Overview
Cholera is an acute diarrhoeal infection caused by ingesting food or water contaminated with the bacterium Vibrio cholerae. Several countries in the Eastern Mediterranean Region have recently recorded a surge in cases of acute watery diarrhoea (AWD)/cholera.
Preventative behaviours adopted by individuals and communities are key to reducing cholera transmission and support the early detection and treatment of people with cholera.
Below are key messages that can be used to communicate cholera information to affected populations, health workers and community leaders. Ministries of health and partners should adapt these messages to local contexts and needs.
Target audiences
The general public
What is cholera?
Cholera is a bacterial infection that causes severe diarrhoea.
It affects both children and adults.
The bacteria live in the faeces (poop) of an infected person.
Cholera spreads when someone drinks water or eats food contaminated with the bacteria.
Symptoms
Most people infected with cholera do not develop symptoms but can still spread the bacteria in their faeces for up to 10 days after infection.
Approximately 1 in 10 people will experience severe symptoms, which can cause severe dehydration.
Common symptoms include:
large amounts of diarrhoea that looks like “rice water”;
vomiting;
leg cramps; and
weakness.
People with symptoms often start feeling unwell between 12 hours and 5 days after ingesting contaminated food or water.
Cholera can weaken a healthy person quickly and can cause death within 24 hours.
What to do if you suspect cholera
Cholera is easily treatable.
If you suspect someone has cholera, don't panic but act quickly.
Immediately give the sick person ORS or water, soups and other fluids until you reach the nearest health facility or obtain ORS.
Seek medical advice for diagnosis and further treatment.
Oral rehydration solution (ORS) and how to use it
ORS can successfully treat 80% of patients.
Prepare an ORS solution by mixing 1 sachet of ORS in 1 litre of clean and safe water.
If you do not have ORS sachets, make the solution by mixing:
half a teaspoon of salt
6 teaspoons of sugar
1 litre of clean and safe drinking water or lightly salted rice water.
How to protect yourself from cholera
Cholera typically spreads through contaminated food or water.
Protect yourself and your family by:
drinking only clean boiled or chlorinated water;
using clean water for washing and preparing food; and
regularly washing your hands with soap and clean water, especially before eating, cooking, after using the toilet/latrine and after changing your child's diaper.
Cook food thoroughly, keep it covered and eat it immediately.
Keep your drinking water sources clean by not washing yourself, your hands or clothes in the source.
Remember – boil it, cook it, peel it or forget it!
How to ensure your water is safe to drink during cholera outbreaks
Drinking clean water is essential to prevent many diseases, including cholera.
Ensure your water is clean by:
boiling – boil your water for 1 minute
disinfecting – add 8 drops or a little less than 1/8 of a teaspoon of 5%-9% unscented household bleach to 1 gallon of water. Wait at least 30 minutes before using.
What to do if you are caring for someone with cholera
Wash your hands thoroughly with soap and safe water after touching the clothes or bedding of the sick person.
Wash the sick person's bedding or clothing away from drinking water sources.
Avoid direct contact with the sick person's stools and vomit.
Place all waste in a toilet and ensure the latrine is properly disinfected.
Disinfect the sick person's clothing and bedding with a chlorine solution or by placing them in boiling water for 5 minutes, or by washing with soap and drying in direct sunlight.
If the sick person uses the household or community toilet, clean and disinfect it thoroughly after each use.
Mothers should continue to breastfeed infants and young children even if diagnosed with cholera.
How to deal with a person who died from cholera
If a person has died of cholera, take extra precautions to reduce the risk of spread during the funeral.
Minimize handling the body and bury it as quickly as possible, preferably within 24 hours after death.
Trained health personnel should help with body preparation and burial to prevent further spread.
Health care providers and community health workers
Symptoms and diagnosis
Common signs and symptoms of cholera include:
acute diarrhoea, described as "rice water" stool;
severe dehydration;
rapid heart rate;
loss of skin elasticity;
dry mucous membranes;
low blood pressure;
vomiting;
thirst;
leg cramps; and
weakness.
If you see patients with signs and symptoms consistent with cholera, administer ORS immediately and conduct testing to confirm the diagnosis.
Testing options include:
rapid diagnostic tests (RDTs); and
laboratory sample testing.
General hygiene
When providing direct care for patients with vomiting and profuse diarrhoea, follow these basic measures:
practice hand hygiene with soap and water or an alcohol-based hand rub;
wear personal protective equipment (PPE) upon room entry and remove it before exiting
wear a clean, non-sterile, long-sleeved gown; and
wear clean gloves that cover the cuffs of the gown.
Safe practices for burial and funerals
Take extra precautions to reduce the risk of cholera spreading during the funeral of a person who died from cholera.
Trained health personnel should help with body preparation and burial to prevent further spread.
Persons handling the body must wear gloves, aprons and masks.
Clean the body with a 2% chlorine solution.
Do not empty the intestines.
Trained staff should fill the mouth, nose and anus of the body (but not the vagina) with cotton wool soaked in chlorine solution.
Carefully wrap the body, preferably in a body bag.
Anyone carrying the body should wear gloves.
Only trained personnel should handle bodies during burial.
Disinfect the deceased's clothing and bedding with a 0.2% chlorine solution. If chlorine is unavailable, disinfect bedding and clothing by stirring them for 5 minutes in boiling water and drying them thoroughly in direct sunlight or by washing with soap and drying in direct sunlight.
If requested, family members may be present during body preparation for burial. Inform them about how to protect themselves from infection and provide them with the necessary personal protective equipment and handwashing facilities.
Community leaders and local NGOs
How to help prevent and respond to cholera outbreaks in your community
Regularly monitor water quality.
Request local authorities to check the quality of community water sources if community members are getting sick.
Encourage your community to follow safe hygiene practices, including handwashing and safe food and water practices.
Encourage safe water measures in your community.
Never assume water is safe to drink – always treat it.
Collect, carry, store and use drinking water properly.
Ensure wells and hand pumps are regularly cleaned.
Stop community members from using stagnant or potentially contaminated community water sources.
Help improve community sanitation by:
encouraging community members to avoid open defecation;
encouraging community members to bury their faeces and not defecate near water sources when no toilets are available;
setting up handwashing stations next to toilets and encouraging handwashing; and
using tippy-taps (a simple handwashing device that uses a foot lever to tip water from a container) if no running water is available.
Practices during funerals
If a community member passes away with suspected or confirmed cholera, take measures to protect the family and broader community.
Grieving families should have the right to bury their loved ones safely, respectfully and appropriately. If funeral ceremonies are held, religious leaders and communities should take the following steps to reduce the risk of spread:
avoid large funeral gatherings. If not possible, ensure all protective measures are in place, including handwashing facilities (soap and safe water, alcohol-based hand rub or 0.05% chlorine solution) for funeral participants;
avoid allowing people attending funerals to touch the body. If the body must be touched, those in contact should immediately wash their hands and avoid touching their mouths. Disposable gloves can also be used and then immediately discarded. Kissing the body should not be allowed; and
avoid serving food at the funeral. If food is served, it should be eaten hot and handwashing should be compulsory before preparing or eating food. Have a community member or health worker in place to supervise and support hygienic practices during the ceremony.
Cholera can spread quickly in the community. As a community leader, proactively address risks associated with cholera. Always encourage community members to inform of any sickness and seek medical support for diagnosis and treatment.
Sources
Cholera: introduction (Open WHO)
Country support platform: global task force on cholera control (CIFRC)
Cholera outbreak response field manual: global task force on cholera control
Water, sanitation and hygiene (CIFRC)
Reducing the spread of cholera in the community: global task force on cholera control