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Cholera disease is one of the common traveling diseases. Causes of cholera during traveling include eating raw meat, contaminated water, and roadside food.

Travelling Diseases | Cholera | Causes | Treatment| Meri Sehat

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How To Avoid Cholera? Advice For Travelers!

Iqra Mazhar

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Cholera Outbreaks – Prevention Strategies For Locals (Pakistan)

Introduction

When a disease spreads in an area, it can be reduced through early detection and case confirmation. It should be followed by an appropriate and well-coordinated multisectoral response. Moreover, for a rapid response to outbreaks, countries under the effect of <a href="https://www.merisehat.pk/disease/cholera">cholera</a> should plan in accordance.

&nbsp;

Understanding Cholera Prevention Strategies In Pakistan

The common sources are:

<ul>
	<li>Contaminated water sources, which are used in cooking and washing food. It can also happen during storage, for example, through feces or cholera-soiled hands.</li>
	<li>Fecal contamination of water that we drink through unprotected wells, standpipes, and boreholes. This can happen during transport and supply, as well as when the water is being supplied.</li>
	<li>Washing uncooked food with contaminated water. Making drinks with contaminated water that is not boiled, or making ice with contaminated water.</li>
	<li>If the food is contaminated with V. cholerae and left at room temperature for hours, it can provide an environment for the growth of cholera.</li>
	<li>Contaminated seafood or seafood that hasn&rsquo;t been cooked sufficiently.</li>
	<li>Fruits and vegetables are grown in contaminated soil, and irrigated with water that consists of human waste. Even rinsing it with contaminated water and eating it raw can put you at risk of cholera.</li>
	<li>The other source of contamination is the bodies of people who have died from cholera, similar to the unfortunate <a href="https://www.merisehat.pk/disease/covid-19">COVID19</a> situation.</li>
	<li>Members of the same community are at risk if someone in their area has cholera. This especially applies to people who live in the slums in Pakistan.</li>
</ul>

&nbsp;

<ul>
</ul>

<ul>
	<li>The epidemic of cholera is controllable, if the people who have been diagnosed take the necessary precautions against the causes mentioned earlier.&nbsp;</li>
	<li>Developed and harmonized&nbsp;messages via mobile networks can ensure the prevention of cholera. Furthermore, surveys and outreaches can determine people&rsquo;s knowledge about it, while simultaneously raising awareness about the disease.</li>
	<li>The message should be about the ongoing cholera outbreak, and guide people on how they should wash their hands, chlorinate, or boil water, with guidance on the preparation of ORS.</li>
	<li>Adaptation of messages based on local cultural beliefs about the disease and implementation of control based on that. For example, chlorinated soap isn&rsquo;t easily available in Pakistan, so other alternatives can be recommended.</li>
</ul>

&nbsp;

&nbsp;

<h5>Safe Drinking Water</h5>

It is essential that people have access to safe drinking water, so the spread of the disease is reduced in the community. If possible, safe drinking water should be provided to people whose areas are at high risk of cholera.

Even when the water to drink is safe, it can still be exposed to cholera and contaminated during transport. Hence, start with an improved source of water and ensure safe collection and handling. Analyzing the context can determine which method is best for treating water and select it accordingly. The treatment methods include disinfection, chlorination, and filtration. It can be chosen based on the available techniques. Moreover, combining treatments can increase effectiveness.

Although in places with high turbid water, pre-treatment may be needed to remove suspended particles. In addition to reducing the turbidity before disinfection chlorination. A turbidity tube can test the turbidity levels.

However, if the quality of water does not have a guarantee, which is very common in Pakistan, it needs to be disinfected when used. For example, boil the water you drink for at least one minute, use filters, get a dispense, and store containers for boiled water.

&nbsp;

<h5>Household Water Treatment</h5>

Various methods are available for treating household water, for example, disinfection, boiling, filtration, and chlorination.&nbsp;

Make sure that people understand the importance of household treatment techniques and the effects of chlorine resides if they use it. Furthermore, to facilitate preparing household water correctly, ensure that the containers are the right size. It is preferred that they are narrow-mouthed and closed. Water quality is also important in houses where chlorine is being used for water treatment.

The collection, transport, and handling of water should also be safe. To ensure water quality, it should be monitored regularly for the minimization of microbial regrowth. Other than the type of preferred containers, they should be cleaned regularly to prevent contamination while refilling and extracting water.

