Greetings to all during this rainy season in post-earthquake Nepal. We hope that you and others around you are keeping well. We also hope that the reconstruction work will begin as quickly as possible since many people in remote villages and in camps, in and around Kathmandu are continuing to suffer.
This newsletter is devoted to the topic of Cholera in Kathmandu. Cholera hits Kathmandu almost every monsoon and one does not hear much about it. This time around everyone is worried about cholera epidemic should it hit resettled communities in remote villages or camps where earthquake affected persons are staying in large numbers in less hygienic conditions. So far, cholera seems to be contained and the disease is not in epidemic proportion.
What is Cholera?
Cholera is an acute infectious disease of the small intestine, caused by the bacteria Vibrio cholerae that is characterized by profuse watery diarrhea, vomiting, muscle cramps and severe dehydration. Within hours of illness, a person can go into shock due to fluid loss and this is the most worrisome feature of cholera. The incubation period is usually 1-2 days but can be several hours to 3-5 days. It is usually transmitted by drinking contaminated water and a large number of bacteria are required to cause the infection.
Cholera has been confirmed in about 35 patients from among several cases of severe gastro-intestinal illness presenting to the Sukraraj Tropical and Infectious Diseases Hospital (STIDH) in Teku, Kathmandu. This is believed to have been from drinking untreated contaminated water in heavily populated areas of Kuleshwor and Kalimati in Kathmandu. Cholera cases do occur every year usually in the month of August and epidemics have occurred from time to time in Kathmandu and in Western Nepal. In the foreigner population with acute diarrhea studied at CIWEC for 2 years from 2012-2014, not a single case of cholera was detected.
How can cholera be prevented?
Cholera can be prevented by drinking boiled, bottled or treated water. There is severe shortage of municipal water supply in Kathmandu and people buy water brought by trucks from different vendors and different sources. Water can be treated with chlorine (available as Piyush in pharmacies) or Iodine if bottled water is not available and boiling water is difficult. Safe bottled water is available as sealed one liter bottles, or 25 liter jars of established brand names only. The big jars that are available cheaply on the streets cannot be trusted to be hygienic. If you are involved in relief or volunteer work in earthquake affected areas, please make sure that these water safety rules are followed by yourself and by the people in villages, and camps. Please also emphasize hand washing before eating, eating of freshly cooked hot foods and proper waste disposal.
We do not promote Cholera vaccine in travelers and it is not available in Nepal. Being careful with what you eat and drink can prevent cholera. Cholera vaccine made by Sanofi in India (Shanchol) has protective efficacy of 67% following 2 doses orally. Dukoral, mostly available in Western countries has protective efficacy of 78% against serotype V. cholerae O1.
Treatment
If someone develops symptoms suggestive of cholera e.g. severe watery diarrhea and features of shock or circulatory collapse, the person should immediately be started on oral rehydration treatment and taken to the nearest medical facility for fluid resuscitation which is the key to treatment. Antibiotics like tetracycline or doxycycline can help shorten the duration of illness.
We continue to monitor the situation closely and will keep in touch with you should there be new developments. Thank you and have a great summer!
