It is considered one of the scourges of mankind: cholera. The bacterial infectious disease has claimed many lives, especially in the 19th century. For example, during the last major cholera epidemic in Hamburg in 1892, nearly 10,000 people died before the disease could be contained. However, cholera is not a disease of the past: regardless of time and place, it always breaks out where there are poor hygienic conditions.
Bacteria develop toxin
Cholera is a bacterial disease caused by smear infections with feces. The starting point of a cholera disease is always in an infected person, who, however, does not have to be ill himself. Where hygienic conditions are poor, i.e. where clean water and sewage disposal cannot be adequately guaranteed, a cholera outbreak can occur.
If the bacterium “Vibrio cholerae” enters the intestine via smear infections, contaminated food or drinking water, it multiplies there and produces a toxin that causes the cells of the intestinal mucosa to excrete huge quantities of water.
Cholera symptoms
That is, cholera sufferers can lose up to 1 liter of fluid per hour this way through this very watery diarrhea. The color and consistency of the stool resemble rice water – hence the name “rice water stool.” This is usually accompanied by vomiting. Because vital minerals and electrolytes are lost with the fluid, the condition can lead to life-threatening circulatory failure within a few hours.
Treatment of cholera
The incubation period for cholera is short: usually only one to two days pass from infection to outbreak of the disease. It is crucial for successful treatment that the disease be recognized quickly and that the loss of water and minerals be compensated for.
Cholera patients are treated with an oral rehydration solution, or ORS. The solution is a mixture of glucose and electrolytes (such as sodium and potassium) dissolved in water. Patients who cannot be treated orally because of concurrent severe vomiting receive an infusion that is compounded appropriately.
The major challenge to physicians and nurses in cholera patients is that severe dehydration of the body often causes the veins to collapse, making it extremely difficult to even find venous access for an infusion. In most cases, treatment succeeds in reducing the mortality rate to 1 percent. Without treatment, it is up to 70 percent, depending on the general condition of the patient. In addition, antibiotics can be used as a supportive measure.
Vaccination against cholera
The risk of contracting cholera is minimal. In 2004, 3 cases of imported cholera were reported in the Federal Republic of Germany; in previous years, the numbers were even lower. The best protection against cholera is to observe elementary hygiene measures, such as washing hands after going to the toilet and before eating, drinking only boiled and bottled water, and avoiding fruits and vegetables that have already been peeled.
Cholera vaccination is no longer officially required by any country upon entry, nor is it recommended by the World Health Organization (WHO). However, if a country with a cholera epidemic is visited during a round trip, a vaccination certificate may have to be presented at the border of the country of entry. This should be taken into account when traveling by ship, for example. Vaccination is recommended for humanitarian missions in crisis areas.
However, the currently available cholera vaccines are less effective than other known vaccines, such as against tetanus. In addition, they do not protect against a new group of cholera pathogens (Vibrio cholerae O139), which has now spread from India to Thailand and Pakistan.
If cholera is to be vaccinated, an oral vaccine is usually given. Adults and children 6 years of age and older receive 2 doses of vaccine at least 1 week apart, and children 2 to 6 years of age receive 3 doses of vaccine at least 1 week apart each. Booster vaccinations are available for adults and children 6 years of age and older two years after the first vaccination, and for children 2 to years of age after 6 months.