Ensure the cleanliness of the drinking water. Keep it covered at all times.

&nbsp;

<h5>Safety Measures For Healthcare Workers</h5>

Healthcare workers should be guided in teaching their patients the importance of clean water. They should also be educated about maintaining hand hygiene while filling and extracting water. It reduces the risk of contamination.

Community development in addition to monitoring can also provide access to safe water for cholera prevention.

&nbsp;

It is important to prepare food safely to prevent and reduce the transmission of cholera within a community. The food can be contaminated during production, preparation, and consumption. Safe and hygienic food preparation should be a part of the healthy hygiene program.&nbsp;

Street food is very common in Pakistan and people indulge in eating it regularly. But since the food is not always hygienic, it can make you sick. Moreover, if proper sanitation is not followed, it can spread cholera.&nbsp;

Pakistan Food Authority can introduce stringent food safety laws and inspection of restaurants (increased frequency). Food vendors should be educated on the consequences of unsafe food practices, so they may avoid them in the future. Moreover, agricultural practices should also be taken into consideration, e.g., sewage water should not be used to irrigate crops.

Reinforce practicing safe preparation of food. Furthermore, hand hygiene and washing hands before eating food should also be reinforced. Soap and safe water should also be available in markets selling food.&nbsp;

&nbsp;

Faeces should be isolated to stop them from contaminating food and water with faecal matter. This can be ensured by improving access to sanitation facilities. For example, latrines should be in places where they will not contaminate the water that people drink or the source of drinking water. It should be at least thirty meters away from any source of drinking water. In addition, it should be two meters above groundwater.

Open defection should be discouraged. People need to be taught about using the restrooms, especially in lower socio-economic areas where access to bathrooms is limited. Moreover, if latrines need to be emptied, avoid doing so during cholera outbreaks or take the necessary precautions. It should also be ensured that the waste is disposed of safely.

Furthermore, healthcare workers should also ensure that washing their hands after defecation is important. They should also wash their hands after making their kids use the latrine.

&nbsp;

Conclusion

Thousands of people in central Pakistan have been infected by the deadly cholera outbreak as the country is also suffering from a water crisis. The crisis has been exacerbated because of the heatwave in South Asia.

The temperatures have increased drastically in Pakistan and other parts of Asia recently, putting millions of people at risk of climate change.

The first case of cholera was identified in Pir Koh, which is a mountainous area in the province of Balochistan on 17th April 2022. According to Dr. Ahmed Baloch from the health department of Balochistan, since then, more than two thousand people have become infected and died.&nbsp;

Due to the lack of rain, the ponds have dried up and there is no access to clean drinking water. The ponds have dried up in most areas and the only source of water to drink is from the pipelines, which are rusted and contain contaminated water. The residents are forced to drink dirty water.

The cholera outbreak is transmitted by consuming dirty food and water, which is contaminated by fecal material infected with V. cholerae.&nbsp;

Scientists have warned of the impact of climate change, and have told people that rising temperatures can cause the spread of the cholera pathogen<a href="#accordion">[1]</a>. The outbreak is happening because Pakistan is facing a serious water crisis. Climate change has a severe impact on the health of humans.

&nbsp;

Key Points

<ul>
	<li>To prevent yourself from getting cholera, make sure you drink water that is boiled or filtered. Do not eat raw seafood, and fruits and vegetables that have been washed with water that is not clean. If it is not possible to boil water, chlorine tablets should be used.&nbsp;</li>
	<li>Healthcare workers should also advise their patients about the importance of clean water and hygiene.</li>
	<li>Do not pass your stool in any kind of water. If you don&rsquo;t have access to a latrine, bury it in the soil.</li>
</ul>

&nbsp;

[1] Asadgol, Z., Mohammadi, H., Kermani, M., Badirzadeh, A. and Gholami, M., 2019. The effect of climate change on cholera disease: The road ahead using artificial neural network. PloS one, 14(11), p.e0224813.

[2] D’Mello-Guyett, L., Gallandat, K., Van den Bergh, R., Taylor, D., Bulit, G., Legros, D., Maes, P., Checchi, F. and Cumming, O., 2020. Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: a scoping review of current international guidelines. PLoS One, 15(1), p.e0226549.

