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Dr. Paul Auerbach is the world's leading outdoor health expert. His blog offers tips on outdoor safety and advice on how to handle wilderness emergencies.

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Cholera in Zimbabwe

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Despite the pronouncements of Robert Mugabe, the President of Zimbabwe, it is apparent that there is a very significant outbreak of cholera in that country, and that it is not under control.

Cholera is a disease caused by an infectious agent that spreads in the general water supply when there is the presence of frequent contamination, such as occurs with the entry of sewage into a nation's water supply. General lack of sanitation is, of course, a contributing factor. Persons who travel to countries where there is little or no control of human wastes are clearly at increased risk in a time of cholera.

To make matters worse, panic has set in. Many Zimbabweans are fleeing their country, bringing cholera to their neighbors in Botswana, Zambia and Mozambique. In Zimbabwe, the death toll from this recent surge in cholera is probably over 1,000 individuals, given that there is almost certainly under-reporting. Soon, more than 20,000 persons will have suffered the disease, and the numbers could certainly go higher.

What has been done? The Zimbabwe health ministry's answer to the cholera outbreak was to shut off the public water supply in Harare, since it did not have the foreign currency to buy chemicals to ensure that the water supply was clean. Aid groups such as World Vision and Oxfam, and UN agencies such as UNICEF have taken up some of the slack by distributing food and water purification tablets, but these are stop-gap measures at best.This is a very sad state of affairs, particularly in light of the lack of food and sometimes shelter for the people of this impoverished nation.

So, anyone traveling to this region is advised to be extremely careful with hygiene, food preparation, sanitation, and choice of drinking water.

The Centers for Disease Control (CDC) distributes timely information about cholera, which includes the following:

Most persons infected with the bacteria that cause cholera suffer mild diarrhea or no symptoms. Less than 10% of persons infected with the El Tor biotype of Vibrio cholerae O1 have illness requiring treatment at a health center if they are adequately hydrated. However, if full blown cholera strikes in geographies where medical personnel are not acquainted with modern treatment methods, many people might die.

Cholera causes profound diarrhea and fluid loss. It has been characterized as a violent gastroenteric illness. Cholera patients should be evaluated and treated quickly. With proper treatment, mostly consisting of rehydration, even severely ill persons can be saved. Prompt restoration of lost fluid and salts is the primary goal of treatment. Delay to therapy can be fatal.

The symptoms of moderate to severe cholera are the hallmark profuse, watery diarrhea (sometimes referred to as "rice water stool") leading to dehydration, nausea and vomiting, muscle (particularly the legs) cramps, restlessness, irritability, signs of severe dehydration (such as dry mouth and tongue, thirst, "tenting" of loose skin, and altered mental status up to unconsciousness. A doctor or medic who examines a person with cholera will find a severely ill victim who is severely dehydrated, confused, in and out of consciousness, and unstable with low blood pressure, a thready pulse, and at risk of death.

Intravenous or oral rehydration are essential for recovery.

An antibiotic given orally will reduce the volume and duration of diarrhea. No other drugs for treatment of diarrhea (such as antimotility agents) or vomiting should be given.

Recommended antibiotics are:

The duration of cholera caused by Vibrio cholerae may be shortened by treating with azithromycin (1 g single dose), ciprofloxacin (1 g single dose; increasing resistance is being noted to this drug) or doxycycline (300 mg single dose) for adults, or trimethoprim-sulfamethoxazole for children (5 mg per kg, or 2.2 lb, of body weight, based on the trimethoprim component, for 3 days). Furazolidone is the antibiotic of choice for pregnant women. Furazolidone is administered in an adult dose of 100 mg 4 times a day for 3 days. The pediatric dose is 1.25 mg per kg of body weight 4 times a day for 3 days. Erythromycin may be used when other antibiotics are not available, or the organism is resistant to them. Resistant strains of the cholera organism are very common; for instance, in Bangladesh, cholera is resistant to tetracycline, erythromycin, and trimethoprim-sulfamethoxazole.

photo courtesy www.itn.co.uk

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Dr. Paul S. Auerbach is the world’s leading authority on wilderness medicine.

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