COM

1. Cholera
Disease
Ahmed Nasser Mobarak
Fahad Ahmed Nasser Al idris
Saeed Hussein Mohammed Al-Harith
Sami Mahdi Al Muammar
HAYA alriyed alrwaili
PRESENTED BY :

2. CONTENT
● Objectives
● Definition
● Pathogenesis
● Incubation period
● Clinical picture
● Transmission
● Risk factor
● Signs and symptoms
● Diagnostic measures
● Prognosis
● Complications
● Prevention & Control
● Chain of infection
● WHO immunization
● Treatment
● Occurrence in KSA
● References

3. Objective
• To understand the definition, pathogenesis, and transmission of cholera.
• To recognize the signs and symptoms of cholera and understand diagnostic
measures.
• To understand the prognosis and potential complications associated with cholera.
• To learn about preventative measures and the WHO immunization program for
cholera.
• To understand the chain of infection and methods of controlling the spread of
cholera.

4. Definition
Cholera is an acute diarrheal illness caused by infection of the
intestine with Vibrio cholerae bacteria.

5. Pathogenesis
• The pathogenesis of cholera involves the production of cholera toxin by the bacteria Vibrio
cholerae.
• This toxin causes the intestinal cells to secrete large amounts of water and electrolytes,
leading to severe diarrhea and dehydration.

6. Incubation period
The incubation period of cholera is typically 1-5 days,
but it can range from a few hours to several days.

7. Clinical picture
• The clinical picture of cholera includes sudden onset of severe watery diarrhea,
vomiting, and dehydration.
• The stool is described as "rice water" due to its grayish color and resemblance to
water in which rice has been boiled.
• In severe cases, cholera can lead to hypovolemic shock and death.

8. Modes of Cholera Transmission
1.Fecal-oral
• Water
• Food
• Fish or raw shellfish
2.Person-to-person (rare)

9. Personal
hygiene
Poor sanitation
inadequate access to
clean water and
sanitation
Poor
conditions
crowded living
conditions.
Unsafe water
lack of clean water
Slum areas
peri-urban slums
Food hygiene
Raw or undercooked food
Risks factors

10. Signs and symptoms
Most people remain asymptomatic. The symptoms of cholera include :
profuse, watery
diarrhea
restlessness or
irritability
leg cramps Mild fever
Vomiting Sunken eyes
and cheeks
Dry mucous
membranes
Decreased
urinary output

11. Severe symptoms
Muscle
cramps
Rapid
heart
rate
Low
blood
pressure
Persiste
nt
vomiting
25% 55% 75% 95%

12. Diagnostic measures
Cholera
Diagnosis
 Culture of rectal swab or stool specimen
– Gold standard
– Special transport (Cary-Blair)
and culture media (TCBS)
 Serology with acute/convalescent titers
 Rapid tests
– Low sensitivity
– Low specificity

13. PROGNOSIS
• With prompt and appropriate treatment, the prognosis
for cholera is generally good.
• However, in severe cases, cholera can lead to death if
left untreated.

14. severe dehydration Shock Renal failure
Death
COMPLICATIONS

15. Chain of infection

16. Water
Prevention and control
Surveillanc
e
Sanitation
Treatment

17. Water and sanitation interventions
Prevention and control
• The long-term solution for cholera control lies in economic development
and universal access to safe drinking water and adequate sanitation.
• Actions targeting environmental conditions include the implementation of
adapted long-term sustainable WASH solutions to ensure use of safe
water, basic sanitation and good hygiene practices in cholera hotspots.
• In addition to cholera, such interventions prevent a wide range of other
water-borne illnesses, as well as contributing to achieving goals related
to poverty, malnutrition, and education. The WASH solutions for cholera
are aligned with those of the Sustainable Development Goals (SDG 6).

18. Prevention and control
Surveillanc
e
• Surveillance is an essential component of cholera prevention and
control, as it enables the early detection of outbreaks and helps public
health officials to track the spread of this disease.
Surveillance systems include
• Monitoring the number of cholera cases,
• Identifying the source of infection, and
• Assessing the effectiveness of prevention and control measures.

