Cholera outbreaks

Cholera is a bacterial infection that can cause severe diarrhoea and vomiting. The symptoms of cholera are:  

• large amounts of diarrhoea (which sometimes looks like rice water) 
• vomiting (which sometimes looks like rice water) 
• leg cramps  
• feeling weak.  

Severe diarrhoea can cause dehydration, which can lead to weakness and even death if not treated rapidly. Symptoms and signs of dehydration are thirst, weakness or fatigue, sunken eyes and decreased skin elasticity. 

Infants, young children, older people and people who are already sick are most at risk of getting severely ill if they get cholera. The most important things to reduce cholera deaths is for anyone with symptoms to drink oral rehydration solution as soon as they become ill, and to get to a health centre fast.  

You can catch cholera by:  

• drinking contaminated water; 
• eating contaminated food (e.g., food that is raw, poorly cooked, or that becomes contaminated with poo (faeces) during preparation or storage); 
• contact with the poo (faeces), vomit or things that have been contaminated with the poo or vomit of someone who has cholera; and  
• unprotected contact with the body of someone who has died from cholera.  

Cholera treatment is simple: using oral rehydration solution. This can be bought/obtained from health workers or even made at home by mixing 1 litre safe water, 6 teaspoons sugar and half a teaspoon of salt.

If someone has cholera, they should be given oral rehydration solution and then taken to a health facility, cholera treatment centre or oral rehydration point. 

People with more severe symptoms may need additional treatment, including intravenous rehydration and antibiotics. 

Cholera is a threat wherever safe water supplies, sanitation, food safety and hygiene are inadequate. Water, sanitation and hygiene facilities are often inadequate in overpopulated settings where there is overcrowding (like refugee/IDP camps or prisons).  

Working hand-in-hand with communities to identify risks and improve water and sanitation systems can have significant benefits.  

People living in high-risk areas can reduce their risk by practicing good hygiene and safe food preparation.  

• Cholera outbreaks can be prevented by making sure that communities have access to safe water and good sanitation.  
• Open defecation (not using toilets/latrines) is a major driver of cholera outbreaks. Providing communities with access to toilets/latrines can provide significant health benefits.  
• Latrines should be at a safe distance (20–30 metres) from drinking water sources.  
• People can reduce their risk by avoiding defecating in or near water. Dirty diapers should be placed in plastic bags before they are thrown away.  

You can reduce the risk for you and your loved ones by:

• drinking safe water (well-monitored piped water, disinfected with household water treatment chemicals, boiled, or bottled); 
• using safe water for washing and preparing food and for cooking; 
• cleaning your hands regularly using soap and safe water (or an alcohol-based hand rub if there is no visible dirt), especially before eating, cooking, after using the toilet/latrine or changing your child’s diaper; 
• cooking food thoroughly, keeping it covered, and eating immediately after cooking it; and  
• not going to the toilet or washing yourself, hands or clothes near where you get your drinking water.

There are several things you can do to make sure that your water is safe to drink at home. If it's well-monitored, water piped into your home is usually safe to drink.

If your water looks dirty or cloudy, physically remove pathogens by filtering your water using a water filter, clean cloth, paper towel or coffee filter. After filtering, you should still boil or disinfect your water.  

You can boil your water for at least one minute before drinking. After boiling, store drinking water safely in a clean, tightly sealed container to avoid recontamination. 

You can also disinfect your water to make it safe to drink. After filtering, use household water treatment chemicals following the manufacturer’s instructions. If household water chemicals are not available, add 3 to 5 drops of chlorine (such as 5–9% unscented household bleach) to one litre of water. Wait at least 30 minutes before using. 

You can also drink bottled water.

There is a vaccine available against cholera. It is called the oral cholera vaccine, or OCV. Being vaccinated with OCV reduces your chances of getting infected with cholera. Vaccination is a critical tool to stopping cholera, but access to safe water and sanitation is the most important thing to protect communities.  

OCV is safe and effective. Rare side effects include nausea, vomiting and mild gastrointestinal discomfort.  

The oral cholera vaccine can be given to children over one year and adults. It is safe for you to receive the oral cholera vaccine if you are pregnant.  

The cholera vaccine is an oral vaccine, meaning it needs to be swallowed. In a 2-dose schedule, the doses should be taken at least 2 weeks apart (and not more than 6 months apart). This provides you with protection for at least 3 years.

Stay calm. Keep hydrated using oral rehydration solution (available from health workers, shops or can be made at home mixing 1 litre water with 6 teaspoons sugar and half a teaspoon of salt) or other fluids (soup, juice, soda, coconut milk etc.). You need to drink enough to replace the fluids you are losing.

