What Every Family Should Know About Cholera

South Africans countrywide are in a state of shock about the recent outbreak of cholera in Gauteng’s Hammanskraal. Read on for some insights into this dreaded disease.

At the time of writing this article, it was reported that in two weeks, 24 people from the area of Hammanskraal had lost their lives to Cholera, and over 200 had been hospitalised. The news has left our nation in shock – how can so many people be dying from a preventable disease, and one that is so easily treatable? It has many of us wondering what we can we do to help, and whether we are safe from the spread of this disease?

What is cholera?

Cholera is an acute diarrheal disease caused by the ingestion of food or water that has been contaminated with the Vibro cholerae bacteria. This intestinal infection is most often spread due to lack of clean water and sanitation facilities. After ingesting contaminated food or water, it can take between 12 hours to 5 days before symptoms begin to show. Once symptoms start, if left untreated, cholera can be fatal within hours.

The symptoms of cholera typically include:

• Profuse diarrhoea: The hallmark symptom of cholera is severe watery diarrhoea. The stools are usually described as “rice water” because they are pale, odourless, and contain flecks of mucus.
• Vomiting: Cholera can cause nausea and acute vomiting, which contributes to the loss of fluids and electrolytes from the body.
• Dehydration: The rapid loss of fluids and electrolytes through diarrhoea and vomiting can lead to severe dehydration. Symptoms of dehydration may include excessive thirst, dry mouth, decreased urine output, dark-coloured urine, dry skin, fatigue, and light-headedness. It can cause muscle cramps, rapid heart rate, low blood pressure, sunken eyes, weakness and extreme fatigue.

It is important to note that not everyone infected with Vibrio cholerae will develop symptoms. Some individuals can be asymptomatic – carrying the bacteria and transmitting it to others without getting sick themselves. If you suspect you have cholera or have been exposed to it, it is crucial to seek medical attention promptly, as the disease can be life-threatening if left untreated.

Treatment of Cholera

Cholera is a preventable and an easily treatable disease. The treatment of cholera remains pretty simple and focuses on two main aspects: rehydration and antibiotics. The primary goal is to replace the fluids and electrolytes lost through diarrhoea, and to treat the underlying bacterial infection. Prompt medical attention is crucial to prevent severe dehydration and potentially life-threatening complications.

Here are the main approaches to treating cholera:

• Oral rehydration therapy (ORT): The cornerstone of cholera treatment, ORT involves drinking a solution of oral rehydration salts (ORS) or a specially formulated solution containing a precise balance of sugars and electrolytes. These solutions help replenish the lost fluids and electrolytes and can be given in large amounts to prevent dehydration. ORT is usually sufficient for mild to moderate cases of cholera. In the event of an emergency, you can make a simple homemade ORS solution by mixing clean water, salt and sugar.
• Intravenous fluid replacement: In severe cases of cholera where dehydration is severe or ORT cannot be tolerated, intravenous (IV) fluids may be necessary. This involves administering fluids and electrolytes directly into a vein to rapidly rehydrate the body.
• Antibiotics: Antibiotics are used to treat the underlying bacterial infection. They help reduce the duration and severity of diarrhoea, decrease the amount of bacteria in the stool, and shorten the period of time that a person remains infectious. Commonly used antibiotics for cholera include doxycycline, azithromycin, and ciprofloxacin. The choice of antibiotic may depend on factors such as local resistance patterns and individual patient factors. It’s important to note that while antibiotics can help in treating cholera, they should always be used in conjunction with rehydration therapy.
• Zinc supplementation: Zinc supplementation is often recommended, particularly for children, as it can help reduce the duration and severity of diarrhoea and promote faster recovery.

More info on gastroenteritis here

What about a vaccine?

There are currently three oral cholera vaccines that have been pre-qualified by the World Health Organisation, namely Dukoral, Shanchol and Euvichol-Plus. While all three of these vaccines have been proven to offer significant protection against Cholera, they do not provide complete immunity against the disease. However, they have been found to provide protection against severe Cholera symptoms and to greatly reduce the risk of death. The duration of immunity provided by the vaccines may vary, and periodic booster doses may be required to maintain long-term immunity.

On hearing about the vaccine, I phoned four pharmacies close to my home, as well as two travel clinics, to see if I could find out more about it. I was told emphatically by all of them that they do not stock the Cholera vaccine, and that they have not done for quite a while.

On further research, I learned that the Cholera vaccine is in very short supply globally. The good news is that in November 2022, South Africa’s Biovac Institute signed a licensing and technology transfer deal with the International Vaccine Institute to develop and make oral cholera vaccine for African and global markets. Production of the vaccine started in January 2023, with the first clinical trial batches expected to be produced in 2024.

Is our water safe to drink?

Despite the cholera outbreak in Gauteng, the country’s Water and Sanitation Department has assured residents they can continue drinking tap water as long as their municipalities give them the go-ahead. This has been further confirmed by tests that have recently been conducted by WaterCAN, an initiative of Organisation Undoing Tax Abuse (OUTA). As part of a comprehensive water quality assessment, the team tested water from 12 different public outlet points across the City of Johannesburg municipality, analysing for contaminants such as E.coli, coliform, nitrates, nitrites, phosphates, metals, pH, chlorine and alkalinity. The tests showed that the water was clean and safe to drink.

On June 1, WaterCAN tested the water in Hammanskraal, and found that it was free from cholera, but that the water from three of four taps tested was not safe to drink. The tests show that a system flush has been performed, which involves elevating chlorine levels to eliminate bacteria and cleanse the water. Although this provides a short-term solution, it may pose a health risk over an extended period of time. According to the report, although the water is devoid of E.coli and cholera, there remains a significant presence of other bacteria, which is concerning.

On 6 June, the Water and Sanitation Department noted a significant decline in South Africa’s water quality as it released the interim Blue, Green and No Drop Watch Reports that assess the state of water provision in the country. The report noted that about 50% of water services sampled by the department showed poor microbiological water quality. WaterCAN is running another initiative called Map my water, which is an online water quality map that provides a visual representation of the state of South Africa’s water. It paints a bleak picture that points to the fact that sterilising your water will soon need to become standard practice.

Boiling water for a minimum of a minute remains one of the most effective methods to kill harmful microorganisms. If you can’t boil the water, it’s been recommended to add 2 drops of household bleach to every one litre of water, and let it stand for half an hour before drinking.

However, if you have the budget, the easiest way to purify your water is by fitting a water filtration system in your home. You can purchase an under-counter system for as little as R950. There are also larger systems that can be bought and used to filter all the municipal and/or borehole water entering your property – they usually comprise a filtration system, and a UV purification system.

Read here about water and baby bottles