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<h3>Cholera impact</h3>
<p>Cholera is a water-borne, acute gastrointestinal infection caused by the <em>Vibrio cholerae </em>bacterium. It is transmitted by contaminated water or food, or direct contact with contaminated surfaces. In non-endemic areas, large outbreaks can occur suddenly and the infection can spread rapidly.</p>
<p>Researchers estimate that roughly 1.4 to 4.3 million cases of cholera occur annually and that 28,000 to 142,000 people die from the disease each year.</p>
<p>Cholera is most common in densely populated settings where sanitation is poor and water supplies are not safe. Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced persons or refugees, where minimum requirements of clean water and sanitation are not met.</p>
<p><em>For more information: <a href="http://www.who.int/mediacentre/factsheets/fs107/en/">WHO cholera fact sheet</a></em></p>
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<h3>Cholera facts</h3>
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<li><strong>Transmission:</strong> A person becomes infected by ingesting the bacteria. If food or water supplies are contaminated, outbreaks can spread very rapidly.</li>
<li><strong>Signs and symptoms:</strong> Cholera causes profuse, watery diarrhoea and vomiting. Most people suffer only a mild infection, but serious cases can lead to severe dehydration and, without rapid treatment, death.</li>
<li><strong>Diagnosis:</strong> A rapid diagnostic test is available, but confirmation from a laboratory is still required, especially in declaring an outbreak.</li>
<li><strong>Treatment:</strong> Most patients can be treated using oral rehydration solution (ORS) – a mixture of water, glucose and electrolytes (sodium and potassium). In more serious cases, fluids and electrolytes are administered by intravenous infusion.</li>
<li><strong>Prevention and control:</strong> Three WHO pre-qualified oral cholera vaccines are available. All three require two doses for full protection. For two of the vaccines, a minimum two-week delay is required between doses. Ensuring safe water and effective sanitation are essential during all outbreaks.</li>
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<h3>MSF activities</h3>
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<p>MSF has developed cholera treatment kits in order to provide rapid assistance in epidemics.</p>
<p>When an epidemic seems imminent, MSF will begin setting up dedicated cholera treatment centres and oral rehydration points as close as possible to the population at risk. As specialised isolation wards designed to prevent the spread of the disease, cholera treatment centres are vital in managing and treating severely sick cholera patients. The onset of cholera is abrupt and cases must be detected and treated as early as possible.</p>
<p>Patients in a more serious condition are transferred to the treatment centres, while more moderate cases are treated at the rehydration points. MSF staff work to raise communities’ awareness of the disease and how it is spread, and promote hygiene messages. Water and sanitation staff will ensure there are sufficient latrines available, adequate quantities of safe water, and soap.</p>
<p>MSF staff first introduced the use of the two-dose oral cholera vaccine in 2012 as part of its response to an outbreak in Guinea. The vaccine has since been used as important tool in MSF responses to outbreaks in countries such as the Democratic Republic of Congo, Ethiopia, South Sudan and Tanzania.</p>
<p>A new cholera control strategy using a single-dose of oral vaccine instead of two is sufficient to protect against the deadly disease during an outbreak, according to a <a href="http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30211… published by MSF</a> in the <em>Lancet</em> <em>Global Health</em> that evaluated the effectiveness of the new strategy, first used in Juba, South Sudan in July 2015. The study found that the single-dose vaccine was 87.3 per cent effective in reducing cholera for up to two months among the nearly 900 people who took part in the study. In April 2016, MSF also vaccinated 423,000 people in Lusaka, Zambia, in the largest ever single-dose oral cholera vaccination campaign to take place during an outbreak.</p>
<p>MSF treated 20,600 people for cholera in 2016.</p>
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