Cholera
Introduction
[Link] Varier BAMS
What is cholera?
An acute diarrhoeal disease caused by Vibrio Cholerae 01
Commonly due to El Tor biotype
Symptomless to severe infections
Majority are mild/ asymptomatic
Biotype
1. A naturally occurring group of individuals with identical genomes.
2. A physiological race (i.e. a group of individuals identical in structure
but showing differences in physiological, biochemical, or pathogenic
characters).
Serotype
a category into which material is placed based on its serological activity,
particularly in terms of the antigens it contains or the antibodies that may
be produced against it.
Symptoms – Typical case
• Diarrhoea - Profuse, effortless, watery
• Followed by - Vomiting, rapid dehydration, muscle
cramps, suppression of urine
• High case fatality rate - 30 – 40 %
Rapid replacement of fluid & electrolytes reduced fatality
Problem statement
• Presence in India since ancient times
• Currently 7th pandemic is ongoing
• 7th pandemic began in 1961 in Indonesia
• > 80 countries in Asia, Africa, Europe
• India got involved in 1964
Magnitude
During non-epidemic situation
• 5 – 10 % of all acute diarrhea = cholera
• Can enter any country but -
can create problems only in areas where other acute enteric
infections are endemic [Defective sanitation]
New strain – Code named 0139
1992
PAKISTAN 1992 INDIA 1993 BANGLADESH
1 lakh cases and 10000 deaths in southern Bangladesh in 1993
Did not spread rapidly thereafter, but still remains a threat
Strain
When colonies of a particular bacterial species is isolated on a petri
plate, various colonies seen on the petri dish represent the different
strains of that particular species of bacteria
Diversity within the species
WHO - 2017
• 2017 - 200 years since 1st recognized cholera pandemic in 1817
• Current 7th pandemic is the longest ever recorded
• Total 12,27 391 cases Death 5654
• Yemen 84% of the cases
• Increase due to severe epidemics in DRC, Nigeria, Somalia & South
Sudan
El Tor biotype
• El Tor biotype of V. Cholerae 01 has replaced classical biotype in India since
1964
• Most of the isolated El Tor biotype belong to serotype Ogawa
• 1964 - West Bengal – “Home” of cholera
• 1966 - Andaman & Nicobar infected for 1st time
• 1969 - Desert areas of Rajasthan
• 1978-79 - Classical type epidemic reported (Unknown reason)
• Currently - MH, TN, Karnataka,Delhi, Gujarat, Kerala
Epidemiological features
Epidiomological features of cholera
• Both epidemic and endemic
• Epidemicity and endemicity depends on
1. Characterestics of the agent
2. Characterestics of the system (environment)
Characterestics of the agent
• Ability to survive in a given condition
• Virulence
• Avgerage number or organisms required to cause infection
Characterestics of the system (environment)
Number of susceptibles
Oppurtunities for transmission of the infections
• Abrupt epidemics creating an acute health problem
• High potential to spread fast and cause death
• Epidemics reaches a peak, then subsides[when force of infection
declines]
Epidemic
• Epi = upon ; demos = people
• “The occurrence in community or region of cases of an illness,
specific health related behavior, or other health-related events
clearly in excess of normal expectancy.”
• The community/region and period must be specified precisely
Endemic
• En = in ; demos = people
• “The constant presence of a disease or infectious agent within a
given geographic area or population group, without importation
from outside;may also refer to the “usual” or expected frequency of
the disease within such area or population group”
• Eg :- common cold
Cholera epidemic – self-limiting
Tends to peak and then decline by the time preventive measures are
instituted
Attributed to
• Acquisition of temporary immunity
• Large number of sub-clinical cases
Force of infection
“Rate at which susceptible individuals acquire an infectious disease”
Force of infection of cholera has 2 components
1. Force of infection through water
2. Force of infection through contacts
“Tail” of the epidemic
Continuation of transmission through contacts even as contaminated
water is eliminated.
Cholera endemicity
• Cholera does not show a stable endemicity like typhoid fever
• Shows seasonal variation
• Seasonal variations may change
eg -
Earlier Now
Summer – Kolkata Autumn
Early winter – Bangladesh
Some parts of India August
Inter-epidemic period
• Cholera occurs at intervals even in endemic areas
3 explanations
1. Existence of long-term carriers
2. Existence of diminished continuos transmission involving asymptomatic
cases
3. Persistance of the organism in a free-living altered form in the
environment
V. Cholerae O1 strain
• Atypical non-toxigenic variant of El Tor biotype\
• Has been found in surface waters of endemic & non endemic areas
• Not related to human infection and disease
Epidemological significance
“Whether transmission of somatic antigen can occur in natural
environment i.e can non-O1 V. cholera become V. cholera O1?”