[3] Morris Jr, J.G. and Black, R.E., 1985. Cholera and other vibrioses in the United States. New England Journal of Medicine, 312(6), pp.343-350.

[4] Colwell, R.R., 1996. Global climate and infectious disease: the cholera paradigm. Science, 274(5295), pp.2025-2031.

[5] Mendoza, C., Meites, E., Briere, E., Gernay, J., Morgan, O., Monegro, N.R. and Hospital Preparedness Working Group, 2011. Preparing health care workers for a cholera epidemic, Dominican Republic, 2010. Emerging Infectious Diseases, 17(11), p.2177.

Staff Writer

Cholera has a sudden onset brought on by the accidental ingestion of Vibrio <a href="https://www.merisehat.pk/disease/cholera">cholera bacteria</a>. The bacteria can infect an individual&rsquo;s intestines and cause severe diarrhea and dehydration. These complications can also be fatal.

Each year, millions of people are affected by <a href="https://www.merisehat.pk/disease/cholera">cholera</a> and bacterial infection is very common in regions with decreased availability of clean water and sewage control e.g. Middle East, Africa, Asia, and South America.

Moreover, cholera outbreaks are more common in places with warmer climates and may also occur as an aftermath of natural disasters such as earthquakes and hurricanes. Natural disasters can damage sewage systems and hence lead to an outbreak of cholera.&nbsp;

Although cholera is rare in the United States and other industrialized&nbsp;countries, everyone should be aware of it when traveling internationally.

&nbsp;

Understanding Cholera Prevention Strategies For Tourists

Cholera comes from the bacteria V. cholera and the main mode of spread is through contaminated feces. The bacteria spread when the infected feces contaminate the water system in places where the water is not sanitized properly. So, when people use that water to cook, drink, or wash, they risk exposure.

When someone eats the contaminated food or drinks the contaminated water bacterial growth commences in their body. The bacteria leak fluid into the small intestine, which leads to diarrhea.

Cholera does not spread from one person to another in most cases. However, it is important to wash your hands to prevent its spread. Some people have also gotten cholera from eating raw or undercooked fish, but it is a rare occurrence.

&nbsp;

Cholera infection is usually mild with no symptoms. However, 10% of the individuals develop symptoms that are severe. The symptoms start within twelve hours and can last upto five days after the bacteria is ingested. These include:

<ul>
	<li>Watery stools and diarrhea</li>
	<li>Extreme thirst</li>
	<li>Low amounts of urine</li>
	<li>Muscle cramps</li>
	<li>Nausea and vomiting</li>
	<li>Irritability and restlessness</li>
	<li>Lethargy and weakness</li>
</ul>

If you have any of the cholera symptoms, contact your doctor immediately. The mild symptoms go away on their own. However, if you have dehydration, it can become very deadly. Getting treated at the earliest can save your life.

&nbsp;

Diarrhea and vomiting due to cholera leads to dehydration and loosing valuable fluid and electrolytes (potassium and sodium etc.) from the body. These loses manifest in the form of the symptoms listed below:&nbsp;&nbsp;

<ul>
	<li>Dry mucous membrane in the eyes, nose, and mouth</li>
	<li>Tachycardia</li>
	<li>Low levels of potassium in the blood</li>
	<li>Low blood pressure</li>
	<li>Loss of elasticity of the skin</li>
</ul>

The symptoms of cholera, if severe dehydration is untreated, are:

<ul>
</ul>

<ul>
	<li>Kidney failure</li>
	<li>Shock</li>
	<li>Coma</li>
	<li>Death</li>
</ul>

&nbsp;

Cholera is tested through stool samples that are collected in a cup or bag. If needed, doctors can also check your rectum (anal opening) by inserting a swab.

The samples are then sent to a lab for testing where experts examine the samples under a microscope for the identification of V. cholera bacterium. In areas where cholera is more common, a dipstick tool is used to test the stool sample immediately (rapid testing).

&nbsp;

Reversing or preventing dehydration is of utmost importance in cholera. People suffering from cholera should replace the lost fluids and salts immediately.

Healthcare providers prescribe:

<ul>
	<li>ORS to drink in large amounts.</li>
	<li>IV fluids for cases of severe dehydration. The doctor may use large bore IV needles to directly pump the fluids into your veins.</li>
</ul>

Other treatments include the following:

<ul>
	<li>Antibiotics&nbsp;</li>
	<li>Zinc in children under the age of five</li>
</ul>

The bacteria V. cholera usually diminishes from the body within a period of two weeks.