19. Oral cholera vaccines
Dukoral®
Shanchol, and
Euvichol-Plus.

20. Oral cholera vaccines
• One of the key interventions to prevent and
control cholera is oral cholera vaccine (OCV).
• OCV is a safe and effective vaccine that can
provide protection against cholera for several
years.
• It can be used as a complementary tool to
improve water, sanitation, and hygiene (WASH)
measures in cholera-endemic areas or during

21. Community engagement
• Another important intervention is community engagement.
• Community Engagement involves involving people and communities in
the development and implementation of programs. It is important to
consider local cultures and practices to promote actions like
handwashing, safe food preparation, and safe disposal of waste. This
engagement should continue throughout an outbreak with increased
communication about potential risks, symptoms, and treatment options.
Communities should be involved in developing programs to address their
needs.

22. Global roadmap to 2030
The WHO and its partners have launched a global strategy on cholera
control, Ending Cholera: A Global Roadmap to 2030, with a target to reduce
cholera deaths by 90% and to eliminate cholera in as many as 20 countries by
2030.
The strategy focuses on three strategic axes:
•Early detection and quick response to contain outbreaks
•A multisectoral approach to prevent cholera in hotspots
•An effective mechanism of coordination for technical support, resource
mobilization, and partnership at local and global levels

23. WHO IMMUNIZATION
Oral cholera vaccines
1. Currently there are three WHO pre-qualified oral cholera vaccines (OCV): Dukoral®,
Shanchol™, and Euvichol-Plus®.
2. All three vaccines require two doses for full protection.
3. Dukoral® is administered with a buffer solution that, for adults, requires 150 ml of clean water.
4. Dukoral can be given to all individuals over the age of 2 years.
5. There must be a minimum of 7 days, and no more than 6 weeks, delay between each dose.
Children aged 2 -5 require a third dose.
6. Dukoral® is mainly used for travellers. Two doses of Dukoral® provide protection against
cholera for 2 years.

24. Oral rehydration salts
• Up to 80% of cases can be treated through this.
Intravenous fluids (Ringer lactate)
• For severe cases.
Antimicrobial Therapy
• can diminish duration of diarrhea, reduce volume
of rehydration fluids needed, and shorten duration
of V. cholerae excretion.
TREATMENT

25. PREVELANCE OF CHOLERA IN SAUDI ARABIA
• Saudi Arabia reported five cases of cholera in 2017, all of which were imported, and
there was no further spread, according to the World Health Organization (WHO).
• In 2018. Cholera cases reported in southern Saudi Arabia as of mid-September; three
suspected cases and one confirmed case recorded, with patients receiving medical
treatment in Jizan.
• I searched for the prevalence of cholera in Egypt and found information from various
sources. According to the World Health Organization (WHO), the average cholera
CFR reported globally in 2021 was 1.9%, with 2.9% in Africa,

26. HISTORY
Cholera has a long and tragic history of affecting people around the world. According to some
sources, cholera-like illnesses have been described since ancient times in India and
Greece. However, the first recorded cholera pandemic occurred in the Bengal region of
India in 1817 and spread to other parts of Asia, the Middle East, Europe, and Africa through trade
routes. Since then, there have been seven cholera pandemics that have killed millions of people
across all continents. The current (seventh) pandemic started in South Asia in 1961 and
reached Africa in 1971 and the Americas in 1991. Cholera is now endemic in many countries,
especially in Africa and Asia.
The discovery of the cholera bacterium, Vibrio cholerae, is credited to Filippo Pacini, an Italian
anatomist who observed it under a microscope in 1854. However, his work was largely ignored
until Robert Koch independently confirmed it in 18833. The development of the first cholera
vaccine was also achieved by Koch’s rival, Louis Pasteur, who immunized chickens against
cholera in 1879. Since then, several oral cholera vaccines have been developed and used to

27. REFERENCES
1. Crisis24. (2018, September 17). Saudi Arabia: Cholera cases reported in south as of
mid-September. Crisis24. Retrieved May 8, 2023, from
https://crisis24.garda.com/alerts/2018/09/saudi-arabia-cholera-cases-reported-in-south-
as-of-mid-september
2. Centers for Disease Control and Prevention. (2022, November 14). Cholera - vibrio
cholerae infection. Centers for Disease Control and Prevention. Retrieved May 8, 2023,
from https://www.cdc.gov/cholera/index.html
3. Centers for Disease Control and Prevention. (2022, June 6). Diagnosis and detection.
Centers for Disease Control and Prevention. Retrieved May 8, 2023, from
https://www.cdc.gov/cholera/diagnosis.html
4. World Health Organization. (2022.). Cholera. World Health Organization.from
https://www.who.int/news-room/fact-sheets/detail/cholera