CHOLERA
BY : RAJLAXMI P. RASAL
ROLL NO: 30
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Introduction
Acute diarrhoeal disease
Caused by Vibrio cholerae O1(Classic or El Tor) & O139
Sudden onset of profuse, effortless watery diarrhoea
followed by vomiting , rapid dehydration , muscular
cramps, supression of Urine
Can cause death within hours if untreated
Both Epidemic and Endemic Disease
CHOLERA
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Cholrea
AGENT FACTORS
Incubation Period
Bacteria: Ranges from 1 to 5 days
Vibrio cholerae Commonly: 1–2 days
Bacteria recovered form
Serogroups:O1 & O139 Stools & Vomit of both
cases and carriers
Serogroup O1 has 2 biotypes
Classic Infective Dose :
El Tor 10¹¹microbes for a
healthy Person
Transmission: Faeco-oral route 3
Survival & Destruction of V. cholerae
Killed by heat:
56°C in 30 minutes
Boiling kills in seconds
Survives in ice:
For 4–6 weeks or longer
Destroyed by:
Sunlight & drying in a few hours
Disinfectants:
Coal tar compounds (e.g., cresol)
Bleaching powder: kills instantly at 6 mg/L
El Tor biotype: More resistant than classical strains
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Age & Sex:
Host Factors :
Affects all ages and both sexes
In endemic areas, children have the highest attack rate
Gastric Acidity:
Acts as a natural barrier
Vibrio destroyed at pH ≤ 5
Low acidity may increases susceptibility
Population Mobility:
Events like pilgrimages, festivals, marriages increase risk
Modern travel spreads infection across borders
Economic Status:
Higher incidence in lower socio-economic groups
Due to poor sanitation and hygiene
Immunity:
Natural infection offers temporary immunity
IgA antibodies develop in intestines
Serum antibodies (vibriocidal, ≥1:20) may protect briefly
Vaccines give partial immunity for 3–6 months 5
Source Of Infection
Both clinical and subclinical cases.
Clinical Cases
25%
Subclinical cases which account for 75per cent of all cases
appear to be responsible for maintaining the cycle of
infection.
Among people who develop symptoms, about 20 per cent
develop acute watery diarrhoea with severe dehydration.
People with low immunity, e.g., malnourished children and Sub-Clinical Cases
75%
people living with HIV are at a greater risk of death if
infected
Carriers are usually temporary , rarely chronic: 4 types
1. Preclinical/incubatory
2. Convalescent
3. Contact/Healthy
4. Chronic
Period Of Communicability
Case of Cholera is
infectious : 7-10 days
Convalescent Carriers :
infectious 2-3 weeks
Chronic Carriers : 1 month
to 10 yrs
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Environmental Factors
Transmission of Vibrio cholerae
1.Main route:
Through contaminated water and food
2.Environmental factors:
Poor sanitation
Contaminated sources (especially water)
Flies may carry bacteria but are not proven
vectors
3. Social factors (especially in India):
Practices that pollute water and soil
Poor personal hygiene
Lack of education
Low standard of living
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Clinical Features
• Severity depends on speed and duration of fluid loss
• >90% El Tor cases are mild and resemble other
diarrhoeas
2. Stage of Collapse
1. Stage of Evacuation • Due to severe dehydration Signs:
• Abrupt onset • Sunken eyes, hollow cheeks
• Profuse, painless watery diarrhoea (“rice water” • Scaphoid abdomen
Typical 3
stools) • Washerman’s hands & feet
Stages of • Absent pulse, low BP, low urine output
• Vomiting
• Up to 40 stools/day Cholera • Intense thirst, cramps, restlessness
• Death may occur from dehydration and acidosis
3. Stage of Recovery
• If patient survives, gradual improvement begins
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Note: The vibrios do not invade tissues; their
Ingestion : V.cholerea enterotoxin acts only on the small intestine.
Penetrates mucus layer of intestinal Profuse and watery diarrhoea
epithelium (via mucinase).
Adheres to intestinal epithelium – via Secretion of isotonic fluid & electrolytes
adherence factor
Produces : Enterotoxin consiting of 2parts ↑ intracellular cAMP
L (light) toxin + H(heavy) toxin
L-toxin binds gangliosides (irreversible). H-toxin activates adenyl cyclase.
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Three main types of oral vaccines available
1. Dukoral (WC-rBS)
Vaccination
Type: Monovalent (killed V. cholerae O1 + recombinant B subunit of cholera toxin)
Age group: ≥2 years
Buffer required to protect B subunit from gastric acid
Dosage:
Adults & children ≥6 years: 2 doses (≥7 days apart, <6 weeks)
Children 2–5 years: 3 doses (≥7 days apart, <6 weeks)
No food/drink 1 hour before & after dose
Booster:
After 2 years (≥6 years)
After 6 months (2–5 years)
Not licensed for children <2 years
Storage: 2–8°C, shelf life 3 years
Protection starts ~1 week after last dose
2. Sanchol & mORCVAX
Type: Bivalent (killed V. cholerae O1 & O139)
Do not contain toxin B subunit →
no buffer needed
Dosage:
≥1 year: 2 doses, 14 days apart
Booster: After 2 years
mORCVAX is similar to Sanchol (prequalified in 2015)
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The live attenuated vaccine (CVD103-HgR) is no longer produced.
Treatment Cholera
Rehydration is key
Oral Rehydration Salts (ORS)
IV fluids (Ringer’s Lactate) in severe
cases
Antibiotics for moderate/severe cases:
Doxycycline
Azithromycin
Tetracycline
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Preventation & Control
Safe drinking water
Sanitation & hygiene
Health education
Cholera vaccines (Oral):
Shanchol
Dukoral
Euvichol
Surveillance during outbreaks
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Thank you
very much!
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