Cholera (Vibrio cholerae)

 

 

Purpose

 

The purpose of these policy guidelines is to recommend procedures for handling potential biological threats of Cholera (Vibrio cholerae).

 

Description of AgentlSyndrome

 

Cholera is an acute bacterial enteric disease. Although more than 100 serotypes of V. cholera exist, only 01 and 0139 are associated with the clinical syndrome of cholera. Cholera is considered a Category B Biological Agent. This guideline addresses only serogroups 01 and 0139.

 

Transmission

 

Through ingestion of food or water contaminated directly or indirectly with feces or vomitus of infected person.

 

Incubation Period

 

1.             Ranges from a few hours to 5 days (usually 2-3 days)

2.             Period of Communicability: Presumably as long as stools are positive, usually only a few days after recovery occasionally carrier state may persist for several months. Antibiotics known to be effective against infecting strains shorten period of communicability.

 

Signs and Symptoms

 

1.             Most infections are asymptomatic.

2.             Clinical illness ranges from mild diarrhea to profuse, painless, dehydrating diarrhea that can be fatal in 2-3 hours if untreated.

3.             Vomiting may also occur.

 

Diagnosis

 

Isolation of organism in stool or vomitus

 

Treatment

 

1.            Rehydration and treatment of complications

 

2.                       Antimicrobial

 

 

Dose

Drug

Adult

Children

Tetracycline

500 mg qid for 3 d

50 mg/kg of body weight qid for 3 d

Doxycycline

300 mg as a single dose

Not evaluated

Cotrimoxazole

160 mg of trimethoprim

800 mg of sulfamethoxazole bid for 3 d

8 mg of trimethoprim

40 mg of sulfamethozazole/kg * divided in 2 doses for 3 d

Norfloxacin

400 mg bid for 3 d

Not recommended

Ciproflaxacin

250 mg/d for 3 d

1 g as a single dose

Not recommended

From Seas C, Dupont HL, Valdez LM, et al. Practical guidelines for the treatment of cholera. Drugs 1996; 51:966-973

 

Since individual strains of V.cholerae may be resistant to some antimicrobials, knowledge of sensitivity patterns of local strains, if available, should be used to guide the choice of antimicrobial therapy.

 

Prophylaxis

 

1.             Treatment of contacts: Surveillance of persons who shared food and drink with cholera patients for 5 days from last exposure. If there is evidence or high likelihood of secondary transmission, treat household members with:

a)     Adults: Tetracycline 500mg QID or Doxycycline 300mg QD x 3 days

b)     Children: Tetracycline 50mg/kg/day in 4 divided doses or a single dose of doxycycline 6mg/kg for 3 days.

 

2.             Vaccine: A vaccine is available that offers partial protection (50%) for short duration (3-6 months) however it is not recommended.

 

3.             Immunization of contacts is not indicated

 

Control Measures and Decontamination

 

1.             Standard Precautions

2.             Use contact precautions for diapered or incontinent children under 6 years of age

3.             Education of those at risk to seek treatment without delay

 

Notification

 

Internal:      At hospital notify_______________________________

 

External:    All suspected cases of suspected Cholera are Class Al Reportable and should be reported immediately to the Local Health Department who will then contact the State Health Department and/or CDC.

 

Lab

 

Due to potential risks associated with handling infectious materials, laboratory testing should be the minimum necessary for diagnostic evaluation and patient care. Laboratory specimens should be placed in plastic bags (with a biohazard label) that are sealed, and then transported in clearly labeled, durable, leak proof containers directly to the specimen handling area of the laboratory. Care should be taken not to contaminate the external surfaces of the container. Lab personnel should be notified of what they are handling. Bio-Safety Level 2 should be used for handling specimens.

 

 

References

 

1.             Chin, J. Control of Communicable Diseases Manual 17th Edition, 2000. American Public Health Association. Washington D.C.

2.             Infectious Disease Control Manual. Ohio Department of Health 11/99.

3.             Mandell, GL, Bennett, JE, Dolin, R, Eds; Principles and Practices of Infectious Diseases. Philadelphia: Churchill Livingstone; 2000.

 

 

 

 

Initially Prepared by

The Akron Regional Hospital Association

Emergency Preparedness Subcommittee

August 20, 2002