community medicine

1. CHOLERA

2. Cholera is an acute diarrheal illness caused by Vibrio
cholera 01 OR O139
V.CHOLERA O1 Classical and El tor biotype
CHOLERA

3. EPIDEMIOLOGY
1
2 2
3
5
CATEGORY 1 CATEGORY 2 CATEGORY 3 CATEGORY 4
24%INCREASE IN BURDEN OF
CHOLERA FROM 2000-2004 TO 2004-
2008
2000 -2004 2004-2008

4. BURDEN OF INFECTIOUS
DESEASES IN PAKISTAN
ACUTE
RESPIRATORY
INFECTIONS
51%
MALARIA
16%
VIRAL HEPATITIS
8%
DIARRHEA AND
DYSENTRY
23%
OTHERS
2%
ACUTE RESPIRATORY INFECTIONS
MALARIA
VIRAL HEPATITIS
DIARRHEA AND DYSENTRY
OTHERS

5. CHOLERA
EPIDEMIC ENDEMIC
AGENT
ABILITY TO SURVIVE
IN A GIVEN
ENVIRONMENT
VIRULENCE
ENVIRONMENT
SUSCEPTIBILITIES OPPORTUNITIES

6.  CASES
 CARRIERS
I. PRECLINICAL OR INCUBATORY CARRIER
II. CONVALLSCENT CARRIER
III. HEALTHY CARRIER
IV. CHRONIC CARRIER
CASES AND CARRIERS

7. a) AGENT
b) RESISTANCE
c) TOXIN PRODUCTION
d) RESERVOIR OF INFECTION
e) INFECTIVE MATERIAL
f) INFECTIVE DOSE(ID)
g) PERIOD OF COMMUNICABILITY
EPIDEMIOLOGICAL
DETERMINANTS
AGENT FACTORS

8. a) AGE AND SEX
b) GASTRIC ACIDITY
c) ECONOMIC STATUS
d) IMMUNITY
e) LACK OF HEALTH EDUCATION
f) POOR PERSONAL HYGIENE
HOST FACTORS

9. ENVIRONMENTAL FACTORS
Drinking
contaminat
ed water.
eating raw
or
undercook
ed shellfish

10. a) Fecaly contaminated water
b) Fecaly contaminated foods and drinks
c) Direct contact
MODE OF TRANSMISSION
Man Man

11. MECHANISM OF ACTION OF
CHOLERA TOXIN

12. Stage of
evacuation
• Onset is
abrupt
• Profuse
diarrhea 40
stools in a
day
Stage of
collapse
• Sunken eyes
• Hallow
cheeks
• Subnormal
temparature
Stage of
recovery
• Mild cases
will recover
in 1-3 days

13. Most people remain asymptomatic. The symptoms of
cholera include :
SIGNS & SYMPTOMS
profuse, watery
diarrhea
stomach
pains
leg cramps Mild fever
Vomiting Sunken eyes
and cheeks
Dry mucous
membranes
Decreased
urinary output

14. severe dehydration Shock Renal failure
Death
COMPLICATIONS

15. STOOLS FOR D/R &C/S
1-3LITRE OF WATER&1-3g OF SUSPECED
WATER AND FOOD IS COLLECTED FOR
CHEMICAL ANALYSIS
DIRECT HEMAGLUTINATION TES
LABORATORY INVESTIGATIONS

16. CONTROL OF CHOLERA
 VERIFICATION OF THE DIAGNOSIS
 NOTIFICATION
 EARLY CASE FINDING
 ESTABLISHMENT OF TREATMENT CENTERS
 ORAL REHYDRATION THERAPY
 SANITAION MEASURES
 CHEMOPROPHYLAXIS
 VACCINATION
 HEALTH EDUCATION

17. Oral rehydration salts
• Up to 80% of cases can be treated through this.
Intravenous fluids (Ringer lactate)
• For severe cases.
Antimicrobial Therapy
• can diminish duration of diarrhea, reduce volume
of rehydration fluids needed, and shorten duration
of V. cholerae excretion.
TREATMENT

18. ORS BICARBONATE
INGREDIENTS QUANTITY
Na bicarbonate 2.5gm
NaCl 3.5gm
Potassium chloride 1.5gm
glucose 20gm
INGREDIENTS QUANTITY
Na Citrate dehydrate 2.9gm
NaCl 3.5gm
Potassium chloride 1.5gm
glucose 20g
ORS CITRATE

19. THANK YOU