Seek medical care. Go to the nearest oral rehydration point, cholera treatment centre or health care facility as fast as possible.  

Stay calm. Cholera is easily treatable if you act fast. Take care of yourself while caring for someone with cholera by washing your hands well after each time you have contact with them.  

Prevent the person who is unwell from getting dehydrated. Give them oral rehydration solution (available from health workers, shops or can be made at home mixing 1 litre water with 6 teaspoons sugar and half a teaspoon of salt) or other fluids (soup, juice, soda, coconut milk etc.). You need to help them replace the fluid they are losing; encourage them to keep drinking even if they can’t keep it down.

Seek medical care. Take them to the nearest cholera treatment centre or health care facility as fast as possible.  

You should seek help immediately if the person is unable to take enough fluids due to vomiting, or if the diarrhoea is severe. Other reasons for emergency care are confusion or drowsiness, muscle cramps, weakness (unable to sit up by themselves) and dizziness. 

Oral rehydration solution can successfully treat 80% of patients. If someone is dehydrated, drinking water alone is not enough to help them recover. This is why using oral rehydration salts is important.  

ORS is solution prepared by mixing 1 sachet of oral rehydration salts in 1 litre of safe water.  Follow the instructions on the packet.

If you don’t have oral rehydration salt sachets, you can make the same solution by mixing:   

• half a teaspoon of salt  
• 6 teaspoons of sugar  
• 1 litre of safe drinking-water or lightly salted rice water. 

If you don’t have access to sachets or sugar and salt for the home-made solution, the most important thing is to keep the patient drinking anything and to seek care fast.  

The risk of you catching cholera when caring for a sick person is low if you take some basic measures to protect yourself: 

• Wash your hands thoroughly with soap and safe water after taking care, touching the clothes, or bedding of the sick person. 
• Wash the sick person’s bedding or clothing away from drinking-water sources. 
• Avoid direct contact with stools and vomit of the sick person. Place all waste in a toilet and ensure the latrine is properly disinfected.  

  If the sick person is using the household or community toilet, make sure it is cleaned and disinfected thoroughly after each use. Don’t let the sick person prepare food. 

  Mothers should continue to breastfeed infants and young children even if they have been diagnosed with cholera. 

  Take care to avoid getting infected via the clothing and bedding of a sick person: 

• Clean clothing and bedding by: 
  • machine washing between 60–90 °C with household laundry detergent following by a complete drying cycle or drying in direct sunlight; or
  • if machine washing is not available, immerse in a large container of water, stir for 10 minutes and scrub to remove dirt (taking care to avoid splashes). 
• Disinfect clothing and bedding by:  
  • immersing in boiling water for 5 minutes; or  
  • immersing in water with a 0.2% solution of chlorine for at least 10 minutes then rinsing. To make 0.2% solution of chlorine: If you are starting with 4% liquid bleach, mix bleach to water with a ratio of 1 : 19.
• Dry clothing and bedding by: 
  • using a full cycle of a dryer machine; or
  • hanging to dry in direct sunlight.   

When a patient arrives at a health facility, they will be assessed by a health worker to see whether they have cholera. In some cases, this may include a test, usually of the stool (poo). A health worker will collect a small sample of stool (poo) either from a bucket/container or directly using a swab. Collection using a swab may be uncomfortable if it is from your body directly but will not be painful. The sample is then either sent to the laboratory for testing or tested in the facility itself using a rapid test. Getting the test results can take less than an hour to a few days, depending on the type of test. 

In cholera treatment centres, health workers will help to make sure the patient remains hydrated using oral rehydration salts. If the patient is severely ill, he/she may be given antibiotics. Children may receive zinc tablets.

Losing a loved one to any disease is incredibly hard. You will want to mourn together and mark their life through your traditional funeral practices.  

There is a very high risk of catching cholera from a dead body. This means it is important to take steps to reduce the risks to you and your loved ones.  

Take steps to reduce the risk of cholera spreading to yourself or others before and during the funeral. Hold the funeral and burial as quickly as possible (preferably within 24 hours after death). Work together as a community to identify alternatives to rituals where people touch or kiss the body.  

Trained health personnel should help you with the respectful and safe preparation of the body and burial process to prevent further spread of cholera. Handle the body as little as possible yourself.  

If working with a trained health personnel to prepare the body is not possible, protect yourself by:  

• touching the body as little as possible; 
• washing your hands thoroughly with soap and safe water after touching their body, clothes or bedding;  
• removing and washing/disinfecting/drying any bedding, towels or clothing that may have had contact with diarrhoea or with the body; and
• washing bedding or clothing away from drinking-water sources.