EPIDEMIOLOGY PAPER 8
Cholerais an infectious disease, which is caused by drinking water or eatingfood that is contaminated with Vibriocholeraebacterium. This disease is usually common in regions that have poorsanitation. Cholera has an incidence rate of approximately 1 in45,333,334 in USA. In the U.S., 0-5 cases of cholera are reportedannually. The purpose of this report is to discuss epidemiologicprinciples of cholera and the role of community health nurse incholera surveillance.
ClinicalDescription of Cholera
Inmost cases, symptoms of cholera are mild, but sometimes they may beremarkably serious. Infected individuals may have severe waterydiarrhea that can be accompanied by vomiting. This diarrhea may attimes result to dehydration. Despite many infected individuals havingminimal or no symptoms, they can still spread the infection. Thewatery diarrhea usually contains spots of whitish material, which areabout the size of rice pieces. This diarrhea usually smells fishy.Besides, individuals infected with cholera may develop other symptomsand signs such as rapid heart rate, dry mucous membrane, loss of skinelasticity, thirst, low blood pressure, restlessness, and musclecramps (Melbourne,2011).Individuals having severe cholera may develop severe dehydration,which can result to acute renal failure, coma, and severe electrolyteimbalances. In case this severe dehydration is not treated, it canresult to shock and death.
Preliminarydiagnosis is mostly done by a caregiver that takes a history from apatient and checks for the characteristic rice-water diarrhea. Thisis usually the case especially if there is an outbreak that has beenidentified in a community. The diarrhea fluid teems with motilebacteria that can be seen with the aid of a microscope thesebacteria are comma-shaped. The definitive diagnosis of the disease ismade by isolating the bacteria from the diarrhea fluid onthiosulfate-citrate-bile salts (TCBS). Furthermore, PCR tests havebeen developed for detecting the genetic material of cholerahowever, they are not commonly used like immunologic tests that arebased on type-specific antiserum (Melbourne,2011).
Rehydrationwith ORS fluids is the primary treatment for cholera. The ORS fluidscontain electrolytes and glucose. Antibiotics can also be given tocholera patients however, antibiotics are usually reserved forsevere cholera infections (Melbourne,2011).Antibiotics function by reducing fluid rehydration volumes and thusspeed up recovery.
Theprognosis of cholera may range from excellent to poor this dependson the severity of dehydration, and how fast a patient is offered andresponds to treatments. Mortality rates in untreated cholera may beas high as 50-60% during large outbreaks, but may be reduced toaround 1% in case treatment protocols becomes put into action rapidly(Melbourne,2011).The less severe the symptoms, the better the prognosis for mostpatients, when dehydration is reversed quickly, prognosis is usuallyexcellent.
EpidemiologicalDescription of the Disease
Epidemiologictriangle describes a model that scientists use in studying healthproblems. An epidemiologic triangle can aid in understanding how aninfectious disease spreads. The triangle comprises of three vertices,which show host, agent, and environment. Agent is used to describethe cause of the disease. In most cases, the agent is a microbe. Onthe other hand, host describes human or animal that is exposed to andharbors a disease (Timmreck,2002).A host may be an organism that gets sick and any animal carrier thatmay or may not get sick. Alternatively, the environment describes thefavorable surrounding and conditions, which are external to the hostand allow a disease to be transmitted. For instance, some diseasesmay thrive well in dirty conditions. A general epidemiologic triangleis depicted in the figure that follows
Inthe case of cholera, the agent is the Vibriocholeraesince this is the micro-organism that causes cholera. When a personeats food or drinks water contaminated with the Vibriocholeraebacterium, he becomes infected with the cholera disease. When itcomes to the host, in the case of cholera, people of all ages andboth sexes are the host. This is because cholera can affectindividuals of both sexes and cuts across all ages, regardlesswhether one is an adult or one is a child. On the other hand, theenvironment for cholera entails contaminated food and contaminatedwater. This is because the micro-organism that causes cholera thriveswell in contaminated water and food.
