Cholera

Cholera is a disease typical of regions suffering water supply problems treated. Dirt and open sewers assist in the increase of cases of the disease. The northeast of Brazil is that most suffers from this problem. Fresh water and untreated sewage treatment and environmental conditions hinder the proliferation of the disease.

Treatment
Treatment consists primarily of cholera rehydration. Dehydration can be harmful at any age, but is particularly dangerous in children and the elderly.
In mild to moderate cases, your doctor may recommend that treatment be done at home with oral rehydration solution.
Travellers should avoid dehydration due to diarrhea (from any cause) drinking plenty of fluids, preferably a solution reidratatante containing electrolytes (salts) and glucose at appropriate concentrations.
The Cives recommends that the traveler is directed to an area of ​​cholera transmission, envelopes lead salts to prepare oral rehydration solution at a ratio of eight to every person. There are several formulas containing these salts, easily found at pharmacies, but containing the composition recommended by WHO should be preferred:
Oral Rehydration Salts for:
Recommended composition - WHO
Sodium chloride 3.5 g
Trisodium citrate, dihydrate 2.9 g
Potassium chloride 1.5 g
20.0 g glucose
In case of diarrhea, oral rehydration solution should be prepared immediately before consumption. To prepare the solution, the contents of an envelope must be dissolved in one liter of boiled water after cooling. The solution can not be boiled after prepared, but may be stored in refrigerator for up to 24 hours.
It can be ingested in accordance with the acceptance, often proportional to the intensity and volume of diarrhea. Should be alternated with other liquids (water, tea, soup).
The supply should be resumed after 3 to 4 hours of proper acceptance of oral rehydration. In infants, breastfeeding should be continued.
In more pronounced diarrhea, a Health Service should be sought as soon as possible severe cases should be hospitalized for intravenous hydration to the improvement of clinical conditions and the person as soon as possible, oral rehydration should be done simultaneously.
The antidiarrheal medications, just as in all other infectious causes of diarrhea, are contraindicated for treating cholera.
These medications decrease bowel movements (peristaltimo), facilitating the multiplication of V. cholerae. As a result, there is worsening or increase in the duration of diarrhea. Similarly, should not be used astringent (kaolin-pectin, charcoal), since that can perpetuate the loss of electrolytes (sodium and potassium) feces.
In children, should be avoided vomiting drugs, since they can cause intoxication, with decreased level of consciousness and involuntary movements, hindering the intake of oral rehydration solution. In addition, this drug is generally unnecessary since they tend to vomit with the top end of rehydration.
In most cases, even in the severe forms, recovery is complete and quick, with only rehydration. In severe forms, antibiotics if started within the first 24 hours of illness, can reduce the duration of diarrhea and, with it, the loss of fluid and electrolytes, which facilitates therapy.
In cases without gravity, the use of antibiotics is not justified, since it does not bring any proven benefit in disease progression or interference in its dissemination. In addition, indiscriminate use of antibiotics increases the risk of the emergence of resistance in V. cholerae (and other intestinal bacteria), which can impede the treatment of severe forms.
Prevention
The Cives recommends that the traveler is directed to an area where there is cholera transmission, note that the protective measures to avoid diseases transmitted through ingestion of water and food. The consumption of treated water and proper food preparation measures are highly effective.
The selection of safe foods is crucial. In general, the look, the smell and taste of food are not altered by contamination with Vibrio cholerae (and other infectious agents). The traveler must feed themselves in places that have suitable conditions for preparing hygienic food. The food on the street with street vendors is a high risk.
Food must be thoroughly cooked and served immediately after preparation to prevent new contamination with bacteria. Foods prepared in advance to be heated again, immediately before consumption and served still hot ("smoke out").
The portable available filters are not capable of retaining the Vibrio cholerae. Sparkling mineral water and other industrially bottled drinks such as soft drinks, beer and wine are generally safe. Coffee and tea still hot drunk is risk. Ice should not be used in beverages, unless has been prepared with treated water (chlorinated or boiled).
The treatment of water to be used as a beverage or in food preparation can be done with sodium hypochlorite at 2 - 2.5% (bleach) or chlorine tablets.
One must be careful in acquiring preparations containing chlorine. There are some that in addition to sodium hypochlorite contains other substances that make them unsuitable for water treatment. The tablets may contain various concentrations of chlorine and some are indicated for the treatment of volumes up to 100 liters of water.
Manufacturers' instructions should always be carefully read and observed shelf life (of the bleach is six months). In general, in the dropper of 1 ml, this volume corresponds to 20 drops. It is prudent, however, that the proportion 1 ml = 20 drops always be assessed at each new dropper used.
The World Health Organization recommends treatment with 6 mg of chlorine per liter of water. When using a dropper 1 ml = 20 drops 5 drops of sodium hypochlorite contains 6 mg 2.5% chlorine. Treatment with tablets must be done according to the manufacturers instructions, observing carefully the recommendations regarding the appropriate concentration for different purposes of use and amounts of water.
Chlorine (sodium hypochlorite or tablets) must be added to the water at least 30 minutes prior to use as a beverage or food preparation. In sealed containers, to chlorinated water can be used for up to 24 hours. The boiling water before consumption, for at least one minute, is a safer alternative to chlorine treatment and should be preferred when the water is turbid.
For disinfecting fruits and vegetables must be used 2 ml (40 drops) of sodium hypochlorite at 2.5% for each liter of water, tablets or chlorine at the concentration indicated by the manufacturer. The fruits and vegetables should be kept immersed for 30 minutes in the chlorinated water. Then must be washed with water treated with the chlorine concentration suitable for its use as a beverage.
The requirement of vaccination against cholera as a mandatory condition for the granting of entry visas was taken from the International Health Regulations in 1973. The latter countries, according to the World Health Organization, no longer require a certificate of vaccination against cholera in 1993.
The Cives does not recommend routine vaccination against cholera. The injectable vaccines have less than 50% efficacy, short duration of immunity (about 3 months) and do not reduce the incidence of asymptomatic infections. Oral vaccines against cholera (there are two) are effective in around 85% and produce immunity for about 3 years.
Although the initial results are promising for application individually, none of these vaccines is recommended for travelers indiscriminately. When the risk of infection is very high, the use of oral vaccines as a further measure, should be considered in people with decreased stomach acid secretion (hypochlorhydria or achlorhydria), or in gastrectomized individuals with high risk activity (such as work refugee camps in endemic areas). In Brazil, the vaccine (injectable or oral) against cholera are not available in the public.