CHOLERA (HAIZA).power point presentation document

CHOLERA (HAIZA)
PRESENTED BY:
DR VINAYAK KALASAD
2ND
YEAR PG SCHOLAR
TAHAFFUZI WA SAMAJI TIB
UNDER THE GUIDANCE OF:
PROF ZARNIGAR
DATE: 27-06-2025

TABLE OF CONTENT
• DEFINITION
• PROBLEM STATEMENT
• EPIDEMIOLOGICAL FEATURES
• EPIDEMIOLOGICAL DETERMINANTS
• PATHOGENESIS
• CLINICAL FEATURES
• LABORATORY DIAGNOSIS
• CONTROL OF CHOLERA
• CONTROL PROGRAMME
• UNANI CONCEPT OF CHOLERA

DEFINITION
Cholera is an acute diarrheal disease caused by vibrio
cholerae O1 and O139. It is now commonly due to the El
Tor biotype and O139.

PROBLEM STATEMENT
The number of cholera cases reported to WHO continues to rise.
It is possible that >2-3million cases of cholera occur yearly and that
result in >50,000-100,000 deaths annually.
From 2020 alone, a total of 1,72,454 cases were notified from 42
countries, including 1,304 deaths.
Cholera remain a global threat to public health and a key indicator of
lack of social development.

PROBLEM STATEMENT IN INDIA
 Since The Introduction Of Cholera El Tor Biotype In 1964, The Geographic
Distribution Has Considerably Changed In India.
West Bengal Has Lost Its Reputation As The Home Of Cholera, Many Of The
States Which Never Had Infection Of Cholera Are Now Newly Infected.
 During 2014, About 969 Cholera Cases Were Reported In India With 4 Deaths
And During 2018 About 651 Cases Were Reported With 6 Deaths.
 Majority Of The Cases Were Reported From Uttar Pradesh, Delhi, West Bengal,
Gujarat.

EPIDEMIOLOGICAL FEATURES
 Cholera is both an endemic and epidemic disease
 Epidemic of cholera are characteristically abrupt and often create an acute public
health problem
 Cholera infection have high potential to spread fast and cause deaths.
 The epidemic reaches peak and subside gradually as the “force of infection” declines
and it is composed of 2 components – A. Water, B.
Contacts
 It is responsible for 7 global pandemics and much suffering over the past 2 centuries.
 Cholera is also called as father of public health indicator

EPIDEMIOLOGICAL DETERMINANTS
• Agent factor: Vibrio cholerae O group 1 or O1, O139
• The species V. Cholera is classified into more than 200 serogroups based on
carbohydrate determinants of their lipopolysaccharide (LPS) O antigens.
• Vibrio cholerae have 2 main biotypes: O1classical and El Tor, each biotypes further
divided into 2 serotypes, termed Inaba and Ogawa.

• Infective material: Immediate source of infection are stool and vomit of cases and
carrier. An average patient excretes 10-20lts of fluids/day.
• Infective dose: Cholera is dose related infection occurs when the number of the
vibrio's exceeds the dose that is infective for the individual.(High dose).
• Period of communicability: Convalescent carriers are infectious for 2-3 weeks.
The chronic state may last for A month up to 10 years or more

CARRIERS IN CHOLERA:
a. Preclinical or incubatory carriers: These are potential patients, short in
duration about 1-5 days.
b. Convalescent carrier: Patient who has recovered from an attack of cholera may
continue to excrete vibrio’s, infective period about 2-3 weeks.
c. Contact or healthy carrier: Result of subclinical information contacted through
association with a source of infection. Infective period less than 10days.
d. Chronic carrier: This state occurs infrequently. The longest carrier state was
found to be over 10years.

HOST FACTOR:
• Age & Sex: It affects all ages and both sexes. In endemic areas attack rate is highest in
children.
• Gastric acidity: An effective barrier. The vibrio is destroyed in an acidity of PH5 or
lower.
• Population mobility: Movement of population results in increased risk of exposure to
infection
• Economic status: Highest in the lower socioeconomic groups and this is attributable
mainly to poor hygiene.
• Immunity: An attack of cholera is followed by immunity to reinfection, but the duration
and degree of immunity are not known.

ENVIRONMENTAL FACTORS:
• The natural habitat of V. Cholerae is coastal salt water and brackish estuaries,
where the organisms lives in close relation to plankton.
• It can also exist in freshwater in the presence of adequate nutrients and warmth.
• It found in community with poor environmental sanitation include contaminated
water and food.
• Humans become infected incidentally but, once infected, can act as vehicles for
spread.

