Remember this information: On 9 June 2024, an outbreak of cholera was declared by the Lagos State government. Three days afterward, it was reported that there were 324 suspected cases in the state, with 15 deaths and 40 people being discharged after treatment. As of 11 June, the Nigeria Centre for Disease Control and Prevention stated that there had been 1,141 suspected cases of cholera reported in 30 states in Nigeria since 1 January 2024. Out of 96 local governments in 30 out of the 36 states, there were 65 confirmed cases with 30 deaths. The Conversation Africa interviewed Stella Smith, a molecular epidemiologist, to discuss the causes, transmission, treatment, and prevention of cholera.

What is Cholera and how does it spread?

Cholera results from consuming food and water that has been contaminated with the bacterium Vibrio cholerae. The symptoms include intense diarrhea (resembling rice water), dehydration, weakness, muscle cramps, fever, vomiting, low blood pressure, and thirst.

The transmission of this disease can occur when individuals fail to cleanse their hands with soap and water after using the restroom before preparing or serving food. Additionally, cholera can spread when individuals neglect to wash their hands both before and after eating. Exposing uncovered cooked food to flies that harbor the bacteria can lead to contamination. Cholera can also spread when raw fruits and vegetables are not adequately washed with clean running water before consumption. Another route of infection is consuming raw seafood that is tainted with the cholera bacterium.

Unsafe water that has not been filtered and boiled before drinking, as well as untreated sachet water, can lead to cholera. Cholera can also be transmitted when an individual who is infected defecates in the open, and their contaminated feces are washed into the water supply that people use for drinking. It’s important that even a pit latrine is situated at least 30 meters away from a source of drinking water.

The following contribute to the spread:

• Refuse is dumped without discrimination, and sewage is disposed of irregularly, which helps flies spread bacteria to water or food.
• overpopulated situations like camps for internally displaced people, refugees, and prisons without access to clean water.
• blocked drains and leaking water pipes

A person who handles food and makes beverages like tigernut or zobo using tainted water can also transmit cholera. The Lagos State government has identified these traditional drinks as potential origins of the recent outbreak.

How deadly is Cholera?

When an individual contracts cholera, the bacteria release a toxin in the small intestine, which triggers the body to expel significant amounts of water. This results in severe diarrhea and a rapid depletion of fluids and electrolytes. If treatment is delayed until the patient experiences severe dehydration and shock, the likelihood of death increases. It’s important to note that even in these critical cases, cholera proves fatal in only a small percentage of instances.

Why is Nigeria prone to annual cholera outbreaks?

Cholera has been present in Nigeria since its first emergence in 1972. The outbreak in 1991 was the most serious ever documented, with 59,478 cases and 7,654 deaths, resulting in a case fatality rate of 12.9%.

The benchmark case fatality rate recommended by the World Health Organization is less than 1%. This rate is calculated as the number of deaths in the country as a percentage of the total confirmed cases, including both the survivors and those who have passed away. In Nigeria, the rates during outbreaks have generally varied between 1% and approximately 4%.

In 1991, the high disease rate was attributed to inadequate sanitation and hygiene practices. There was minimal surveillance, lack of community engagement, and little to no education about the risks associated with the disease.

Nigeria is prone to a variety of factors that lead to recurring cholera outbreaks. They include lack of access to potable (safe to drink) water. Safe water is needed to maintain good hygiene practices. Other factors are lack of continued surveillance even after the outbreak has ended; flooding; poverty (although currently cholera treatment is free in all government facilities); lack of health facilities; illiteracy; lack of infrastructure for water supply and waste disposal; and conflict, leading to overcrowded conditions for displaced people.

Preventions

Preventions from Cholera depends on:

• sanitation
• access to clean water
• proper waste disposal
• personal hygiene
• food safety practices.

Individuals may also consume Oral Rehydration Solution or create their own oral rehydration salts by combining one liter of clean water with six teaspoons of sugar and half a teaspoon of salt. If symptoms continue throughout the day, promptly seek medical attention. Reporting cholera early helps stop its spread, while delayed reporting could result in fatal consequences.

Oral cholera vaccines are available for use in areas with a high risk of cholera. These vaccines are administered in two doses, which are spaced one week to six weeks apart. They offer protection for a duration of three years.

“Currently, Nigeria is struggling with a shortage of these vaccines, which is making it really tough to prevent and treat illnesses.”