With the recent cholera outbreak in Zimbabwe, this little known disease has been thrust into the forefront of the news. Many questions are being asked about the illness, its dangers and possible treatment.

Commenting on the level of concern that has been raised of late, Glenda Seeger, Operations Manager of Netcare Travel Clinics was quick to put the illness into perspective.

"Cholera is a disease of poverty that occurs in people who live in overcrowded conditions and are exposed to heavily contaminated food and water. People most at risk are those working at refuge camps and relief centres."

"Cholera really is not a disease of tourists. In fact, research has indicated that the incidence per journey for foreign travellers visiting Africa or Asia is about one in 500 000 only. It however bears mentioning that Sub Saharan Africa has the highest reported cholera incidence and mortality rates in the world," explains Seeger.

How do you get it?

She adds that in order to contract severe diarrhoea as a result of cholera a large number of bacteria has to be ingested. "Severe forms of the disease are rarely seen in travellers who follow good food and water hygiene," she says.

The disease itself is caused by bacteria known as Vibrio Cholerae and is commonly transmitted by contaminated food and water or by oral contact with faecal matter. Humans are the only natural hosts.

"The main symptom associated with Cholera is diarrhoea. The cholera bacteria is killed by the acid in the stomach but if ingested in large amounts the bacteria passes from the stomach to the intestine, causing diarrhoea," says Seeger.

"In about 80 percent of cases there will be no symptoms or a mild diarrhoea. However, infected persons eliminate vibrio cholera in their faeces for a few days and are infectious. In 10–20 percent of cases; mostly children, elderly or patients with chronic conditions, diarrhoea might be severe and can cause shock and death in hours if fluid is not replaced. Cholera kills solely by dehydration. Patients developing severe watery diarrhoea should therefore immediately start rehydration therapy," cautions Seeger.

Cholera treatment?

There is an oral vaccine, Dukoral, available for use against cholera. The vaccine consists of two doses given at least one week apart up to six weeks apart.

According to an article published by the National Institute of Communicable Diseases (NICD) the vaccine provides 80-85 percent protection which decreases to 62 percent protection after three years.

Protection starts only 15 days after the second vaccine dose which explains why it is not used in the communities where there are already cases of cholera. However, it is used for people who need to travel frequently in areas where there is cholera.

In any case, vaccines are not a substitute for caution on the part of the traveller and are only one component of disease prevention, it is more prudent to take appropriate food and water precautions.

With prevention being the only full-proof protection against cholera the question that comes to mind is how does one prevent oneself from contracting cholera?

According to Seeger the best way of preventing cholera is to pay careful attention to what you eat and drink.

Here are some useful guidelines pertaining to food and water consumption courtesy of Netcare Travel Clinics:

Tips for safe drinking water

• Filtered, bottled, boiled or chemically treated water should be used for drinking purposes and also to brush your teeth.
• Bottled fizzy drinks with an intact seal are safe, as is boiled water and hot drinks made with boiled water.
• Ice in drinks should be avoided.
• The most reliable way to purify water is by boiling, but this isn't always convenient.
• Chemical disinfectants such chlorine will usually kill bacteria and viruses.

What to eat and what to avoid

• Some developing countries use animal waste as fertiliser. Certain foods, especially those growing close to the ground, are particularly prone to contamination and should, where possible be avoided.
• Food items that may be unsafe include: Salads, such as lettuce, uncooked fruits and vegetables, unless they have been washed and peeled by the traveller.
• Food that has been allowed to stand at room temperature in warm environments, or that has been exposed to flies. If left unchecked, open buffets can prove problematic.
• Unpasteurised milk, cheese, ice cream and other dairy products.
• Raw or undercooked shellfish or seafood.
• Buying food, that may be unclean of not particularly fresh, from street vendors.
• Remember even food served in hotels and/or restaurants of good standing may not always be safe, as it may have been contaminated during preparation.

Please do not hesitate to contact your nearest Netcare Travel Clinic should you have any queries or questions regarding travel-health related topics. You may also visit our website on www.travelclinic.co.za.