Cholera is a acute diarrhoeal disease caused by Vibrio cholerae. Majority of infection are mild or asymptomatic. IV B.PHARM, 8-SEMESTER ,SOCIAL AND PREVENTIVE PHARMACY. CHOLERA DISESASE DEFINITION, SYMPTOMS, CAUSES, TREATMENT, PREVENTION.

1. CHOLERA
BY;
GOWTHAMRAJ.S, B.PHARM.,
EXCEL COLLEGE OF PHARMACY,
NAMAKKAL , TAMILNADU .

2. CHOLERA
 Cholera is an acute diarrhoeal disease caused by Vibrio Cholerae O1 and V.Cholerae O139.
 The majority of infections are mild or asympatomatic.
 It mainly affect the lumen of the stomach.
 It is characterized by intense vomiting and profuse watery diarrhoea and that rapidly leads to
dehydration and often death.
 It is often mild or without symptoms.
 It can affect all age groups and majorly children are affected
and may also leads to death.
INCUBATION PERIOD
 Few hours up to 5 days , but commonly 1-2 days.

3. VIBRIO CHOLERAE
 It is comma – shaped.
 Gram negative , aerobic or facultative anaerobic bacillus.
 Varies in sixe from 1-3Âμm in length by 0.5-0.8Âμm in diameter.
 Grows in salt and fresh water.
 Only O1 and O139 are toxigenic and cause cholera disease.
 Its antigenic structure consists of
a. Flagellar H antigen
b. Somatic O antigen
 Bacteria are easily destroyed by coaltar disinfectants such
as cresol and bleaching powder.
 The vibrios multiply in the lumen of the small intestine
and produce an exotoxin.

4. SYMPTOMS
 Effortless
 Fever
 Watery diarrhoea
 Vomiting
 Rapid dehydration
 Muscular cramps
 Suppression of urine
 Leg cramps
 Dry mouth
MUSCLE CRAMPS

5. MODE OF TRANSMISSION
A. FAECALLY CONTAMINATED WATER
Uncontrolled water sources such as wells, lakes, ponds, streams, and rivers.
B. CONTAMINATED FOOD AND DRINKS
Ingestion of contaminated food and drinks have been causes the cholera disease.
C. DIRECT CONTACT
Person to person transmission through contaminated fingers while carelessly handling excreta
and vomit of patients and contaminated linen and fomites.

6. OTHER CONDITIONS OF TRANSMISSION
 Cholera transmission is closely linked to inadequate environmental management
 Urban slums – where basic infrastructure is not available
 Areas where consequences of disaster
 Distruption of water and sanitation system
 Displacement of population to inadequate and overcrowded camps
 Poor drainage and contaminated food and water
 Open air defection

7. EPIDEMIOLOGY
 Cholera is both an epidemic and endemic disease.
 The epidemicity and endemicity of the disease depends on characteristics of the agent and the
prevailing environment.
EPIDEMICS
 Cholera are characteristically abrupt and often create an acute public health problem.
 They have a high potential to spread fast and causes death.
 Thus cholera epidemic in a community is self- limiting.
 “ force of infection” – two components – infection through water and the contacts.

8. ENDEMICS
 In areas where cholera is endemic, it does not show a stable endemicity like typhoid fever.
 It undergoes seasonal fluctuations as well as epidemic outbreaks.
 The seasonal variation differs between countries and even between regions of the same country.
 Eg: the disease used to be most common in the summer in Kolkata and in early winter in
Bangladesh ; in both places frequent in autumn.
 In some parts of India the peak incidence is in Augest.

9. EPIDEMIOLOGICAL DETERMINANTS
 AGENT FACTORS
 HOST FACTORS
 ENVIRONMENTAL FACTORS
AGENT FACTORS
AGENT : agent which involves in the cause for cholera
1. The organism that causes cholera is labelled as V. cholera O group 1 or Vibrio choleraeO1
and O139.
2. Vibrio cholera are killed within 30mins by heating at 56 deg C or by boiling.
3. Infective material
4. Infective dose

10. HOST FACTORS
AGE AND SEX:
 it affects all ages and both sexes.
 in endemic areas , attack rate is higher in children
GASTRIC ACIDITY
 An effective barrier. The vibrio is destroyed in an acidity of pH 5 or lower.
 Conditions that reduce gastric acidity may influence individual susceptibility
POPULATION MOBILITY
 Movement of population – like, pilgrimages, marriages , festivels.
 In this cases carriers can easily transfer infection to other countries.

