Seniors And Cholera Protection

  • Vivien Karen MokBachelor of Science – Biomedical Science, King's College London
  • Chimdi OkoyeBachelor of Science - BS, Pharmaceutical Science with Regulatory Affairs, Kingston University

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Cholera is caused by the bacteria Vibrio cholerae and is a prevalent disease found mainly in countries within Africa and some within Asia. Its infection can lead to severe diarrhoea and dehydration, often fatal if left untreated. Seniors are most susceptible to the virus as they have increased vulnerability to dehydration and weakened immune systems.

The Cholera disease disrupts the livelihood of millions as the disease prevents its victims from their usual routine, prolonging recovery periods and potential long-term health complications. Due to these factors, many families are negatively impacted socioeconomically. 

Introduction to cholera and its impact on seniors

The Asiatic bacteria Vibrio cholerae originated from the Ganges delta in India.1 This bacteria causes Cholera, an acute diarrhoeal disease that causes intestinal inflammation which triggers rapid fluid and electrolyte loss, leading to severe dehydration. Seniors and children are especially vulnerable to Cholera due to their increased vulnerability to dehydration. Seniors have weakened immune systems, making them more susceptible to the severe symptoms of the disease.

They also have decreased kidney function, and reduced thirst sensation exacerbates dehydration, leading to a more rapid progression of the Cholera disease due to their tendency to rapid fluid loss and electrolyte imbalance. It can be noted that seniors have the highest mortality rate of 16%.2 Since seniors and infants are the most vulnerable and defenceless against this disease, their protection against Cholera must be a priority as opposed to other age groups. 

Understanding cholera

The Vibrio cholerae bacteria spreads primarily through ingestion of contaminated water and food. Its contamination is caused by poor sanitation and hygiene practices, such as when untreated sewage water enters the water source used for drinking, cooking, or washing food. Seafood that is harvested from contaminated waters also circulates the bacterium when consumed raw or undercooked. Poor or lack of hand-washing practises after using the washroom or prior to handling food causes bacteria transmission to the mouth and or eyes. 

The symptoms of Cholera are having extreme watery diarrhoea, particularly a rice-water characteristic stool from continuous purging.9 It is painless but often is accompanied by abdominal discomfort and crampy from fluid distension in the bowel. Some other symptoms are vomiting during the early stages, bile in the stool, sunken eyes, cold clammy skin, and decreased skin turgor from dehydration.

Cholera also causes long-term health conditions due to severe dehydration. From stool bicarbonate losses, metabolic acidosis occurs. For seniors with kidney issues, this occurrence can be severe and could lead to renal dysfunction. Dehydration also decreases blood volume, hence leading to a lowered blood pressure. 

The patient would be diagnosed with Cholera if they have developed acute watery diarrhoea in an area with high rates of cholera. Places with microbiology facilities allow confirmation of Vibrio cholerae presence in stool samples. The treatment for Cholera mainly involves rehydration with clean water and electrolytes, along with equimolar concentrations of sodium and glucose for increased sodium uptake in the inflamed small intestine.

Patients with severe Cholera symptoms require 200 mL/kg of isotonic oral or IV fluids in the first 24 hours, then an increased 350 mL/kg after 24 hours.3 Effective antibiotics can reduce the duration of diarrhoea and the volume of stool, however, it also carries a risk of increasing antibiotic resistance. 

Cholera disease can be prevented and its symptoms mitigated through the provision of safe water and the practice of hand-washing. This can be achieved through the development of infrastructures with systems that provide safe water and adequate sanitation. A cost-effective solution is the oral cholera vaccine with a focus on areas with high risk of outbreaks. 

Risk factors for seniors

From epidemiology statistics, seniors have the highest mortality rate of 16% compared to other age groups, and the case fatality ratio found in areas that are cholera-prone were as high as 54 to 68%.2 As the immune system ages, its ability to fight off pathogens and heal wounds decreases substantially, hence vaccine responses are also impaired. Older individuals with weakened immune systems are naturally more susceptible to inflammatory and tissue-damaging diseases like Cholera.4 

Not only do seniors have weakened immunity, but they most likely also have existing health conditions including compromised kidney functions and impaired gastrointestinal motility. With a compromised kidney function, the characteristics of the Cholera disease cause an increased threat of renal failure. With acute dehydration, there is a significant decrease in blood volume, hence a decrease in renal blood flow.