MODE OF TRANSMISSION:
• Man to man transmission. Via,
a. Fecal contaminated water
b. Contaminated food and drink, bottle-feeding could be a significant risk factor
for infections.
c. Direct contact: in developing countries through the fingers while carelessly
handling excreta and vomit of patients and contaminated linen and fomites.
• It can also transmit through vectors: House flies.

INCUBATION PERIOD:
From a few hours up to 5days, but commonly 1-2 days.
PATHOGENESIS:
• In the final analysis, cholera is a toxin-mediated disease.
• The watery diarrhea characteristic of cholera is due to the action of cholera toxin, a
potent protein enterotoxin elaborated by the organism in the small intestine.
• It attributed in factors as increased permeability of the intestinal epithelial cells,
increased peristalsis, mucosal damage, increase in mesenteric blood flow and failure of
the “sodium pump”.
• Appearance of watery stools.

CLINICAL FEATURES:
 The majority of infections are mild or asymptomatic
 Typical case will show sudden onset of profuse, effortless, watery diarrhea
followed by vomiting, rapid dehydration, muscular cramps and separation of
urine.
 Severity depends on the rapidity and duration of fluid loss.
 90% of E1 Tor cholera cases are mild and clinically indistinguishable from other,
acute diarrheas.
 Typical case of cholera shows 3 stages
a. Stage of evacuation
b. Stage of collapse
c. Stage of recovery

A. Stage of evacuation:
• The onset is abrupt with profuse, painless, watery diarrhea followed by vomiting.
• The patient may pass as many as 40 stools in a day (rice water appearance of stool).
B. Stage of collapse:
• Patient soon passes into this stage because of dehydration.
Classical signs:
Sunken eye Hollow cheeks,
Scaphoid abdomen, Sub normal temperature,
Washerman’s hand and feet, Absent pulse,
Unrecordable bp, Loss of skin elasticity,
Shallow and quick respirations.

• Decreased urine output and may ultimately cease.
• Patient become restless and complaints of intense thirst and cramps in legs and
abdomen.
• Death may occur at this stage, due to dehydration and acidosis resulting from diarrhea.
C. Stage of recovery: if death does not occur, the patient begins to show signs of clinical
improvement.
• Bp begins to rise and temperature returns to normal and urine secretion is re-established.
• As a result, mild cases recover with in 1-3 days.
• Death from cholera is due to hypovolemic shock.

LABORATORY DIAGNOSIS OF CHOLERA:
A. Collection of stools: fresh specimen of stool should be collected before the person treated
with antibiotics. Collected in rubber catheter/rectal swab.
B. Vomitus: this is practically never used as the chances of isolating, Vibrio’s are much less
and there is no advantage
C. Food samples: suspected to be contaminated with V. Cholerae
D. Water: samples containing 1-3 liters of suspect water should be collected in sterile bottles.
E. Transportation: this must be conducted in sterile method
F. Direct examination: if a microscope with dark field illumination is available, it may be
possible to diagnose about 80% of cases within a few minutes and more cases after 5-6
hours of incubation in alkaline peptone water.
G. Culture methods: Shooting star like appearance of stool culture.

CONTROL OF CHOLERA
GUIDELINES PROPOSED BY WHO – 11 steps
i. Verification of the diagnosis
ii. Notifications
iii. Early case finding
iv. Establishment of treatment centres
v. Rehydration therapy
vi. Adjuncts therapy
vii. Epidemiological investigations
viii. Sanitation measures
ix. Chemoprophylaxis
x. Vaccination
xi. Health education

I. VERIFICATION OF THE DIAGNOSIS:It is important to have confirmation of the outbreak as
quickly as possible
• All diarrhea cases should be investigated for specific diagnosis of cholera
• It is important to identify V. Cholerae O1 in the stools of the patient
II. NOTIFICATION:
• Cholera is the notifiable disease locally and nationally.
• Under the international health regulations cholera is notifiable to WHO within 24 hours of its
occurrence by the national government
• Number of cases and deaths are also to be reported daily and weekly till the area is declared
free of cholera
• An area is declared free of cholera when twice the incubation period has elapsed, since the
death, recover or isolation of the last case