&nbsp;

Foreigners visiting Pakistan or other low-socioeconomic countries can follow certain strategies to prevent cholera.

&nbsp;

<h5>Food And Drinks</h5>

<ul>
	<li>Eat food and drinks that are cooked and served hot. You can also eat well-packaged foods.</li>
	<li>Avoid buffet food and raw food, e.g., sushi.</li>
	<li>Eat raw vegetables and fruits after washing them thoroughly with clean water and peeling the skin off.</li>
	<li>Avoid drinking water from the tap, or water fountains, and sucking on ice cubes. This precaution also applies to the water you drink, use to wash dishes, prepare food, and brush your teeth. Use bottled water instead for all activities during your stay.</li>
	<li>Only drink factory-sealed beverages and drinks.</li>
	<li>If you do not have water filters or dispensers in your hotel/stay accommodation, boil the water before drinking. For bathing and washing purposes, you may boil the water for a few minutes and also add two drops of bleach (to every liter of water) or use chlorine tablets.</li>
	<li>Avoid using ice because it may have been made using dirty water unless you have frozen it yourself.</li>
	<li>Always opt for pasteurized milk.</li>
</ul>

&nbsp;

<h5>Hand Washing</h5>

<ul>
	<li>Wash your hands with soap, especially after using the bathroom and before eating food.</li>
	<li>If you don&rsquo;t have soap and water, use an alcohol-based sanitizer with at least 60% alcohol.</li>
	<li>Avoid touching your face and mouth with your hands.</li>
</ul>

<div>
<div class="container" style="max-width:1320px; padding:0px; width:966.007px">
<div class="content">
Although cholera vaccines are not available in Pakistan, a licensed cholera vaccine is available in the US called Vaxchora and is available for adults between the ages of 18 and 64 years<a href="#accordion">[1]</a>. The vaccine prevents severe diarrhea that is caused by the most common kinds of cholera-causing bacteria. As the number of places with active cholera is limited, the vaccine is not often required.

 
 
However, adults traveling to countries with active cholera transmission should consult their healthcare provider, to consider getting vaccinated. The following questions can help with this decision.

1. Is cholera common in the area that they are planning to visit?

2. What is the prevalence of cholera at their travel destination?

3. Which activities can put a person at risk for cholera?

4. Does the destination that they are choosing to visit have rapid treatment for cholera?

The most important treatment for cholera is fluid replacement for dehydration. In addition, antibiotics can shorten the length of the illness and prevent the loss of fluids in people who have severe cholera. Zinc treatment is also beneficial and has shown improvement in children with cholera.

&nbsp;
</div>
</div>
</div>

Cholera goes away on its own in a few days but if the symptoms are severe, you will start becoming dehydrated. In such cases, medical attention is needed. You should replace fluids immediately.

&nbsp;

CDC (The Centers of Disease Control and Prevention) has a website (the Travel Health Notice Website) where people can check about the current cholera outbreaks and other diseases.

If you are planning on traveling to an area prone to cholera outbreaks, make sure to follow all the previously mentioned precautions. You may also buy the items listed below for extra caution:

<ul>
	<li>Chlorine tablets</li>
	<li>Bleach</li>
	<li>Chlorine and iodine tablets</li>
	<li>Prepackaged food</li>
</ul>

&nbsp;

<ul>
	<li>Cholera is a bacterial disease that spreads through contaminated water and food.</li>
	<li>Most people who are infected will have mild or no symptoms and rehydration can treat it successfully.</li>
	<li>Severe symptoms include severe diarrhoea and dehydration, which if left untreated can be fatal.</li>
	<li>Prevention includes diligent hand washing, eating cooked food and using bottled water.</li>
	<li>Travellers from the US are advised to get vaccinated prior to their travel to areas prone to Cholera outbreaks.</li>
</ul>

[1] Gabutti, G., Rossanese, A., Tomasi, A., Giuffrida, S., Nicosia, V., Barriga, J., Florescu, C., Sandri, F. and Stefanati, A., 2020. Cholera, the current status of cholera vaccines and recommendations for travellers. Vaccines, 8(4), p.606.