Cholera Prevention and Control Strategies; A Global Overview

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 social development and this is a course for concern, considering the stigmatization that accompanies it. The pathogenic V. cholerae O1/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 the stockpile 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 this review, 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.