III. EARLY CASE FINDING:
• An aggressive search for cases ( mild, moderate, severe) should be made in the
community to be able to initiate prompt treatment.
IV. ESTABLISHMENT OF TREATMENT CENTERS:
• The mild dehydrated patients should be treated at home with oral rehydration fluid
• Severe dehydrated patients requiring intravenous fluids, should be transferred to the
nearest treatment center / hospital
• Mobile treatments should be established at the district level

V. REHYDRATION THERAPY:
• Cholera is now the most effectively treated disease
• Mortality rate have been brought down to less than 1% by effective Rehydration
Therapy, It should be given through Oral rout (ORS) and IV routes.
• Oral rout: in children <2years 50-100ml of ORS to a maximum of 0.5L/d
• 2-9years 100-200ml of ORS to a maximum of 1L/d
• ≥ 10years as much ORS as desired to a maximum of 2L/d.
• Intra vascular (IV) fluids: most probably Ringer’s lactate 80-150ml/kg body
weight in the first 24hours and then gradually slow down, for fluid replacement.

VI. ADJUNCTS TO THERAPY:
• Antibiotics should be given as soon as vomiting has stopped which is usually 3-4 hours of oral
rehydration
• Antibiotics used like Fluro Quinolones, Tetracycline, Azithromycin, Ampicillin and Trimethoprim
sulphathiazole (TMP-SMX)
VII. EPIDEMIOLOGICAL INVESTIGATIONS:
• General sanitation measures must be applied at the onset of the outbreak.
• At the same time epidemiological studies must be undertaken to define the extent of outbreak and
identify the modes of transmission so that more effective and specific control measures can be
applied.
• There are certain institute for assessing communicable disease, The National Institute of
Communicable Diseases, Delhi and All India Institute of Hygiene and Public Health, Kolkata where
the WHO International Centre for Vibreos is located.

VIII. SANITATION MEASURES:
a. Water control: most important vehicle of transmission of cholera, all steps must be taken to
provide properly treated or other wise safe water to the community for all purposes.
b. Excreta disposal: provision of simple, cheap and effective excreta disposal system is a basic
need of all human settlements. The importance of hand washing with soap after defecation.
c. Food sanitation: it may be an important vehicle of infection steps should be taken to
improve food sanitation, particularly sale of foods under hygienic conditions.
• Health education is must. Importance of eating cooked hot food and of proper individual food
handling techniques.
• Cooking utensils should be cleaned and dried after use.
• The Housefly plays relatively small role in transmitting cholera, but its prevalence is a general
indicator of the level of sanitation.

d. Disinfection: it should be both concurrent and terminal. Most effective disinfectant for general
use is a coal tar disinfectant with Rideal-Walker coefficient of 10 or more such as cresol.
• Bleaching powder if used should of good quality.
IX. CHEMOPROPHYLAXIS: Mass chemoprophylaxis should not be advised for whole
community.
• Tetracycline is the DOC for chemoprophylaxis, given over 3 days, twice daily in the dose of
500mg for adults,
• 125mg for children aged 4-13yrs and 50 mg for children aged 0-3yrs.
• Doxycycline may also used. Single oral dose 300mg for adults and 6mg/kg body weight for
children under 15yrs has proved to be effective.

X. VACCINATION:
Oral vaccines 3 types available.
A. DUKORAL (WC-rBS) :
• It is monovalent vaccine based on formalin and heat-killed whole cell of V. Cholerae 01
plus recombinant cholera toxin B subunit.
• The vaccine is provided in 3ml single dose vials together with the bicarbonate buffer.
• Vaccine and buffer are mixed in 150ml of water for persons aged >5 yrs and in 75ml of
water for children aged 2-5 yrs, given orally.
• Vaccine has shelf life of 3yrs at 2-80
C and remains stable for 1 month at 370
C.

Vaccination schedule and administration :
• Primary immunization consist of 2 oral doses given ≥ 7 days apart for adults and children
aged ≥ 6 years
• Children aged 2-5 years should receive 3 doses ≥ 7 days apart.
• Food and drink should be avoided before and after 1 hour of vaccination
• 1 booster dose is recommended, after 2 years for adults and children aged ≥ 6 years, for
children aged 2-5 years 1 booster dose is recommended every 6 months
• If the interval between primary immunization and the booster dose is >6months, primary
immunization must be repeated.
• DUKORAL is not licensed for children aged<2 years

B. Sanchol and mORCVAX
• The closely related bivalent oral cholera vaccine are based on serogroups 01 and 0139.
• Administration : orally in 2 liquid doses 14 days apart for individuals aged ≥ 1 year.
• A booster dose is recommended after 2 years.
C. Euvichol
• It was prequalified in December 2015 and has same characteristic as Sanchol.

