Given the re-emergence of cholera in Haiti, PAHO/WHO recommends that Member States strengthen and maintain surveillance for cholera for the early detection of suspected cases and to provide adequate treatment to prevent its spread. Early and adequate treatment limits the case-fatality rate (CFR) of hospitalized patients to less than 1%.
PAHO/WHO encourages Member States to continue their efforts to ensure adequate basic sanitation conditions and access to drinking water, in addition to safe hygiene promotion and social mobilization, in order to reduce the impact of cholera and other waterborne diseases.
Cases dashboard
Confirmed and suspected cholera cases and deaths by administrative level
Recommendations
Under the International Health Regulations (IHR (2005)), public health events that involve the risk of cholera cases should be evaluated using the IHR Annex 2, and the WHO IHR Regional Contact Point should be notified accordingly.
Surveillance for cholera should be part of an integrated surveillance system within a country and should include timely feedback of information at local and global levels. It is recommended to use the WHO standardized case definition3 to obtain a more precise estimation of the cholera burden at the global level in order to define more sustainable support strategies.
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Monitor the trend of acute diarrhea diseases with an emphasis on adults.
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Immediate notification of all suspected cases from the local to the central and
peripheral levels.
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Investigation of all suspected cases and clusters.
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Laboratory confirmation of all suspected cases.
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Intensified surveillance with the inclusion of active case finding.
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Laboratory confirmation to monitor the geographic spread and resistance patterns.
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Weekly analysis of the number of cases and deaths by age, sex, geographical location, and hospital admission.
Cholera is a disease that responds satisfactorily to medical treatment. The first treatment goal is to replace fluids that have been lost by diarrhea and vomiting. Up to 80% of cases can be treated through early administration of oral rehydration salts (WHO/UNICEF oral rehydration salts standard sachet).
It is recommended to administer liquids intravenously to patients that have lost more than 10- 20 ml/kg/h or patients with severe dehydration. Following the replacement of the initial liquid lost, the best guide for fluid therapy is to record losses and gains in fluids and to adjust administration as appropriate.
The administration of appropriate antibiotics, especially in severe cases, shortens the duration of diarrhea, reduces the volume of hydration fluids necessary, and shortens the time V. cholerae is excreted.
The massive administration of antibiotics is not recommended because it has no effect on the spread of cholera and contributes to the production of bacterial resistance. With appropriate treatment the fatality rate is less than 1%.
In order to provide timely access to treatment, cholera treatment centers should be established in affected populations. These centers should be located at strategic points to maximize the number of affected individuals that can be treated outside of a hospital setting and based on management protocols defined by and agreed to by all parties.
Response plans must provide for coordination between treatment centers, healthcare centers, and levels of care in the communities in which they are located and should include the dissemination of proper hygiene practices and public health measures.
The diagnosis of cholera is established by the isolation of V. cholerae or by serological evidence of recent infection. It is important that public health laboratories in the Region are prepared to identify the two serotypes, Ogawa and Inaba.
Recomendaciones para el manejo clínico de cólera - 2010 (Available in Spanish)
The following recommendations are aimed at reducing the transmission of fecal-oral cholera infection in the healthcare environment:
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Hand washing with soap and water or glycerine alcohol before and after contact with the patient.
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Use of gloves and gowns for close contact with the patient and for contact with excretions or secretions.
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Isolation of patients in a single or cohort room.
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Separation between beds of more than one meter.
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Cleaning of waste and organic matter with sodium hypochlorite (bleach or bleach) dilution (1:10).
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Cleaning the environment with sodium hypochlorite (bleach or bleach) dilution (1:100).
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People who care for children who use diapers and incontinent people should strictly follow the same precautions mentioned above, especially regarding hand hygiene (after changing the diaper and after contact with excreta). Frequent removal of dirty diapers is also recommended.
The implementation of prevention activities in the medium and long term is the key in the fight against cholera. Generally, the response to cholera outbreaks tends to be reactive and take the shape of an emergency response; this approach prevents many deaths, but not cholera cases themselves.
A coordinated multidisciplinary approach, supported by a timely and effective surveillance system is recommended for prevention, preparedness, and response.
Key sectors that should be involved are:
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Health care.
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Water supply and sanitation.
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Agriculture and Fisheries.
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Education.
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Professional associations, non-governmental organizations and international partners in the country.
The improvement of water supply and sanitation remains the most sustainable measure to protect people against cholera and other waterborne epidemic diarrheal diseases. However, this approach may be unrealistic for those poorest populations in our region.
Cholera is usually transmitted by food or water contaminated with feces. Sporadic outbreaks can occur anywhere in the world where water supply, sanitation, food safety, and hygiene are inadequate.
The cholera vaccine is administered orally (in the mouth). Usually, cholera vaccines require two doses with an interval of 7 to 14 days depending on the vaccine being used. However, due to the high number of cholera outbreaks worldwide and the shortage of oral cholera vaccine (OCV), the International Coordination Group (ICG), which manages the global OCV stockpile, recommends administering only 1 dose to support control of cholera outbreaks.
Currently, cholera vaccination is limited and recommended to cholera-endemic areas, in humanitarian crises with high cholera risk, and during cholera outbreaks.
OCV is not recommended for children under 1 year of age.
Experience has shown that measures such as quarantine to limit movement of people and the seizure of goods are unnecessary and ineffective in controlling the spread of cholera. Therefore, restricting the movement of people or imposing restrictions on imported food produced by good manufacturing practices, based solely on the fact that there is a cholera epidemic or endemic in a country, is not justified.
Routine monitoring or restrictions on the movement of people, including quarantine or cordon sanitaire measures, have not been shown to be effective in controlling cholera and are therefore considered unnecessary. WHO advises against the application of routine checks or any other restrictions on movements, such as the quarantine of travelers coming from areas with a cholera outbreak. Any health measures on arrival or departure, or related to the entry of travelers, must be applied in accordance with the provisions of the IHR (2005).
The risk of infection for international travelers is very low for most travelers, even in countries where cholera outbreaks are active, as long as proper preventive measures are followed. Humanitarian workers may be at risk if they are likely to be directly exposed to cholera patients or to contaminated food or water, especially those staying in areas with poor access to healthcare facilities.
Key resources
Antimicrobial susceptibility testing for treatment and control of cholera
Specimen packaging & domestic transportation for laboratory confirmation of Vibrio cholerae O1/O139
Strain conditioning for international transportation of Vibrio cholerae O1/O139
Cholera App
As part of the effective implementation of the Ending Cholera: A Global Roadmap to 2030, the GTFCC developed a phone-based application containing technical information and practical documents to provide clear guidance and up to date information for early detection, monitoring and efficient response to cholera outbreaks. The application is designed for public health professionals from all sectors working in cholera control. The app is designed to be used offline to accommodate those working in the most remote areas.
This OpenWHO introductory level course provides a general overview of cholera including prevention and control principles. In addition, the course participants will learn about the Global Task Force for Cholera Control (GTFCC) and the Ending Cholera – A Global Roadmap to 2030 strategy. The target audience for this course is personnel responsible for prevention and control of cholera including those involved in cholera outbreak response.
Self-paced
Free access
Languages: English, French, Portuguese
Level: Basic
The Cholera Kit is designed to be flexible and adaptable for preparedness and outbreak response in different contexts. The overall Cholera Kit is made up of an Investigation Kit, Laboratory materials, 3 Treatment Kits (community, periphery and central) and a Hardware Kit. By the end of this course, participants should have a basic understanding of the Revised Cholera Kits and how to use the Kit Calculation Tool.
Self-paced
Free access
Language: English
Level: intermediate