Post by Gina Gabelia
A
cholera outbreak, which spreads rampantly through infected water sources, is a
real threat post two major earthquakes, which significantly damaged Water,
Sanitation, and Hygiene (WASH) systems and displaced tens of thousands of
people, forcing them to live in congested, poorly constructed areas with
limited access to potable water and sanitation.
These dismal risk factors are compounded by the imminent monsoon
season. Soap, bottled water, water
purification tablets, and oral rehydration tablets alongside cholera
messaging need to be widely distributed to all communities to prevent
outbreaks.
OVERVIEW:
Cholera
is an acute enteric infection caused by the ingestion of the bacterium vibrio cholerae, which is present in
fecally contaminated water or food (4).
Cholera spreads when vibrio cholerae from infected persons' feces
spreads to potable water or food (6).
Cholera is linked to poor access to clean water and proper sanitation
and its incidence is pronounced when basic WASH systems have been damaged or
destroyed (4).
Nepal Specific Considerations:
Cholera
is endemic to Nepal; the first case was recorded in 1823 (1). The majority of reported cases occur during
the monsoon when flash floods and landslides can destroy WASH systems (1). Rural and urban areas are susceptible to
cholera. The most recent outbreaks
occurred in Rautahat in 2014; the deadliest outbreaks occurred in 2009 in
Jajarkot, which affected 30,000 people (1).
Before
the earthquakes, roughly 37% of the population had access to latrines, making
open defecation common practice; if latrines are unavailable, please refer to
the guidance below for cholera prevention practices. Nepali people eat with their hands and in
this environment, it is more important than ever to wash hands thoroughly
with soap before and after eating, preparing food, using latrines,
etc. If soap is not available, scrub
hands with sand or ash and safe water. The
search for survivors is ongoing, and decomposing bodies contaminate water
sources. Therefore it is crucial to
ensure water sources have not been compromised – if you are not sure, it is
better to be safe than sorry, and purify water before consumption. Remote, isolated communities need to be
especially vigilant in protecting water sources; if those have been
compromised, take measures to prevent disease contraction by following
guidelines listed below, and purify water before consumption.
Cholera
Symptoms, and Treatment:
Cholera
infection is usually mild without symptoms, but 5 to 10 percent of infected
persons experience severe symptoms:
·
profuse watery diarrhea (can
look like cloudy rice water)
·
vomiting
·
leg cramps (10)
Rapid
loss of body fluids lead to dehydration and shock and can result in death
without immediate rehydration (10). Patients experiencing cholera symptoms must
seek immediate medical attention.
Affected
patients need to be treated with Oral Rehydration Solution (ORS), a prepackaged mixture of sugar and salts to mix with clean water
and consumed in large amounts. If
commercial ORS packets are not available, a solution can be replicated at
home by combining 6 teaspoons of sugar and ½ teaspoon of salt in 1 liter of
bottled/boiled/treated water. Please
measure the sugar and salt as accurately as possible as too much sugar can
exacerbate diarrhea (5). Antibiotics can shorten the course and reduce the
severity of cholera, but rehydration is the life-saving cholera treatment
which saves 80% of patients (7).
Cholera Vaccines:
The
Government of Nepal has a stockpile of 18,000 doses of the oral cholera
vaccine, Shanchol produced by Shantha Biotech of Hyderabad, which can vaccinate
9,000 people (2 doses 2 weeks apart per person for full vaccination), (2). The World Health Organization (WHO) holds a
stockpile of 2 million doses of Shanchol for emergency cholera outbreaks (3),
which can be deployed. Considering the
challenges of tracking people in temporary housing in a disaster situation to
complete vaccination rounds, it is advisable to advocate for prevention
messaging.
CHOLERA
PREVENTION:
Cholera
messaging across national radio, community fora, relief stations, etc. is
critical and NGOs on the ground are engaged in messaging information for
prevention (8).
To
protect yourself and your family from cholera, follow the guidelines from the
Centers for Disease Control (CDC) below as closely as possible (6):
1) Drink and use safe water* (6).
••Bottled water with unbroken seals are safe to drink and use.
••Use safe water to brush your teeth and wash and prepare food.
••Clean food preparation areas and kitchenware with soap and safe
water and let dry completely before reuse.
* Piped water sources,
drinks sold in cups or bags, or ice may not be safe and should be boiled or
treated with chlorine.
To be sure water is safe to drink and use:
••Boil it or treat it with water purification tablets or household
bleach.
••If boiling, bring your water to a complete boil for at least 3
minutes.
•• Boil milk for at least 3 minutes to
ensure safety (8)
•• Add two water purification tablets per one liter of water, and
allow to sit for at least 30 minutes after the tablets dissolve. Water
purification tablets have an expiration date, and the bottle must be firmly
sealed between uses (9).
••If a treatment product is
not available, you can treat your water with household bleach. Add 2 drops of
household bleach for every 1 liter of water and wait 30 minutes before
drinking.
••Always store your treated water in a clean, covered container.
2) Wash your hands often with soap and safe water* (6).
••Before you eat or prepare food.
••Before feeding your children.
••After using the latrine or toilet.
••After cleaning your child’s bottom.
••After taking care of someone ill with diarrhea.
* If no soap is available,
scrub hands often with ash or sand and rinse with safe water.
3) Use latrines or bury your feces (poop); do not defecate in any body of water (6).
••Use latrines or other sanitation systems, like chemical toilets,
to dispose of feces.
••Wash hands with soap and safe water after defecating.
••Clean latrines and surfaces contaminated with feces using a
solution of 1 part household bleach to 9 parts water.
What if I don’t have a latrine or chemical toilet?
••Defecate at least 30 meters away from any body of water and then
bury your feces.
••Dispose of plastic bags containing feces in latrines, at
collection points if available, or bury it in the ground. Do not put
plastic bags in chemical toilets.
••Dig new latrines or temporary pit toilets at least a half-meter
deep and at least 30 meters away from any body of water.
4) Cook food well, keep it covered, eat it hot, and peel fruits and vegetables* (6).
••Boil it, Cook it, Peel it, or Leave it.
* Avoid raw foods other than
fruits and vegetables you have peeled yourself.
5) Clean up safely—in the kitchen and in places where the family bathes and washes clothes (6).
••Wash yourself, your children, diapers, and clothes, 30 meters away
from drinking water sources.
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