Generality
Cholera is an infectious and contagious disease of bacterial origin, determined by the enterotoxin of the vibrio cholerae vibrio. It is contracted through the ingestion of contaminated food or water and manifests itself with abundant diarrhea and abdominal pain.
To inactivate it, simply boil the water for a few seconds or cook the food carefully.
Epidemiology
Widespread especially in Asia and Africa, in recent decades cholera has not spared even the industrialized countries (small epidemics have also appeared in Italy).
The most serious massacre in recent history has been recorded on the borders of Rwanda, where in 1994 cholera caused the death of 20, 000-50, 000 people.
The spread of the disease was favored by the overcrowding and poor hygiene conditions that characterized the Rwandan refugee camps.
Contagion
The main vehicles of choleric infection are water (the causal agent par excellence) and food contaminated by it (especially vegetables and molluscs).
Carriers, the sick and convalescents eliminate cholera vibrios with faeces and vomit. In the case of poor sanitation, these microorganisms can pollute water intended for human consumption or irrigation, with consequent contamination of fruit and vegetable products. The polluted groundwater can also reach the sea and transmit the infection to molluscs such as mussels and clams. Flies and the direct handling of food by patients and carriers also favor the spread of the disease. For all these reasons the hospital isolation of patients is extremely important and mandatory by law.
Symptoms and Complications
To learn more: Colera symptoms
Orally penetrated, the cholera vibrio reaches and colonizes the small intestine, producing an enterotoxin responsible for the watery diarrhea classically associated with the disease.
When the infection is particularly severe, diarrheal discharges become more intense and are accompanied by vomiting and muscle cramps. Fever and blood are sometimes present in the stool.
Unfortunately, if action is not taken promptly, guaranteeing the patient a high fluid intake, the considerable loss of water and mineral salts can lead to the death of the individual.
Therapy and vaccination
Treatment
The therapy is based in the first place on the timely rehydration of the patient, through specific saline solutions to be administered orally or through a drip. The intravenous route should be used in severe cases, in the case of vomiting or in the presence of behavioral disorders. The treatment of cholera cannot however prescind from a suitable antibiotic treatment, necessary to reduce the duration of the infection and accelerate the recovery.
In addition to water, it is necessary to supply the body with lost mineral salts, stimulating the intake of liquids in the form of fruit, juices, vegetable broth or meat.
Deepening: Cholera Treatment Medicines "
Vaccination
The anticoleric vaccination is no longer obligatory since, in 1973, the WHO established that this practice should not be required of any traveler. In the same year, in southern Italy, there was an epidemic of cholera with 227 cases and 24 deaths in Campania, attributed, mostly, to the consumption of infected seafood.
The risk for the traveler to contract cholera during visits to countries at risk is reduced, since this disease is the prerogative of the poorest rural areas which are generally not affected by the tourist flow.
In the case of a cholera epidemic the prophylaxis is based on the administration of recently marketed oral vaccines, such as Dukoral, which can offer good protection without causing the unpleasant side effects associated with the old vaccine.
In any case, before leaving for areas at risk of epidemics, it is advisable to consult a doctor's advice, for example by contacting the Center for Travel Medicine at the nearest ASL.
Prevention
For preventive purposes, once you reach your destination in areas at risk, it is good practice to ascertain the origin of the water intended for food (prefer the bottled or boiled water) and to personal hygiene which, among other things, must always be scrupulous.
The prevention of cholera is also based on the consumption of well-cooked foods (the foods most at risk are molluscs and raw vegetables) and on the protection of the skin from contact with insects capable of conveying the vibrations of cholera from food excretions.
Deepening: Rules for the prevention of cholera »
