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What you need to know about recent cholera outbreak in Nigeria

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According to The World Health Organisation, Cholera is an acute diarrhoeal infection caused by ingesting 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.

There was a call for heightened guidelines against cholera by the Lagos State Government after they had reported cases of death from the outbreak. In the statement, the Commissioner for Health, Akin Abayomi, noted,  

“We have activated statewide heightened surveillance and response and have been alerted to investigate a possible water contamination source in the Lekki Victoria Island axis. We suspect a possible cholera outbreak; however, samples have been taken for confirmation. As of April 28, 2024, Nigeria reported 815 suspected cholera cases and 14 deaths across 25 states.”

Cholera can cause severe acute watery diarrhoea, and the severe forms of the disease can kill within hours if left untreated. The risk of a cholera epidemic is highest when poverty, war or natural disasters force people to live in crowded conditions without adequate sanitation.

Cholera can be endemic or epidemic. A cholera-endemic area is where confirmed cholera cases were detected during the last three 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.

Causes of cholera

A bacterium called Vibrio cholerae causes cholera infection. The deadly effects of the disease result from a toxin the bacteria produce in the small intestine. The toxin causes the body to secrete enormous amounts of water, leading to diarrhoea and a rapid loss of fluids and salts (electrolytes). 

Cholera bacteria might not cause illness in all exposed people, but they still pass the bacteria in their stool, which can contaminate food and water supplies. Contaminated water supplies are the main source of cholera infection. The bacterium can be found on surfaces, well water, seafood, raw fruits and vegetables, and grains. 

Risk factors

Cholera bacteria can not survive in an acidic environment; ordinary stomach acid often serves as a defence against infection. However, 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 are at greater risk of cholera.

You are also at risk if you live with a person suffering from cholera. Cholera is more likely to flourish when a sanitary environment, including a safe water supply, is difficult to maintain. Such conditions are common in refugee camps, impoverished countries, and areas of famine, war, or natural disasters.

Symptoms 

According to the Mayo Clinic, most people exposed to the cholera bacterium (Vibrio cholerae) don’t become ill or know they have been infected. However, because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water.

Some symptoms include diarrhoea, nausea and vomiting, and dehydration. Other signs are irritability, fatigue, sunken eyes, a dry mouth, extreme thirst, dry and shrivelled skin that’s slow to bounce back when pinched into a fold, little or no urinating, low blood pressure, and irregular heartbeat.

Cholera-related diarrhoea comes on suddenly and can quickly cause dangerous fluid loss of as much as about 1 litre an hour. Due to cholera, diarrhoea often has a pale, milky appearance that resembles water in which rice has been rinsed.

Prevention 

A multifaceted approach is key to controlling cholera and reducing deaths. Surveillance, water, sanitation and hygiene, social mobilisation, treatment, and oral cholera vaccines are some of the steps for control of the disease. 

Wash your hands frequently with soap and water, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water aren’t available, use an alcohol-based hand sanitiser.

You can use bottled water or water you’ve boiled or disinfected yourself. You can even use bottled water to brush your teeth.

Hot beverages and canned or bottled drinks are generally safe, but wipe the outside before you open them. Don’t add ice to your drinks unless you made it yourself with safe water.

If possible, eat completely cooked and hot food, and avoid food vendors on the street. If you buy a meal from a street vendor, ensure it’s cooked in your presence and served hot.

Treatment 

Cholera is an easily treatable disease. Most people can be treated successfully by promptly administering oral rehydration (ORS). 

Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids. These patients are also given appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of cholera excretion in their stool.

Patients should also seek medical advice and views immediately when they feel signs and symptoms to get a proper diagnosis and treatment. 

The Commissioner of Health in Lagos State also advises citizens to rely on the Lagos State Ministry of Health, NCDC, and other accredited local health facilities for guidance, advice, and updates on prevention, treatment, and management.

Expert Opinion 

We also spoke to Subulade Owo, a Public Health Officer specialising in preventive measures and control. He explained that Cholera is a bacterial infection found in an infected person’s faeces. Some people might show symptoms, others may have mild symptoms, and some may be very serious. 

The cholera outbreaks happen in unhygienic places, overcrowded and slums. He noted that cholera is most likely linked to a lack of access to clean water and slums. 

Mr Owo noted that the government and individuals have roles to play in preventive measures. He mentioned that the government should maintain good housing systems, monitor waste disposal, and ensure strict compliance with these. 

For individuals, he emphasised the need for good hygiene and sanitation to practise hygienic toilet standards. “Communities that are overcrowded should ensure they have committees that would set standards on cleaning to ensure a clean and tidy environment and abolish open defecation,” he noted. 

He finally noted that people with symptoms should not self-medicate but go to the hospitals for proper checkups and receive adequate treatments, and vaccines can help during outbreaks. 

Another public health officer, Kedei Ibang, explained that cholera is a highly infectious bacterial disease that affects the intestines and causes diarrhoea and vomiting. It is caused by the bacterium Vibrio cholerae, usually found in contaminated food, water, or surfaces.

She emphasised the importance of prevention and treatment. To prevent cholera, people should drink safe and clean water, wash their hands regularly with soap and clean water, avoid eating undercooked or raw foods, and avoid close contact with sick people.

“⁠Please go to the hospital if you suspect you may have contacted Cholera. It can be treated with Oral rehydration therapy (ORT) to replace lost fluids and electrolytes and antibiotics to shorten the duration of the illness, visit the hospital and do not self-medicate,” she wrote.

Conclusion

Cholera is a preventable and treatable disease. By practising good hygiene, drinking clean water, and seeking medical attention if symptoms occur, we can prevent the spread of cholera and keep our communities safe.

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