Cholera in Nepal

Cholera in Nepal

Cholera in Nepal (updated July 2023)

Every year Kathmandu valley sees a little over 100 cases (June-November) of Cholera except in some years when there is an epidemic with larger number of cases. Cholera is an acute infectious disease of the small intestine, caused by the bacteria Vibrio cholera. Cholera is characterized by profuse watery diarrhea termed rice water stools, vomiting, muscle cramps, decreased urine output and severe dehydration. The incubation period is usually 1-2 days but can be from several hours to 3-5 days. It is usually transmitted by drinking contaminated water and a large number of bacteria are required to cause the infection.

How can cholera be prevented? – Cholera can be prevented by drinking boiled, bottled or treated water. Water can be treated with chlorine (available as Piyush/Aquatabs in pharmacies) or Iodine, if bottled water is not available and boiling water is difficult. If you are involved in relief or volunteer work in cholera affected areas, please make sure that these water safety rules are followed by yourself and by the people in villages or towns. Please also emphasize hand washing before eating and proper waste disposal. Hands should be properly washed after touching anything that might be contaminated with faeces from an infected person. There is severe shortage of municipal water supply in Kathmandu and people buy water brought by trucks from different vendors and different sources. This water has to be boiled or treated before drinking. Bottled mineral water particularly the 1-liter bottles and 20-liter jars of established brand names seem safe for drinking but this is expensive for the local population. We do not promote Cholera vaccine in travelers except if they are going to be volunteering in areas where access to clean drinking water is difficult particularly during the monsoon months when cholera surfaces in Kathmandu. Being careful with what you eat and drink can prevent cholera.

Cholera vaccine made by Eubiologics in South Korea (Euvichol-Plus®) is available with us. It has protective efficacy of 65% following 2 doses orally. Euvichol-Plus contains whole cell killed bacteria, is protective 7-10 days after completing primary series and can be given to persons > 1 year of age. Dukoral, mostly available in Western countries with protective efficacy of 78% against a certain serotype V. cholerae O1 is not available with us. Cholera vaccine made by Sanofi in India (Shanchol) is currently not available and production of Vaxchora (oral live attenuated cholera vaccine) has been discontinued.

Treatment: If someone develops symptoms suggestive of cholera e.g. severe watery diarrhea and features of shock or circulatory collapse, the person should immediately be started on oral rehydration treatment and taken to the nearest medical facility for fluid resuscitation which is the key to treatment. Antibiotics are used in patients with severe dehydration. Doxycycline is recommended as a first line treatment in adults. Azithromycin and ciprofloxacin are alternative options.



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