Impactof Cholera from a Global Perspective
Statisticsfrom World Health Organization (WHO) indicates that, in 2013, 47countries from different continents had 129,064 reported cases ofcholera. Of these cases, 43% were from Africa while 47% were from theAmericas this was due to the vast outbreak that began in Haiti inOctober 2010. Despite these statistics being reported by WHO, theactual number of cholera cases in the globe is estimated to be muchhigher than the reported number. In the entire world, cholerarepresents a burden of approximately 1.4 to 4.3 million cases, aswell as approximately 28000 to 142000 deaths annually (World HealthOrganization, 2015). This translated to weekly terms indicates thatthere are approximately 539 to 2731 cholera deaths per week globally.Explosive outbreaks of cholera have been indicated to cause highfatality rates. For instance, cholera outbreak in Rwanda after theRwanda crisis of 1994 resulted to 48000 cases, where 23800 deathswere recorded within one month. In the local, state, national andinternational situation, cholera has the impact of reducing thepopulation. Cholera outbreak can reduce population significantly dueto high fatality rates, especially when the disease is severe andmedical practitioners do not act fast.
Apartfrom the human suffering caused by cholera, outbreaks of cholera cancause panic, interrupt the social and economic structure and impededevelopment in affected communities. When there is a cholera outbreakin a given country or community, there is panic that emerges in othercommunities or nations. This leads to countries or communitiesrestricting or curtailing travel from other countries. At times,countries may restrict importation of food from countries where thereis a reported cholera outbreak. This can affect the economicperformance of a country, as well as impede development. Forinstance, in 1991, cholera outbreak in Peru cost the country $770million this was because of the food trade embargoes placed andnegative effects on tourism (World Health Organization, 2012).
Rolesof Professional Nursing in Regard to the Surveillance of Cholera
Casefinding entails the strategy used in surveying a population so as toidentify individuals that are sick. This is a critical step in theannihilation of a disease. During case finding, a nurse has a role ofobserving the clinical signs and symptoms that are associated withcholera. It is through finding out whether people in a certaincommunity depict the clinical signs and symptoms of cholera that anurse would consider making a confirmation that certain individualsin the community have cholera. In order to confirm that individualsin a community have cholera, it is important for a nurse to carry outlaboratory tests. This would aid in knowing which individuals havethe disease.
Publichealth authorities have classified different infectious diseases asvital public health threats. Community health practitioners arerequired to report infectious diseases cases to the state and localauthorities. In this case, the community health practitioners give adetailed report that indicates signs exhibited, symptoms, treatmentoffered to the infected individuals. In the case of cholera, it isimportant for a community health care nurse to give report concerningthe signs and symptoms of individuals indicated to have cholera, aswell as the treatments offered to the patients discovered having thedisease.
DataCollection and Analysis
Itis critical for health care providers in a community to ensure thatthere is sufficient and accurate data that communicates about acertain disease affecting a community. Here, the role of communitycare providers is to find critical information concerning the diseaseaffecting the community and needs to analyze the informationconcerning the disease for better understandability. For the case ofcholera, health care community nurses will have the role ofcollecting information concerning what is leading to cholera in acommunity, individuals affected, and projected outcomes.
Itis important for community nurses to make follow-ups concerningreported cases and findings. For instance, in case a community isindicated to have some individuals having cholera, and theseindividuals are given some treatments, it is critical for nurses tocarry out a follow-up so as to see whether the case has beeneradicated.
Melbourne,E. L. (2011). Cholera:Symptoms, diagnosis, and treatment.New York: Nova Science Publishers.
Sanyal,SC. (2000). Cholera in its present day scenario. Journalof the Indian Medical Association.Vol. 98(7), 371-76.
Timmreck,T. C. (2002). Anintroduction to epidemiology.Sudbury, Mass: Jones and Bartlett Publishers.
WorldHealth Organization (WHO) (2012). Bulletinof the World Health Organization:theglobal burden of cholera.90:209-218A. doi: 10.2471/BLT.11.093427.WorldHealth Organization (WHO) (2015). GlobalHealth Observatory (GHO) data,Numberof reported cholera cases.