Cholera outbreak: Here's what you need to know

The National Department of Health has urged the public to take precautionary measures and maintain proper hand hygiene in the wake of an outbreak of diarrhoeal disease, and the rising number of laboratory-confirmed cases of cholera.

By 22 May 2023:

• 44 cholera cases had been confirmed in Gauteng, with 107 people already seen for diarrhoeal disease at hospitals and 46 admitted.
• 15 deaths (2 children and 13 adults) had also been reported.
• Cases have been reported across the country - 1 in Limpopo, 6 in the Free State and 44 in Hammanskraal (a town north of Pretoria in the Tshwane metro and the worst-hit area, currently accounting for all the Gauteng cases).

What is cholera?

"Cholera is a diarrhoeal disease caused by a bacteria called Vibrio Cholerae. The bacteria infects our intestine and cause severe diarrhoea and dehydration. If left untreated, cholera can be fatal in a matter of hours, even in previously healthy people," explains Dr Noluthando Nematswerani, Chief Clinical Officer at Discovery Health.

How does cholera spread?

People can contract cholera when they drink water or eat food containing cholera bacteria. The bacteria can spread from an infected person if they handle food without washing their hands first or relieve themselves into a water source. Drinking unclean water or using it to wash food or other items puts people at risk of infection. Hand hygiene and food safety is therefore very important in preventing the spread of cholera.

"Cholera outbreaks usually occur in the developing world and are associated with poor water, sanitation and hygiene infrastructures," adds Dr Nematswerani.

Here's where to find credible information on cholera:

• Access updates on the cholera outbreak (see Media Alerts) and also general information on the disease through the National Institute for Communicable Diseases (NICD).
• Also access the NICD's FAQ on Cholera.
• See the National Department of Health's twitter feed.

Contaminated water key to cholera's spread

The NICD tells us that water contaminated with human faeces is the main way cholera spreads, either directly (through drinking contaminated water) or indirectly (through eating contaminated food).

Also, some people who are exposed to the cholera bacterium don't become ill and so don't know they've been infected. But because they shed cholera bacteria in their faeces for seven to 14 days, they can still infect others through contaminated water.

Food can become contaminated when it comes into contact with contaminated water. Dirty hands can also contaminate clean drinking water and food.

How can we protect ourselves from getting cholera?

1. Avoid known or suspected contaminated food, water and surfaces
2. Wash hands thoroughly with soap and clean water before handling food or after using the bathroom
3. Never drink water from unsafe sources such as rivers, dams, streams, unless boiled or disinfected first.
4. Water should be clean and safe to use: If you suspect that the water you are using or drinking is not clean then treat or sterilise it before use (methods listed below).

What are the symptoms of cholera?

The NICD shares that a few hours to two to five days (usually two to three days) can pass from when a person comes into contact with cholera-contaminated water or food, to when they first become sick.

• People generally become sick around 12 to 48 hours after exposure to the bacteria that cause the disease.
• Most people who are infected with cholera have very mild illness with some diarrhoea or don't feel sick.

In more serious cases people experience a sudden onset of illness with:

• Severe diarrhoea - which is painless and watery, with flecks of mucus in the faeces
• Vomiting, usually early in the illness
• Fever, mostly in children
• Dehydration - which happens fast, and if untreated can be fatal.

How do we protect ourselves from getting cholera or other bugs that can cause diarrhoeal illness?

This information comes from the Gauteng Department of Health:

Water

If you are worried about the water quality, treat the water like this:

• Boil it - pour out the water into a clean container and bring it to a boil for one minute.
• Or treat it with household bleach:
  • Add 1 teaspoon of household bleach (containing 3 to 5% chlorine concentration) to 20 litres of water, mix well and leave it to stand for at least 30 minutes before you use it.
  • The same applies to larger quantities - add 1 tablespoon of household bleach to 25 litres of water.
• Water should be stored covered, in clean containers.
• Contaminated food can also be a source of cholera infection, so make sure you wash food with clean, safe water and pay attention to food safety. Don't eat the food if you are worried about the source or how clean it may be.

Hands

Wash your hands with soap and water:

• Before, during making and after you make food.
• Before and after you eat.
• Before and after feeding children.
• After you use the toilet or clean your child when they use the toilet.
• After taking care of someone who has diarrhoea.

Food

Wash your hands with soap and water:

• Always cook food well and keep it covered afterwards.
• Peel your fruits and vegetables and avoid raw fruit and vege that you can't peel (peeling gets rid of any bugs on the skin).

Make sure your food is very well cooked - especially fish or seafood.

Surfaces

• Always clean and disinfect surfaces regularly, especially in areas used for food preparation.
• Clean kitchenware with soap and clean water.
• Clean and disinfect toilets and areas that have been contaminated with faeces, with soap and clean water.
• Safely get rid of soapy water and dirty cleaning cloths.
• Wash your hands again with soap and water after you clean and disinfect surfaces.
• If you don't have soap and water use an alcohol based hand rub with at least 60% alcohol.

Going to the toilet

• Use toilet facilities that are cleaned regularly and safely managed.
• Wash hands with soap and water after using the toilet.
• If you can't access a toilet, do not go to the toilet close to a body of water (make sure you are at least 30 meters away and bury the faeces).

How is cholera treated?

"As dehydration can happen so fast, rehydration (replacing lost body fluid) is really important, and is in fact lifesaving," explains Dr Nematswerani.

"Mild cases of cholera can be managed outside the hospital with oral rehydration. Moderately ill or very sick people need to be admitted to hospital for intravenous fluid rehydration. Antibiotics are also given to people who are moderately or very dehydrated."

• How do you make your own oral rehydration solution for someone who has diarrhoea?

The Department of Health advises that we make an oral rehydration fluid for the person to drink by boiling one litre of water and adding 8 teaspoons of sugar and half a teaspoon of salt, before mixing it well.

Discovery Health paying close attention to the cholera outbreak

"At present, our records show that two members belonging to medical schemes administered by Discovery Health have been admitted to hospital for a possible cholera diagnosis," adds Dr Nematswerani.

Where people contract a diarrhoeal illness and require treatment at home they will be able to access cover from their day-to-day benefits (Medical Savings Account). Hospitalised medical scheme members, will be covered from their risk benefits, according to their plan type.