11. IMMUNITY
 An attack of cholera is followed by immunity to reinfection, but the duration and degree if immunity are
not known.
 Vibriocidal antibodies in serum have been associated with protection against colonization and disease
 The presence of antitoxin , antibodies has not been associated with protection.
 Vaccination gives only temporary, partial immunity for 3-6 months.
ENVIRONMENTAL FACTORS
 Readily possible in a community with poor environmental
sanitation include contaminated water and food.
 It comprise of favouring water and soil pollution, low standards of
personal hygiene, lack of education and poor quality of life.

12. PATHOPHYSIOLOGY
V.Cholerae accumulates in stomach
Produce toxins
Toxins will bind to G- protein coupled receptor
Inactivation of GTP ase
G- protein stuck in “on” position
Increase c AMP
Activation of ion channels
NaCl influx into intestinal lumen to drag water into lumen
Lead to watery diarrhoea

14. DIAGNOSIS
 Stool culture
 Confirm presence of cholera toxin
 Cholera rapid test dipsticks
STOOL CULTURE
 Rectal swab method
 Cather method
 Blotting paper method
CONFRIM PRESENCE OF CHOLERA TOXIN
 Culture of stool specimen on selective
thiosulfate – citrate- bile salts – sucrose (TCBS) agar plate
 Yellow colonies are formed
CHOLERA RAPID TEST
 The sensitivity and specificity of the test is not optimal

15. TREATMENT
 REHYDRATION THERAPY
 ANTIMICROBIAL THERAPY
REHYDRATION THERAPY
 Oral – administered through oral route – powder or liquid dose
 Intravenous – administered through I.V. route – parental dose
PHASES
 Rehydration phase
1. restore normal hydration status , should take no more than 4 hours
2. lactated ringer solution is prefered over isotonic sodium chloride solution
3. 50-100ml/kg/hr
 Maintanence phase
1. the goal of maintanence phase is maintain normal hydration status by replacing ongoing
losses.
2. the oral route is preferred , the use of ORS at a rate of 500-1000 ml/hr
3. fluids should never be restricted

16. ANTIMICROBIAL THERAPY
It is useful for
 Prompt eradication of the vibrio
 Diminish the duration of diarrhea
 Decrease the fluids loss
Antibiotics should be administered to moderate or severe cases
AGE DRUG
Adults doxycycline , 300mg po single dose
Azithromycin 1g po single dose
Pregnant Erythromycin 500mg/ 6 hours for 3 days
Children >3yrs Erythromycin 12.5mg/kg/ 6 hours for 3 days
Children <3yrs Erythromycin 12.5mg/kg/ 6 hours for 3 days

17. CONTROL OF DISEASE
 Verification of the diagnosis
 Notification
 Early case finding
 Establishment of treatment centres
 Rehydration therapy
 Adjuncts to therapy
 Epidemiological investigations
 Sanitation measures
 Chemoprophylaxis
 Vaccinations
 Health education

18. 1.VERIFICATION OF THE DIAGNOSIS
 It is important to have conformation of the outbreak as soon as possible
 It is very imoortant for the diagnosis of cholera in the early stages.
 Once the presence of the cholera has been confirmed , it is necessary to culture stools of all cases or contacts
 There should be a well organized system of laboratory services in the community
2.NOTIFICATION
 Cholera is notifiable to the WHO within 24 hours of its occurance by the national government
 The number of cases and deaths are also to be reported daily and weekly till the area is declared free of
cholera
3.EARLY CASE FINDINGS
 Early detection of cases also permits the detection of infected house hold contacts and spread of the diseases
 Early finding of the cases helps in control of the spread of the cholera
 It take part in the making awareness and safety measures to reduce the spread of the cholera

19. 4.ESTABLISHMENT OF TREATMENT CENTRES
 It is necessary to establish easily treatment facilities in the community
 The mildly dehydrated patients should be treated at home with oral rehydration fluid
 Severly dehydrated patients , requiring intravenous fluid should be admitted to the nearby hospital or
treatment centres
 If less hospital facilities which are not sufficient , then the nearby school or govt. buildings can be take
over and converted into temporary treatment centres.
 In the risk situation there should be a sufficient hospital or treatment centres with standard medical
facilities
5.REHYDRATION THERAPY
 In cholera, the rehydration may be oral or intravenous
 During vomiting and diarrhoea conditions there is a loss of electrolytes and body fluids from the body
 Rehydration therapy involves in the retention of the electrolytes and body fluid in the body during the
diseased conditions
 ORS ( Oral Rehydration Salt ) is the powder or in liquid dose which is majorly used in the rehydration
therapy.

