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Key facts about Cholera

27 February 2024 Bonitas Medical Fund
Dr Themba Hadebe

Dr Themba Hadebe

South Africa had recorded at least 46 suspected cholera cases in the first month of 2024. According to the Minister of Health, three of these cases were due to cross-border travel. With these outbreaks making headline news, Dr Themba Hadebe, Clinical Executive at Bonitas Medical Fund has put together eight key facts about cholera.

Researchers have estimated that each year there are around 1.3 to 4.0 million reported cases of cholera, resulting in between 21 000 to 143 000 deaths. However, general consensus is that this is under-estimated because of low reporting and limited laboratory services.

1. What is Cholera?
Cholera is an acute diarrhoea disease caused by the bacterium Vibrio cholerae. It can either be mild or without symptoms or severe and life-threatening if left untreated.

2. Who is at risk?
The highest at-risk populations are more often in underdeveloped countries where poor sanitation and inadequate hygiene practices contribute to its spread, especially in areas with limited access to clean water and proper sanitation facilities.

Cholera can be endemic or epidemic. A cholera-endemic area is where confirmed cholera cases were detected but not brought in from somewhere else. A cholera outbreak/epidemic can occur in both endemic countries and in countries where cholera does not regularly occur.

3. How is it spread?
It is primarily spread through contaminated water and food. Ingesting water or food contaminated with faeces containing the bacterium can lead to infection. It is not likely that cholera is spread directly from one person to another.

4. What are the symptoms?
The symptoms of cholera typically include profuse watery diarrhoea, vomiting, and dehydration. In severe cases, rapid fluid loss can lead to electrolyte imbalances, muscle cramps and shock. Without prompt treatment, severe dehydration can be fatal within hours.

5. How long before you show symptoms?
It takes between 12 hours and 5 days for a person to show symptoms – which could include acute watery diarrhoea with severe dehydration.

6. How serious is it?
According to the World Health Organization (WHO) only around 25% of infected persons become symptomatic. Of these, 10 - 20% experience severe disease.

7. How do you treat Cholera?
Cholera can be effectively treated with rehydration therapy, which involves replacing lost fluids and electrolytes. This can be orally - in non-severe cases - or via intravenous fluids for more severe cases. Antibiotics may also be prescribed to shorten the duration of illness and reduce the severity of symptoms.

Immediate treatment in an outbreak is essential which is not always the case in poverty -stricken areas.

8. Can you prevent Cholera?
Yes, you can, it involves improving sanitation and hygiene practices, ensuring access to clean water, and promoting proper food handling and preparation. Measures such as boiling, filtering or treating water with chlorine tablets can help reduce the risk of contamination. Additionally, practising good hand hygiene, especially before eating or preparing food, can help prevent the spread of the disease.

A global strategy on cholera control was launched in 2017: ‘Ending cholera: a global roadmap to 2030’, had a target to reduce cholera deaths by 90% as well as timely access to healthcare services during outbreaks.

Remember, your GP should be your first port of call for all your healthcare needs. Bonitas believes there needs to be coordination of care and encourages you to see your GP who can refer you to a specialist or auxiliary provider as and if the need arises.

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