The lessened renal blood flow increases the risk of ischemia, meaning a reduced oxygen supply to the kidney organ. Some long-term health conditions following renal ischemia are severe metabolic acidosis (lack of oxygen supply causing lactic acid buildup), acute tubular necrosis (cell death of renal tubules), and tubulointerstitial nephritis (inflammation around the renal interstitium tissue).5 Cholera causes intestinal inflammation so impaired gastrointestinal motility would cause great discomfort if Cholera is contracted, impeding recovery from the infection. The existing health condition already makes a normal lifestyle difficult, with the symptoms of Cholera on top of these health conditions, the risk for fatality and pain increases significantly. 

The Vibrio cholerae bacteria can grow and thrive in hotter climates where the temperature is between 20°C and 45°C.6 Unsanitary and hotter living conditions accelerate the Cholera infection rate and the progression of the disease infection. Hotter and uncomfortable living conditions prevent the speedy recovery of patients. 

Strategies for cholera protection 

The following bullet points outline important aspects that can effectively mitigate the spread of Cholera. 

Vaccination

Although vaccinations may be less effective and impaired for seniors with weakened immune systems, vaccination and booster shot availability to a community prone to Cholera is essential to prevent the severity of symptoms. According to the World Health Organization, the recommended vaccination schedule is to have two doses of the oral cholera vaccine, administered at least one week apart for full protection.1 

Improved hygiene practices

Handwashing techniques are also crucial in preventing the spread of infectious diseases including Cholera. The following steps show the proper technique for handwashing:

  1. Wet your hands with clean, running water and apply soap
  2. Lather all of your hands with soap by rubbing them together. Make sure to lather the backs, between fingers, and under the nails
  3. Scrub your hands with soap for long enough, at least 20 seconds
  4. Rinse your hands well under clean, running water
  5. Dry your hands using a clean towel or air dry them

Make sure that handwashing is done constantly, especially before, during, and after handling food, before and after caring for someone who is sick, before and after treating a cut or wound, after using the washroom, after changing diapers or cleaning up a child who used the toilet, after blowing your nose, coughing, or sneezing, and after touching an animal, animal feed, or animal waste. Thorough and consistent handwashing is an easy and effective way to prevent the spread of infectious diseases. 

Safe water consumption 

Areas with unsanitary water sources are prone to spreading Cholera. By treating water, the spread can be mitigated and prevent a worsening situation. 

  1. Bleach: Add 8 drops of household bleach for every 1 gallon of water 
  2. Filter: use a filtering device with less than 0.3 microns pore size
  3. Boil: Bring the water to a rolling boil for at least 1 minute
  4. Chlorine: Add a chlorine tablet to the water

Safe food consumption

Ingesting contaminated food also spreads Cholera. Cook food until piping hot to ensure it is thoroughly cooked and eat it hot, when not ready for consumption, keep the food covered. Be sure to thoroughly cook seafood, especially shellfish as they are most easily contaminated feed. Avoid raw vegetables and always peel the fruits.7 

Environmental sanitation

Needless to say, a clean environment with sanitary conditions would prevent the spread of diseases. The Global Task Force on Cholera Control (GTFCC) is an NGO whose main purpose is working alongside experts to end Cholera by providing clean water, sanitation, and promoting hygiene (WASH) as disease prevention measures. They also assist with case management, epidemiology and providing Oral Cholera Vaccine (OCV).8 GTFCC also looks into building proper sewage disposal to suppress contamination into essential water sources.

Caregiver responsibilities

  • Monitoring symptoms: Seniors who are suffering from cholera should have their symptoms regularly monitored by carers. These symptoms include vomiting, copious watery diarrhoea, and indicators of dehydration such as sunken eyes, dry lips, and decreased urine output
  • Hydration management: By encouraging regular sips of oral rehydration solution (ORS) or water and keeping an eye on fluid intake and output, carers can help seniors with cholera stay adequately hydrated
  • Providing nutritional support: To replenish lost nutrients and energy during cholera recuperation, carers should serve seniors small, frequent meals and snacks. Foods high in electrolytes, such as rice, yoghurt, and bananas, can assist in restoring lost nutrients
  • Ensuring comfort for recovery: Seniors suffering from cholera should be encouraged to take it easy and refrain from physically demanding activities. Creating a welcoming and encouraging environment can help in the healing process
  • Administering medications: To treat cholera symptoms and complications, carers may be required to deliver prescription drugs, such as antibiotics or antiemetics, as instructed by medical professionals
  • Infection control: To stop the spread of cholera to other family members and carers, carers should adhere to appropriate infection control protocols and maintain stringent hand hygiene