XI. HEALTH EDUCATION:
Most effective prophylactic measures
a) Effectiveness and simplicity of oral rehydration therapy (ORT)
b) Benefits of early reporting for prompt treatment
c) Food hygiene practices
d) Hand washing after defecation and before eating
e) The benefits of cooked, hot foods and safe water

DIARRHEAL DISEASES CONTROL PROGRAMME
• During the year 1980-81, strategy of the National Cholera Control Programme has
undergoes changed.
• Now it is termed as Diarrheal Disease Control Programme.
• Oral Rehydration Therapy (ORT) programme started in 1986-87 in a phased manner.
Main Objective:
• To prevent diarrhea associated deaths in children due to dehydration.
• The training programme and health education material highlight the rational management of
diarrhea in children.
• ORS is promoted as first line of treatment.
• ORS is being supplied as a part of the sub-center kits.

UNANI CONCEPT OF
CHOLERA (HAIZA)

INTRODUCTION
• It is an acute disease in which undigested and putrefied food stuff of the stomach and
intestine is pushed out through vomiting and diarrhea.
• It is caused by Fasd-i- Ghizai (decay of food) and Fasad-i- Hazm
(dyspepsia/indigestion)
• It is characterized initially by restless, excessive thirst, cold, sweating, muscular cramps
followed by severe vomiting and diarrhea.
Cholera (Haiza)

Usul-i- ilaj (principles of treatment):
• Tanqiya-i- Me’da (evacuation of putrefied matter from stomach)
• Taqwiyat-i- Hararat-i- Ghariziya (strengthening innate heat)
• Ta’deel-i-Quwa (restoration of body faculties)
• Taskin-i-Atash (quenching of thirst)
• Taqwiyat-i-Qalb (strengthening of heart)
• Taqlil-i- Ghiza (reduce diet/food)
• Habs-i- Qay’ (control of vomiting)
• Habis-i- Ishal (control of diarrhoea)

Ilaj Bi’l-dawa (pharmacotherapy)
• Oral administration of lukewarm water mixed with common salt to induce vomiting in
early stage of the disease.
• Nusqa for throat: Narjil Dariya’i, Ood Saleeb, Jadwar, powdered and mixed with Arq
Gulab.
• Oral administration of mixtures: Papita, Fifil Siyah/Narjil dariya’i, Filfil Siyah/Jadwar,
Filfil Siyah/Papita 2gm, with Arq Gulab.
• Oral administration of the decoction: Post-i- Ilaichi Safed 12-24gm. Boiled in Arq Gulab.
• Oral administration of mixture of Papita with Arq-i- Keora.

COMPOUND DRUGS
Jawarish-i- Anarain 7gm
Jawarish Safarjali Qabiz 7-12gm
Sharbat Habb al- As 12-24ml
Sharbat Abresham 12ml
Rubb Anar Tursh 6-12gm
Dawa al-Misk 5-10gm along with Arq Bedae Mushk
Jawahar Mohra 30-60mg along with Dawa al Misk Mu’tadil Jawahar Wali
5gm
Yaquti 5-9gm
Sharbat Anar Tursh 24ml with water
Qurs Kafur 3gm
Qurs Ood 7gm

• Ilaj bi’t- tadbir (Regimenal therapy):
• Hammam (bath)
Dietary recommendations:
• Aghziya latif (light diet)
• Aab sard (cold water)
Dietary restrictions:
• Aghziya kasif (heavy diet)
• Contaminated diet
Tahaffuz (prevention/precaution):
• Abrupt arrest of vomiting and diarrhea should be avoided.

References
• Park’s Textbook of Preventive and social medicine.
• Harrison’s textbook of Medicine
• Qamri abu al-Mansur al-Hasan, 2008, Ghana Mana (Urdu translation), CCRUM, new Delhi,
pp127-294
• Khan M A 1906, Iksir-i A’zam, Vol II, Matba’ Nami Munshi Naval Kishor, Lucknow, pp. 427-
445
• Kabiruddin M, 2008, Bayaz-i Kabir Vol II, CCRUM, New Delhi, pp.34, 35, 86

CHOLERA (HAIZA).power point presentation document

CHOLERA (HAIZA).power point presentation document

More Related Content

Similar to CHOLERA (HAIZA).power point presentation document

Recently uploaded

CHOLERA (HAIZA).power point presentation document