Cholera cases appear in Wuhan! In the face of severe infectious diseases, how can we prevent it?

Today, Wuhan University reported a case of cholera with a positive serological test for O139.

 

At present, the patient ‘s condition has been controlled after diagnosis and treatment. The Health and Health Commission of Wuchang District, Wuhan City has organized professional institutions to manage relevant personnel and places, and no new cases have been found .

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Announcement from the Health Bureau of Wuchang District, Wuhan City. The “virulence gene negative” in the text means that the bacterial load may not be high, the pathogenicity is limited, and the subsequent health risk of the case should be low.丨The official account of Rong Media Center, Wuchang District, Wuhan City

In many people’s minds, cholera is an ancient and distant disease. In fact, on a global scale, the threat of cholera is always present.

For cholera, we don’t have to panic, but we need to always be alert to the risk of infectious diseases.

 

Cholera, the only category A infectious disease

 

Cholera is a severe infectious disease caused by the bacterium Vibrio cholerae and is mainly spread by eating contaminated water and food . Vibrio cholerae is widely present in rivers, lakes, seas and other water bodies in nature, and there are more than 200 serogroups, of which O1 and O139 serogroups can cause cholera.

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Vibrio cholerae under the microscope丨wikimedia commons/Zeimusu

Cholera and plague are currently among the 40 statutory infectious diseases in China, the only two category A infectious diseases that require compulsory management . Once a medical and health institution finds a suspected or confirmed case of a Class A infectious disease, it needs to report directly to the Internet within 2 hours in urban areas and within 6 hours in rural areas.

 

The reason why cholera and plague are Class A infectious diseases is that on the one hand, they have caused many pandemics in human history ; , high case fatality rate , cholera causes about 1.3 million to 4 million cases each year, of which 21,000 to 143,000 deaths [1] .

 

Thanks to the improvement of the public health environment, especially the popularization of clean drinking water, and the establishment of urban feces and sewage treatment systems, there have been few large-scale outbreaks of cholera in modern countries and cities .

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In Haiti’s cholera-prone area, people use specially made toilets to block the risk of fecal-oral transmission from water pollution丨wikimedia commons/SuSanA Secretariat

However, in poor countries and regions, cholera outbreaks occur from time to time : in 2018, cholera outbreaks broke out in 10 African countries. In the same year, the Chinese embassy in Kenya reminded Chinese citizens in Kenya to pay attention to cholera prevention; in May this year, African Malawi, Benin, A cholera epidemic broke out in Cameroon, and the General Administration of Customs of China issued an announcement on May 19 to strengthen border quarantine.

 

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Announcement No. 40 [2022] of the General Administration of Customs (Announcement on Preventing the Introduction of Cholera Epidemic into my country)丨customs.gov.cn

Therefore, the cholera incident at Wuhan University is relatively special in that the outbreak occurred in an urban area with a good public health environment, which is not considered a cholera risk area . Therefore, it is even more necessary to strictly trace the transmission chain to find out how the case was infected; At the same time, colleges and universities are gathering places , and in the next few days, they should also track and manage relevant risk personnel and investigate new risks.

 

What are the symptoms of cholera infection?

 

According to the “National Cholera Surveillance Program”, any person with diarrhea symptoms and positive for Vibrio cholerae group O1 or (and) O139 group in stool, vomit or anal swab samples can be laboratory confirmed cases .

 

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Definition of monitoring diagnosis丨References [6]

According to clinical manifestations, the course of cholera can be roughly divided into three stages.

 

The first is the diarrhoea period . The patient may have several to a dozen bowel movements per day, and the stool will become watery, and may have projectile vomiting.

 

Then comes the dehydration period . Due to severe diarrhea and vomiting, the patient suffered severe loss of water and electrolytes. Decreased blood volume at this time can lead to circulatory failure and the patient is at risk of death from shock.

 

The last is the reaction period and the recovery period . After correction of dehydration, symptoms disappear in most patients and gradually return to normal.

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Cholera hospitals in Bangladesh, using special ‘cholera beds’丨wikimedia commons/Mark Knobil

Symptoms are mild for most people with cholera, but nearly one in 10 suffers from severe symptoms. Left untreated, 25% to 50% of severe cases are life-threatening.

 

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Dehydrated cholera patient has sunken eye sockets and wrinkled hands due to dehydration丨wikimedia commons/cdc

Now, cholera is a curable disease, and the emphasis is on prompt treatment .

 

Regardless of the serogroup caused by cholera, the treatment is exactly the same: according to the severity of symptoms and the degree of dehydration, adequate and timely supplement of fluids and electrolytes by oral or injection to correct dehydration . In addition, since Vibrio cholerae is a kind of bacteria, combined with drug susceptibility test to select sensitive antibiotics for adjuvant treatment , the course of disease can be shortened.

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Cholera patients receiving oral rehydration fluids丨CDC

 

Prevention is the top priority in the fight against cholera

 

For infectious diseases, prevention is extremely important .

 

At the national level, cholera surveillance is being done all the time . At present, my country has set up 34 national-level monitoring points in 17 provinces including Hainan, Guangdong, Fujian, and Zhejiang to monitor water systems, marine/aquatic products, intestinal clinics, and diarrhea patients in the region, and report them level by level. The purpose of such surveillance is to detect new cases as early as possible, identify outbreaks, and try to stifle the epidemic in its cradle.

At the same time, cholera is also a key infectious disease of international health and quarantine in China and even around the world. Avoiding imported cases is also preventing potential risks at the national level.

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Web direct reporting system page丨wendangwang.com

 

For individuals, the National Centers for Disease Control and Prevention uses “keep a good mouth” to summarize how the public can prevent cholera, mainly avoiding drinking unclean water, cooking water/seafood thoroughly before eating, separating raw and cooked chopping boards, and paying attention to hand hygiene In addition, if you have related symptoms, seek medical attention in time – these preventive measures are actually effective for many intestinal infectious diseases.

 

The human body is generally susceptible to Vibrio cholerae, and the immunity after the disease is not long-lasting, usually 1 to 3 years, so there is the possibility of secondary infection after the disease. There is already a cholera vaccine , and the new rBS/WC oral cholera vaccine (capsule type) developed in China has already been approved for marketing.

However, vaccines have a limited duration of protection and are not routinely promoted in healthy populations. Cholera vaccination is also necessary if traveling to high-risk areas, working in the field or on the water.

 

references

[1] https://ift.tt/yVemz7l

[2] Zhu Wanfu, Zhuang Hui, editor-in-chief. Medical Microbiology. Peking University Medical Press

[3] https://ift.tt/UeH9ay3

[4] https://ift.tt/HyK69nj

[5] https://ift.tt/IUCglyL

[6] “National Cholera Surveillance Program” (2017)”

Author: Li Xiaoqiu, Li Xiaokui

Editors: Li Xiaokui, luna

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