Delhi is facing the worst episode of cholera in last 16 years. MCD has reported as many as 548 cases of cholera in the city up to May 15. In the earlier years outbreaks of cholera and gastroenteritis usually used to occur May onwards, but this year it seems to have started a month earlier in April and that too with alarmingly high number of cases. The gastroenteritis cases so far reported are around 19,663.
The main cause for cholera and gastroenteritis outbreak is water contamination. i.e. a person will get infected if he consumes contaminated water or food.
Hence, it is imperative to be aware about various measures that can help prevent these infections and also educate oneself about proper management of these diseases. Before we get to that though, let’s get some basic facts about cholera and gastroenteritis.
Cholera is an infection of the small intestine caused by the bacteria Vibrio Cholerae. It can spread rapidly in areas with inadequate treatment of sewage and drinking water. The condition is usually mild but in severe cases it can result in profuse and watery diarrhea causing rapid loss of fluid from the body (dehydration). If not managed timely it may lead to death. The symptoms include:
- Diarrhea (profuse, rice water like stools with a fishy odor)
- Cramps in the abdomen
- Signs of Dehydration (such as excessive thirst, dry mouth, skin is dry and loses its elasticity, little or no urine or dark yellow urine, decreased or no tears, severe weakness or lethargy, rapid pulse, sunken eyes, and unusual sleepiness)
Cholera can be easily detected by stool culture and blood culture.
Immediately consult your doctor if you develop :
- Profuse, watery diarrhea
- Signs of dehydration
Gastroenteritisis the infection of the stomach and the intestines. It can be caused by virus, bacteria, and parasites or may be of unknown cause. Viral gastroenteritis is caused by a variety of viruses that result in vomiting and diarrhea. These may include rotaviruses, adenoviruses, calciviruses, astroviruses, Norwalk virus etc. The symptoms usually begin 1-2 days following infection and may last for 1-10 days depending upon the type of virus causing it. The symptoms include:
- Nausea or vomiting
- Bloated abdomen
- Abdominal cramps
- Headache, fever
Gastroenteritis is an infectious disease and can be spread through close contact with infected persons (for example, by sharing food, water, or eating utensils). Eating or drinking contaminated foods or beverages may also infect a person. Person-to-person transmission is especially common with gastroenteritis caused by Shigella, Escherichia coli Giardia, Norwalk virus, and rotavirus.
It is usually diagnosed by symptoms and physical examination. However, your doctor may advise a stool test for rotavirus or to rule out bacterial or parasite infection. There is no routine test available to detect other viruses.
Immediately consult your doctor if :
- Problems persists for > 36 hours
- Diarrhea becomes bloody
- Fever is 103° F or higher
- You have lightheadedness or fainting occurs with standing
- Confusion develops
- Significant abdominal pain develops
By now it is quite clear that both these conditions are infectious, hence adequate measures should be taken to prevent getting them and also to avoid spreading them further.
I. Drink safe water
- Collect water from the cleanest source and keep water for drinking separately.
- Water can be treated to make it safe (if the safety of the source is uncertain) by:
- Boiling – Bringing water to boil once is enough.
- Chemical disinfection – Iodine or chlorine tablets can be used (Iodine provides better disinfection).
- Avoid drinking water sold through trolleys, fruit juices prepared in shops and drinks containing commercial ice.
- Drink only well-sealed bottled or carbonated water.
- Avoid ice cubes, because ice cubes may be made from contaminated water.
II. Eat safe and properly cooked food
- Avoid eating raw / uncooked foods e.g. salads, raw vegetables, unpeeled fruits, unpasteurized milk and dairy products, raw meat and shellfish.
- Peel fruits yourself and wash vegetables thoroughly under running water before eating.
- Eat your food while it’s still hot.
- Promptly refrigerate leftovers and foods to be eaten not later than 2 hours after preparation to prevent growth of bacteria.
- Thaw frozen foods in refrigerator and not outside. Do not refreeze foods once they have been thawed.
- Hands, preparing surface (cutting board, knife) and utensils should be washed with soap after handling raw meat, poultry, seafood or eggs.
- Persons ill with diarrhea or vomiting should not prepare food for others.
- Avoid sharing utensils, glasses and plates.
- Avoid eating food from street vendors.
III. Wash hands thoroughly : Use warm water and soap and rub hands vigorously for at least 10 seconds. Do not forget to wash around cuticles, beneath fingernails and in the creases of the hands. Then rinse thoroughly.
- Always wash hands:
- before preparing food
- before eating
- after using the toilet
- before cleaning a child who has defecated or after changing diapers
- Use separate towels in the bathroom
IV. Safe disposal of stools (especially in slum areas where people do not have an access to functioning sanitary latrine)
- As germs of diarrhea are excreted in stools, proper disposal of stools is necessary to prevent spread of diarrheal agents.
- Government should take measures to provide clean functioning sanitary latrine in such areas.
V. Vaccination / Immunization
- Vaccination against rotavirus (a major cause of diarrhea in children) is available and it not only prevents but also reduces severity of rotavirus infections.
- Injections are given between the age of 6 weeks-1 year.
- 3 doses are given at 2 months intervals.
- Consult your doctor for more information.
- Vaccine against cholera is also available but it is effective only in 30-50% cases. Each dose schedule protects an individual only for six months.
- Dosage schedule consists of 2 equal doses injected subcutaneously (0.5 ml in adults and 0.3 ml in children) at intervals of 4 to 6 weeks.
- Protective value is only 50% and it protects for 4-6 months only. Therefore booster injections are required every 6 months.
- Work is in progress for developing more effective oral vaccines.
If you are already suffering from cholera or gastroenteritis consult your doctor so that he can institute proper treatment.
Treatment of Cholera
- The main goal of treatment is to replace the lost body fluids (i.e. dehydration). Depending upon the severity of the disease oral or intravenous fluid may be given to the patient.
- Antibiotics are given to shorten the duration of symptoms
- WHO has developed and recommends giving ORS (Oral rehydration solution) which is easier and cheaper to use. You can even prepare ORS at home by mixing 1 level teaspoonful of common salt and 4 level teaspoonful of sugar in one litre of water. ORS helps to replace the lost fluids, minerals and salts.
- Take bland, light food and avoid fatty or highly seasoned food.
- Avoid milk and dairy products, caffeine, alcohol.
Treatment of Gastroenteritis
Usually viral gastroenteritis is self-limiting and does not require any specific treatment. Antibiotics are not given as they are not effective against viral infection. The main goal of treatment is to reduce symptoms and restore the lost body fluids (i.e. dehydration).
- Dehydration can be taken care by oral fluids. Best is to give WHO developed ORS or ORS can be prepared at home
- IV fluids may be required in severe cases of dehydration.
- To reduce symptoms of gastroenteritis:
- Avoid eating for a few hours as this will allow your gastrointestinal tract to settle.
- If you are having severe vomiting try to take small sips of water or you may suck on ice cubes.
- Give ORS to children to replace lost fluid, minerals and salts.
- You may gradually start taking food, beginning with bland, light food such as toast, broth, rice, khichri, apples, bananas etc. Avoid fatty or highly seasoned food.
- Avoid milk and dairy products, caffeine, alcohol.
- Take plenty of rest
For nutritional management of diarrhea, click here