Cholera often breaks out when there is overcrowding and inadequate access to clean water, sanitation and proper toilets. It causes profuse diarrhea and vomiting, which can lead to death by intense dehydration, sometimes within a matter of hours.

According to the World Health Organization, cholera affects three to five million people worldwide and causes between 100,000 and 130,000 deaths per year.

Doctors Without Borders/Médecins Sans Frontières (MSF) has developed cholera treatment kits in order to provide rapid assistance in epidemics.

When an epidemic seems imminent, MSF will begin setting up dedicated cholera treatment centres and oral rehydration points as close as possible to the population at risk. As specialized isolation wards designed to prevent the spread of the disease, cholera treatment centres are vital in managing and treating severely sick cholera patients. The onset of cholera is abrupt and cases must be detected and treated as early as possible.

Patients in a more serious condition are transferred to the treatment centres, while more moderate cases are treated at the rehydration points. MSF staff work to raise communities’ awareness of the disease and how it is spread, and promote hygiene messages. Water and sanitation staff will ensure there are sufficient latrines available, adequate quantities of safe water, and soap.

Democratic Republic of Congo: MSF working to contain country's worst cholera outbreak in 20 years

Democratic Republic of Congo is currently facing its most significant cholera outbreak for 20 years: in 2017, 55,000 people fell ill across 24 of the country’s 26 provinces, and 1,190 died. MSF has been at the forefront of the medical and humanitarian response, treating half of the cases (about 25,300 people) across the country. The epidemic has now reached the country’s capital, Kinshasa. This megapolis of 12 million people is the nerve centre of the country’s trade and home to one in every six Congolese. It is vulnerable to cholera because of a lack of drinking water, a lack of sanitation, and a lack of health infrastructure that is properly adapted to provide treatment in cholera-affected areas. From the end of November 2017 until January 22, 2018, health authorities indicated 826 suspected new cases and 32 deaths.

 

What causes cholera?

Cholera is caused by an infection of the small intestine with the bacterium Vibrio cholerae. The bacterium causes the cells lining the intestine to produce large amounts of fluid, leading to profuse diarrhea and vomiting.

The infection spreads when someone ingests food or water contaminated with the feces or vomit of someone carrying the disease.

Contaminated food or water supplies can cause massive outbreaks in a short period of time, particularly in overcrowded areas such as slums or refugee camps.

 

Cholera amid conflict in Yemen 

In 2017, a cholera outbreak in Yemen caused widespread suffering and mortality for a population already trapped in a violent conflict zone. The outbreak has wreaked havoc in a country already struggling with a collapsed health system. In March 2017, the city of Abs registered its first cholera case. By June, the MSF cholera treatment centre in Abs was receiving as high as 460 cholera cases in a single day.

 

Symptoms of cholera

Typically, symptoms of cholera appear within two to three days of infection. However, it can take anywhere from a few hours to five days or longer for symptoms to appear.

A cholera infection is often mild or without symptoms but can sometimes be severe, resulting in profuse watery diarrhea and vomiting.

Sufferers rapidly lose body fluids, leading to dehydration and shock. Without treatment, they may die within hours.

 

 

Diagnosing cholera

Cholera can be diagnosed by examining stool samples or rectal swabs, although due to the fast-acting nature of the disease there is often little time to do so.

In epidemic situations, a diagnosis is often made by taking a patient history and conducting a brief examination, with treatment given before there is time for a laboratory to confirm the diagnosis.

 

Go inside an MSF cholera treatment centre

 

Treating cholera

Cholera can be treated simply and successfully by immediately replacing the fluids and salts lost through vomiting and diarrhea — with prompt rehydration, less than one per cent of cholera patients die.

Cholera victims are treated with oral rehydration solutions — prepackaged mixtures of sugars and salts that are mixed with water and drunk in large amounts. Severe cases will need to receive fluids intravenously, and antibiotics are sometimes administered.

MSF has treated cholera outbreaks in Algeria, Angola, Cameroon, the Democratic Republic of Congo, Haiti, India, Kenya, Pakistan, Papua New Guinea, Somalia, South Sudan, Uganda and Zimbabwe.