20. REDUCED ORS gm/lit
NaCl 2.6
Glucose, anhydrous 13.5
Potassium chloride 1.5
Trisodium citrate,
dehydrate
2.9
Total weight 20.5
REDUCED ORS Mol/lit
Sodium 75
Chloride 65
Glucose, anhydrous 75
Potassium 20
Citrate 10
Total weight 245
Age <4
months
4-11
months
1-2 yrs 2-4 yrs 5-14 yrs 15yrs<
Weight(kg) <5 5-7.9 8-10.9 11-15.9 16-29.9 30<
ORS SOLUTION
(ml)
200-400 400-600 600-800 800-1200 1200-2200 2200-4000
Guidelines for oral rehydration therapy during first four hours
COMPOSITION OF ORS

21. 6.ADJUNCTS TO THERAPY
 Antibiotics should be given as soon as vomiting has stopped
 After 3 to 4 hours of oral rehydration
 The commonly used antibiotics are
Flouroquinolones
Tetracyclines
Ampicilline
Azithromycin
 No other medication should be given to cholera patients like antidiarrhoeals, antiemetics,
antispasmodics, steroids.
 If diarrhoea perisists after 48hours of treatment , the antibiotic resistance is suspected
7.EPIDEMIOLOGY INVESTIGATION
 Epidemiology studies must be undertaken to define the extent of the outbreak and identify the modes
of transmission so that specific control measures can be applied

22. 8. SANITATION MEASURES
a. WATER CONTROL
 Water is the most important vehicle of transmission of cholera
 All steps must be taken properly to provide safe water for drinking, cooking and washing
 In rural areas water can be made safe by boiling or by chlorination
 The drinking water should be stored in covered containers
b. FOOD SANITATION
 Food is also a factor which involves in the infection
 The food should be cooked full and stored in the closed containers
 Cooking utensils should be cleaned and dried after use
 The housefly play important role in transmission of disease so the food should be covered and
sanitation should be followed
c. DISINFECTION
 The most effective disinfectant for general use is a coal disinfectant with Eideal-Walker (RW)
coefficient of 10 or more such as cresol
 Bleaching powder used should be of good quality
 Patients stools and vomiting cloths and other personal items should be washed with the
disinfectants and should be handle safely

23. 9.CHEMOPROPHYLAXIS
 Chemopropylaxis refers to the administration of medication to prevent disease or infection.
 In the case of cholera , healthy individuals are given antibiotics with the aim of protecting them
against the disease, limiting the spread of the disease and curtailing an epidemic.
 Tetracycline is the drug of choice for chemopropylaxis.
 It has to be given twice daily for 3 days at dose of 500mg for adults, 125mg for children (4-
13yrs), 50mg for children (0-3yrs).
 A single oral dose of doxycycline – 300mg for adults and 6mg/kg for children under 15yrs.
10. VACCINATIONS
ORAL VACCINE
a. Dukoral (WC-rBS)
b. Sanchal and mORCVAX
11. HEALTH EDUCATION
Health education provides the knowledge about the disease and preventions
a. Food hygiene practices.
b. Hand washing after defecation and before eating.
c. The benefit of cooked , hot foods, and safe water.

24. PREVENTION
 Drink and use hot or safe water
 Wash hands often with soap and safe water
 Cook food well, keep it in a covered , eat it hot, and peel fruits and vegetables
 Clean up safely – in the kitchen and in places where the family bathes and washes cloths
 Use flush toilets or approved septic system ; double bag soiled materials when discarding in trash
 Possible , use rubber gloves when cleaning any room or surface that may contact with patients with
the patients fecal matter
 Use any household disinfectant or a 1:10 dilution of bleach solution to clean any area that may
have contact with fecal matter including the patients
 Personal hygiene should be followed in perfect guidelines.

25. THANK YOU…
STAY HOME STAY SAFE