Community support and resources

Resources and community support are essential in the fight against cholera outbreaks. Since polluted water is the main way the disease spreads, having access to safe water sources is essential. Government health programmes, including those run by UNICEF and the World Health Organization (WHO), emphasise the importance of basic sanitation techniques, safe food preparation, and good hygiene habits. In addition, the Global Task Force on Cholera Control (GTFCC) oversees the implementation of the WHO's pre-qualified oral cholera vaccines (OCV), which are essential instruments in the fight against cholera transmission. The GTFCC emphasises targeted ways to avoid cholera recurrence, early diagnosis and quick action, and efficient coordination for technical support and resource mobilisation at local and international levels.

See this link for more information on GTFCC 

In communities, senior centres and support groups are crucial for managing and preventing cholera. These facilities provide focal points for senior care providers and the public's knowledge, awareness, and assistance. Support groups and senior centres play a vital role in shielding vulnerable populations from the effects of cholera outbreaks by offering a forum for the dissemination of knowledge on cholera prevention techniques and facilitating access to resources like clean water and medical assistance.

Summary

Seniors are more vulnerable to serious complications and death from Cholera, thus public health initiatives must give priority to protecting them. Senior health must be given top priority in Cholera preventive methods as they have the greatest mortality rate among impacted demographics. This call to action emphasises the necessity of focused interventions and assistance that are adapted to the particular vulnerabilities faced by seniors, such as access to immunisation, clean water sources, and appropriate hygiene practices.

In the long run, Cholera research should concentrate on improving knowledge of the variables that lead to seniors' higher mortality and susceptibility as well as creating more efficient preventive and treatment plans that are especially suited to their needs. By tackling these obstacles and giving seniors' health top priority in Cholera prevention initiatives, we can strive to lessen the prevalence of Cholera and enhance results for susceptible groups across the globe. 

References

  1. Cholera [Internet]. World Health Organization; [cited 2024 Feb 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/cholera.
  2. Phelps M, Perner ML, Pitzer VE, Andreasen V, Jensen PKM, Simonsen L. Cholera epidemics of the past offer new insights into an old enemy. J Infect Dis [Internet]. 2018 [cited 2024 Feb 15]; 217(4):641–9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5853221/.
  3. Oral rehydration therapy - an overview | sciencedirect topics [Internet]. [cited 2024 Feb 16]. Available from: https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/oral-rehydration-therapy#:~:text=When%20dehydration%20is%20not%20severe,within%20the%20first%2024%20hours
  4. Weyand CM, Goronzy JJ. Aging of the immune system. Mechanisms and therapeutic targets. Ann Am Thorac Soc. 2016; 13 Suppl 5(Suppl 5):S422–8.
  5. Knobel B, Rudman M, Smetana S. [Acute renal failure as a complication of cholera]. Harefuah. 1995; 129(12):552–5, 615.
  6. Martinez RM, Megli CJ, Taylor RK. Growth and laboratory maintenance of Vibrio cholerae. Curr Protoc Microbiol. 2010; Chapter 6:Unit 6A.1.
  7. CDC. Five basic cholera prevention steps. Centers for Disease Control and Prevention [Internet]. 2023 [cited 2024 Feb 16]. Available from: https://www.cdc.gov/cholera/preventionsteps.html.
  8. About the gtfcc – global task force on cholera control [Internet]. [cited 2024 Feb 16]. Available from: https://www.gtfcc.org/about-gtfcc/.
  9. Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB. Cholera. The Lancet [Internet]. 2012 [cited 2024 Feb 16]; 379(9835):2466–76. Available from: https://linkinghub.elsevier.com/retrieve/pii/S014067361260436X.

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Vivien Karen Mok

Bachelor of Science – Biomedical Science, King's College London

Vivien is a Biomedical Science student and a dedicated advocate for regenerative medicine and healthcare communication. She harnesses a profound passion for advancing research and making healthcare accessible to all. Using her prior experience writing on platforms, Vivien has ventured into the field of medical communications with the goal of amplifying voices and reaching a wide range of audiences with important information.

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