Let's talk about cholera

Commenting on the level of concern that has been raised of late Glenda Seeger, Operations Manager of Netcare Travel Clinics was quick to put the illness into perspective: “Cholera is a disease of poverty that occurs in people who live in overcrowded conditions and are exposed to heavily contaminated food and water. People most at risk are those working at refuge camps and relief centers.”

“Cholera really is not a disease of tourists. In fact, research has indicated that the incidence per journey for foreign travellers visiting Africa or Asia is about 1 in 500 000 only. It however bears mentioning that Sub Saharan Africa has the highest reported cholera incidence and mortality rates in the world,” explains Seeger.

She adds that in order to contract severe diarrhea as a result of cholera a large number of bacteria has to be ingested. “Severe forms of the disease are rarely seen in travelers who follow good food and water hygiene,” she says.

The disease itself is caused by bacteria known as Vibrio cholerae and is commonly transmitted by contaminated food and water or by oral contact with fecal matter. Humans are the only natural hosts.

“The symptom associated with cholera is diarrhea. The cholera bacteria is killed by the acid in the stomach but if ingested in large amounts the bacteria passes from the stomach to the intestine, causing diarrhea. In about 80% of cases there will be no symptoms or a mild diarrhea. However, infected persons eliminate vibrio cholera in their faeces for a few days and are infectious. In 10 - 20% of cases; mostly children, elderly or patients with chronic conditions, diarrhea might be severe and can cause shock and death in hours if fluid is not replaced. Cholera kills solely by dehydration. Patients developing severe watery diarrhea should therefore immediately start rehydration therapy,” cautions Seeger.

She added that there is an oral vaccine, Dukoral, available for use against cholera. The vaccine consists of 2 doses given at least one week apart up to six weeks apart. According to an article published by the National Institute of Communicable Diseases (NICD) the vaccine provides 80-85% protection which decreases to 62% protection after 3 years. Protection starts only 15 days after the second vaccine dose which explains why it is not used in the communities where there are already cases of cholera. However, it is used for people who need to travel frequently in areas where there is cholera. In any case, vaccines are not a substitute for caution on the part of the traveler and are only one component of disease prevention, it is more prudent to take appropriate food and water precautions.

With prevention being the only full-proof protection against cholera the question that comes to mind is how does one prevent yourself from contracting Cholera? According to Seeger the best way of preventing cholera is to pay careful attention to what one eats and drinks.

Here are some useful guidelines pertaining to food and water consumption courtesy of Netcare Travel Clinics:

Some tips regarding the safe consumption of water:

* Filtered, bottled, boiled or chemically treated water should be used for drinking purposes and also to brush your teeth.
* Bottled fizzy drinks with an intact seal are safe, as is boiled water and hot drinks made with boiled water.
* Ice in drinks should be avoided.
* The most reliable way to purify water is by boiling, but this is not always convenient.
* Chemical disinfectants such chlorine will usually kill bacteria and viruses.

Advice when it comes to what to eat and what to avoid:
* Some developing countries use animal waste as fertiliser. Certain foods, especially those growing close to the ground, are particularly prone to contamination and should, where possible be avoided.
* Food items that may be unsafe include: Salads, such as lettuce, uncooked fruits and vegetables, unless they have been washed and peeled by the traveller.
* Food that has been allowed to stand at room temperature in warm environments, or that has been exposed to flies. If left unchecked open buffets can prove problematic.
* Unpasteurised milk, cheese, ice cream and other dairy products.
* Raw or undercooked shellfish or seafood.
* Buying food, that may be unclean of not particularly fresh, from street vendors
* Remember even food served in hotels and/or restaurants of good standing may not always be safe, as it may have been contaminated during preparation

Your travel-health lifeline

Please do not hesitate to contact your nearest Netcare Travel Clinic should you have any queries or questions regarding travel-health related topics. You may also visit our website on www.travelclinic.co.za .

Netcare Travel Clinics

Website: www.travelclinic.co.za

Issued on behalf of Netcare Travel Clinics