In the wake of the cholera outbreak in Hammanskraal, Tshwane and the Free State, Tukkievaria asked Prof Veronica Ueckermann, Head of Infectious Diseases in the Department of Internal Medicine at the University of Pretoria (UP), for information about the course of the illness and tips on treatment.

What is cholera and what triggers it?

Cholera is an acute, severe diarrhoeal disease caused by the bacteria Vibrio cholerae. It is usually spread through contaminated water and is associated with poor water and sanitation conditions. Water that is contaminated with human faeces is the most common source of the illness, and humans can be exposed directly (by drinking contaminated water) or indirectly (by eating contaminated food). Hands that are soiled can also contaminate food and water.

What are the common symptoms of cholera?

The symptoms of cholera typically occur within two to three days of ingesting contaminated water. Some people will have a mild illness that does not differ from other types of viral diarrhoea. If a person experiences severe symptoms, they typically have a sudden onset of profuse, watery diarrhoea. The flecks of mucus in the stools are what led to the description of “rice water” diarrhoea that is sometimes used. Vomiting may occur and some people (especially children) may develop a fever. If the diarrhoea is severe, symptoms of dehydration rapidly ensue.  

Can cholera clear on its own?

Some people will have a transient, mild case, which clears in much the same way as a bout of gastroenteritis would.

What is the best treatment?

The most important treatment is rehydration (replacing fluids lost). Adequate rehydration is a life-saving measure. In severe cases, rehydration will require intravenous fluid (a drip). In mild cases, rehydration can be achieved with an oral rehydration solution that can be drunk. These solutions are available at pharmacists and clinics. One should not rely on energy drinks that have a lot of glucose (sugar) but not enough electrolytes. We give antibiotics to patients with moderate or severe symptoms to shorten the course of the illness.

How do you treat cholera at home?

If you treat cholera at home, there are three important principles that must be considered. Firstly, rehydration is very important. When you have diarrhoea and feel unwell, it is important to continue to take in oral fluids and rehydration solutions. Secondly, you must ensure that you seek medical help if you become sicker. Cholera can cause rapid dehydration, so if you feel weak, have a dry mouth, or sunken eyes or are unable to keep up with oral fluids, you need to get medical attention. Thirdly, it is important to practise good hygiene (washing your hands, using chlorine-containing disinfectants in toilets, etc.) to avoid infecting other people around you.

What can I do to protect myself?

In areas of outbreak, it is important to identify the source of contamination. Handwashing is essential to prevent the spread. Use safe water – if you are concerned about the quality of your water, use bottled water, boil water in a clean container for one minute, or treat water with chlorine tablets. If water safety is a concern, it is also possible to decontaminate it with household bleach – for 20 litres of water, you would add one teaspoon of bleach. You need to ensure that the container that you use is clean and that it stands for at least 30 minutes before consumption. The water won't taste great, but it will be safe to drink.  

Contaminated food may also be a source of cholera, so attention should be paid to food safety. It is important that places that supply food have excellent hygiene practices and cook food properly.