ABSTRACT
The observed devastating effects of cholera disease, usually instil fear in the population whenever a cholera outbreak is reported in a particular region. Cholera outbreaks have become key indicators of socialdevelopment and this is a course for concern, considering the stigmatization that accompanies it. The pathogenic V. choleraeO1/O139 (the watery diarrheal causing agent), is shed in feces, survive as free-living bacteria in water and enters a new host system through the fecoral route. There is therefor, every reason to conclude that, water and food (especially raw or undercooked shellfish), that is contaminated with feces, is the most implicated cause of outbreaks and epidemics in the endemic areas of the world. Cholera mortality rate can rise to about 50% if severe cases are left untreated, but rapid fluid replacement therapy and supportive treatment can reduce the mortality to around 1%. Prompt intervention strategies are therefore necessary if cholera deaths must be prevented and controlled. These strategies may include; getting access to good potable and clean Water, Sanitation and Hygiene (WASH) facilities, good surveillance/community education systems, Oral Cholera Vaccine (OCV), Oral Rehydration Therapy (ORS), and prompt Antibiotic treatment. However, it has been noted that most of the regions that are prone to this flesh eating diarrheal disease, are usually, low resource communities with little or no available road networks and infrastructural facilities. These major challenges render most of these cholera prone areas of the world in accessible. To assist these areas (for example the Nigerian population), in the cholera prevention and preparedness, free-of-cost cholera Vaccines have been sent from thestockpile to the affected areas. Thanks to the concerted efforts made by Gavi, WHO, and partners, who with the NCDC and Borno State Ministry of Health, have made the vaccine available (to Nigeria) and other hot spots. Moreover, the basic requirements for effective surveillance systems, (effective targeted prevention and control) and early warning units, (detection of the index cases, initiation of outbreak control measures through an integrated approach, identification of high risk areas/vulnerable populations and immediate dissemination of information with stakeholders for timely action), have now put been established in most vulnerable location/cholera hot spots in the world. Better still, the Solidarités International (SIs) which was established in Nigeria since 2016, has intervened in cholera outbreaks especially that which occurred in the Borno state in 2017. They make available to susceptible areas, multi-sectorial, life-saving humanitarian aid, especially to the internally displaced and host communities, who suffer from disease outbreaks. Combining the efforts to improve on water quality, sanitation, hygiene (WASH) and OCVs (targeting the highest risk groups first), would help overcome resource/logistical limitations and enable higher coverage. In thisreview, we seek to look at the prevention and control strategies put in place by the Government and other bodies, to reduce cholera burden in Nigeria and other cholera hotspots, and the level of effectiveness towards achieving their goals.
ABSTRACT
The severe diarrheal diseaseCholera, has gained public health importance because of its life-threatening effect. The detection of the causative agent of this disease(Vibrio cholerae(V. Cholerae)O1 or O139) from a specimen (stool, vomitus of food sample) remains a major concern in the world today. Phenotypic finger printing (the conventional methods) of the toxigenic V. choleraestrain, remains the gold standard for the laboratory diagnosis of cholera; especially during cholera epidemic outbreaks.Detection around the remote areas which are usually rampaged by these outbreaks is usually difficult due to lack of required diagnostic facilities in small laboratories.However, the use of phenotypic approaches have some major setbacks as they are usually labor-intensive and time consuming. This delays treatment commencement especially in life threatening cases.To alleviate these setbacks, rapid molecular typing techniques involvingthe Polymerase chain reaction (PCR) amplification, hybridization methods,Pulsed Field Gel Electrophoresis (PFGE), Multilocus Sequence Typing (MLST), Multiple-Locus Variable Number Tandem Repeat Analysis (MVLA), Fluorescent Amplified Fragment Length Polymorphism (FAFLP), Whole Genome Sequencing (WGS) etc. represent promising tools for early detection of the pathogen V. choleraeO1/O139 even in remote areas where laboratory resources are poor. Immunoassay-based techniques like enzyme-linked immune-sorbent assay (ELISA), coagglutination, immunofluorescence, and quartz crystal microbalance (QCM), are capital/labour intensive and expensive for low resource settings. Rapid diagnostic tests based on immune-chromatography principle have also been developed for simultaneous detection of V. choleraeserogroups O1 and O139. These test kits are easy to use, transport, and fast.All these methods enable the subtyping of unrelated bacterial strains and they all operate with different accuracies, discriminatory ability, and reproducibility.This review sought to address some of the methods used in diagnosing the disease cholera, with the objective of identifying the best and easiest of the methods that can help to curb the cholera problem (deaths) often encountered, especially in low resource settings in the developing countries (Nigeria inclusive)
ABSTRACT
Cholera is still a problem in the world today. A huge population of deaths due to cholera disease still occur in Sub-Saharan Africa (Nigeria most especially), Asia, the Americas and other developing countries,whereapproximately 1.7 billion inhabitants are still served by faecally polluted water sources. Approximately, 2.4 billion inhabitants of these areas of the world lack the majorly required sanitary conditions of living. Legros,asserts that, as of 2019, about forty-seven countries of the globe, are still affected by cholera. Raw or undercooked, contaminated seafood, serves as a vehicle for the transmission (especially to non-endemic areas). A Case Fatality Rate of 4.87% was recorded from 34 Local Government Areas of Bauchi, Borno, Kaduna, Kano and Zamfara state in Nigeria by the 34thweek, in 2018, while 298 confirmed cases and 38 deaths (CFR 1.5%) were recorded from three Local Government Areas in two States (Adamawa & Borno) byEpidemiological week 41 in 2019. Cholera in some cases is regarded as a “disease of the poor” because the populations most affected are those that cannot afford to provide the basic health facilities for themselves. For example, waste management systems, and good accommodation with toilet facilities (the living and health conditions of the people) are wanting. In 2017,A Global Roadmap to 2030was launched by the Global Task Force on Cholera Control (GTFCC EndingCholera) to decrease the death rate due to cholera by 90%. By so doing, the disease can be eradicated from at least half of the 47 cholera-affected countries. The objectives of this roadmap are: to fortify health systems, water, sanitation and hygiene (WASH), and to coordinate different ways by which cholera can be controlled in these countries by 2030 (ensuring early detection and prompt response to contain outbreaks). This review aimed to understand the epidemiology of cholera in Nigeria, Africa and the world at large, to access the level of spread, management and preventive measures so far implemented in the endemic regions