Guinea-Bissau cholera outbreak risks expected to ‘linger for several months’
The west African country of Guinea-Bissau has reported 700 cases of cholera thus far in 2013, making it the country in the region with the most cases, according to a IRIN, the humanitarian news and analysis service of the UN Office for the Coordination of Humanitarian Affairs report.
Guinea-Bissau’s poorest region, southern Tombali, is the worst hit, with 225 cases and 21 deaths as of late July, said Nicolau Almeida, a health ministry director.
The UN Children’s Fund (UNICEF) reported last month that there has been 742 cases in Guinea-Bissau, 416 in Niger and 368 in Sierra Leone. The outbreak in Guinea-Bissau is a continuation of the 2012 epidemic, when 3,359 people contracted cholera.
“To confirm a new epidemic, the 2012 outbreak should have been declared over” by demonstrating the absence of vibrio cholera in diarrhea, said Inàcio Alvarenga, an epidemiologist with World Health Organization (WHO).
“For reasons I’m not aware of, the government did not test cases in the first weeks of the year. These cases did not disappear but got spread around,” he continued. “I don’t think we will hit the 2008 level [when 14,204 people were infected and 225 killed], but the disease risks will be lingering for several months like in 1996-1998.”
IRIN does point out that the numbers so far this year in Guinea-Bissau are down from 2012 levels.
Cholera is an acute bacterial intestinal disease characterized by sudden onset, profuse watery stools (given the appearance as rice water stools because of flecks of mucus in water) due to a very potent enterotoxin. The enterotoxin leads to an extreme loss of fluid and electrolytes in the production of diarrhea. It has been noted that an untreated patient can lose his bodyweight in fluids in hours resulting in shock and death.
It is caused by the bacterium, Vibrio cholerae. Serogroups O1 and O139 are the types associated with the epidemiological characteristics of cholera (outbreaks).
The bacteria are acquired through ingestion of contaminated water or food through a number of mechanisms. Water is usually contaminated by the feces of infected individuals. Drinking water can be contaminated at the source, during transport or during storage at home. Food can get contaminated by soiled hands, during preparation or while eating.
Beverages and ice prepared with contaminated water and fruits and vegetables washed with this water are other examples. Some outbreaks are linked to raw or undercooked seafood.
The incubation for cholera can be from a few hours to 5 days. As long as the stools are positive, the person is infective. Some patients may become carriers of the organism which can last for months.
Cholera is diagnosed by growing the bacteria in culture. Treatment consists of replacement of fluids lost, intravenous replacement in severe cases. Antibiotic therapy can shorten the course of severe disease.
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