is key for mitigating cholera outbreaks, controlling cholera in
endemic areas and reducing deaths.
Cholera is an easily treatable disease. Up to 80% of people can be treated successfully
through prompt administration of oral rehydration salts (WHO/UNICEF ORS standard
sachet). Very severely dehydrated patients require administration of intravenous fluids. Such
patients also require appropriate antibiotics to diminish the duration of diarrhoea, reduce the
volume of rehydration fluids needed, and shorten the duration of V. cholerae excretion. Mass
administration of antibiotics is not recommended, as it has no effect on the spread of cholera
and contributes to increasing antimicrobial resistance. In order to ensure timely access to
treatment, cholera treatment centres (CTCs) should be set up among the affected
populations. With proper treatment, the case fatality rate should remain below 1%.
Outbreak response
Once an outbreak is detected, the usual intervention strategy is to reduce deaths by ensuring
prompt access to treatment, and to control the spread of the disease by providing safe water,
proper sanitation and health education for improved hygiene and safe food handling
practices by the community. The provision of safe water and sanitation is a formidable
challenge but remains the critical factor in reducing the impact of cholera.
Oral cholera vaccines
There are two types of safe and effective oral cholera vaccines currently available on the
market. Both are whole-cell killed vaccines, one with a recombinant B-sub unit, the other

13
without. Both have sustained protection of over 50% lasting for two years in endemic
settings. Both vaccines are WHO-prequalified and licensed in over 60 countries. Dukoral has
been shown to provide short-term protection of 85–90% against V. cholerae O1 among all
age groups at 4–6 months following immunization.
The other vaccine (Shanchol) provides longer-term protection against V. cholerae O1 and
O139 in children under five years of age. Both vaccines are administered in two doses given
between seven days and six weeks apart. The vaccine with the B-subunit (Dukoral) is given
in 150 ml of safe water. WHO recommends that immunization with currently available
cholera vaccines be used in conjunction with the usually recommended control measures in
areas where cholera is endemic as well as in areas at risk of outbreaks. Vaccines provide a
short term effect while longer term activities like improving water and sanitation are put in
place. When used, vaccination should target vulnerable populations living in high risk areas
and should not disrupt the provision of other interventions to control or prevent cholera
epidemics. The WHO 3-step decision making tool aims at guiding health authorities in
deciding whether to use cholera vaccines in complex emergency settings. The use of the
parenteral cholera vaccine has never been recommended by WHO due to its low protective
efficacy and the high occurrence of severe adverse reactions.
11. Management
Step 1. Assess for dehydration.
Step 2. Rehydrate the patient, and monitor frequently. Then reassess hydration status.
Step 3. Maintain hydration: replace ongoing fluid losses until diarrhoea stops.
Step 4. Give an oral antibiotic to the patient with severe dehydration.
Step 5. Feed the patient.
12. Treatment

Cholera requires immediate treatment because the disease can cause death within hours.
 Rehydration. The goal is to replace lost fluids and electrolytes using a simple
rehydration solution, oral rehydration salts (ORS). The ORS solution is available as a
powder that can be made with boiled or bottled water. Without rehydration,

14
 approximately half the people with cholera die. With treatment, fatalities drop to less
than 1%.
 Intravenous fluids. Most people with cholera can be helped by oral rehydration
alone, but severely dehydrated people might also need intravenous fluids.
 Antibiotics. While not a necessary part of cholera treatment, some antibiotics can
reduce cholera-related diarrhea and shorten how long it lasts in severely ill people.
 Zinc supplements. Research has shown that zinc might decrease diarrhea and
shorten how long it lasts in children with cholera.

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13. Conclusion
In summary, we found that it is feasible and impactful to vaccinate the populations at risk in
Bangladesh with OCV. A single dose of Shanchol can be protective in children over the age
of 5 and adults, and Shanchol can be delivered in field settings without using a cold chain.
However, the use of 1 dose of Shanchol, or OCVs like Shanchol, during an emergency
response in a cholera-endemic setting with immunologically primed individuals may be
considered in circumstances in which the supply of vaccine is limited—a likely scenario for
an increasing number of cholera vaccine campaigns while the current global shortage of
WHO-prequalified inactivated whole-cell OCVs persists. However, with locally produced
inactivated wholecell
OCVs becoming available, we are optimistic that introduction of a complete 2-dose regimen
for the population at risk in Bangladesh will be feasible in the near future. It is expected that
of the 160 million people of Bangladesh, at least 66 million will need protection from
cholera. However, for children under the age of 5, additional doses as well as further
research on more efficacious vaccines are needed to control cholera. Meanwhile, large-scale
vaccination with available vaccines can also provide indirect herd protection to children in
high-risk settings.

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References

 https://www.who.int/news-room/fact-sheets/detail/cholera
 https://academic.oup.com/jid/article/218/suppl_3/S171/5085578
 https://www.who.int/news-room/fact-sheets/detail/cholera
 https://www.who.int/topics/cholera/about/en/
 https://www.cdc.gov/cholera/illness.html
 https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-
20355287
 https://www.cdc.gov/cholera/diagnosis.html
 https://www.who.int/topics/cholera/publications/WHO_CDD_SER_91_15/en/

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