Description
Cholera is an acute diarrhoeal disease caused by intestinal invasion by enterotoxin produced by strains of the bacterium Vibrio Cholera. Some of the enterotoxin serotypes cause severe disease known as "cholera" and epidemics. Residents of disease-endemic areas acquire antibodies to cholera in childhood.
Cholera epidemics with tens of thousands of cases and hundreds of deaths have been described in the past. Cholera cases are continuously recorded in many parts of the world, particularly in countries with a low socio-economic level, mainly in Africa and Asia. Recently cholera cases have been recorded in countries neighbouring Cyprus, namely in Syria (807 confirmed cases and 68 deaths with several more suspected cases between the end of August and October 2022) and Lebanon (5.912 cases with 23 deaths from the beginning of October 2022 to 5 January 2023).
Modes of transmission
The disease is transmitted through consumption of contaminated water or food. Water is usually contaminated by patient faeces which in turn can directly or indirectly contaminate food. Food can also be contaminated by dirty hands during meal preparation or when consumed.
The incubation period of the disease ranges from a few hours to five days and the patient transmits the disease up to 10 days after the onset of the disease. The disease affects all ages and presents mainly with severe acute diarrhoeal syndrome and vomiting leading to dehydration and in severe cases death if not treated in time.
Treatment
Hydration is the cornerstone of treatment. Oral administration of fluids and salts, as well as intravenous administration of fluids and electrolytes in severe situations reduces mortality. Antibiotics are given only in severe cases.
Information for Travelers Returning from Countries with Cholera Outbreaks
Travelers returning from countries with outbreaks should be on heightened vigilance for symptoms of the disease, as listed below. If symptoms of the disease develop, they should apply contact precautions and strict hand hygiene measures and report to the hospital.
General precautions for travellers travelling to high-risk countries
As a precautionary measure, people travelling to areas with poor sanitary conditions are recommended to consume bottled water and drinks, and pasteurised dairy products and milk. They are also advised to avoid ice cubes, raw salads, reheated food and raw seafood and prefer peeled fruit. In addition, they should strictly follow the rules of good hygiene.
It should be noted that in the event of any medical problem one should immediately contact the official medical services of the country.
Food and drink consumption
In particular, travellers should. All food, especially raw food, should be considered potentially contaminated (avoid cold, raw or undercooked, unpasteurised food). [*]Eat food that is well cooked and still warm when served. Dishes containing meat or fish should be eaten if the traveller knows they are freshly cooked and not reheated. [*]Fruits, fruits and vegetables with thick skins, peel or shells should be preferred and should be washed or peeled by the traveller before consumption. [*]Use sealed and bottled water or aerated water. [*]Consume beverages directly from the can or bottle. [*]Ask for drinks without ice. [/LIST]
Travelers should NOT:
- Consume fresh salads, raw or undercooked eggs, poultry, meat and seafood.
- Consuming cooked foods that have been at ambient temperature for several hours (e.g. buffets)
- Consuming popsicles or frozen drinks that are likely to have been prepared with contaminated water.
- Consume fruit juice unless it comes directly from a sealed can.
- Consume tap water.
Resources
[*]https:/eody.gov.gr/disease/cholera [*]https:/www.gov.uk/guidance/cholera [*]https:/www.ecdc.europa.eu/en/cholera
(AF)
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