Borehole-water-cholera

Expert : Beware Borehole Water! It Could Also Be Contaminated By Cholera!
“One of the first cases of cholera in Brits was from borehole water,” Mr Dirk Bouwer, an acknowledged water expert told MadibengPulse on Tuesday. “If there is contamination of a stream or river by sewage it will seep into the ground water and the borehole water,” he said. This is in light of the story we published on Monday about the 16 people on the Rheeders Boerderye farm north of Brits who took ill with cholera-like symptoms. We were enquiring as to the safety of the boreholes of neighbouring farms near the Rheeders family. Mr Bouwer says that it’s imperative for anyone with flu like symptoms, diarrhoea and stomach pains to have themselves tested immediately by a doctor. “It could also be ecoli,” he says. “The next step is to test the water. It has to be done by a pathologist and Mr Jan Jacobs at Madibeng Municipality would be able to point residents in the right direction. There is also a laboratory at the municipality, but I’m not sure whether they can test for cholera. If there is cholera in your water, it is mandatory to inform the authorities. “You have to boil all suspected cholera water, even for washing,” he told MadibengPulse. “Chlorinating the water is a more complicated process, and even this is not a guarantee that the water will no longer carry cholera. Cholera is extremely contagious. It could take a while before the cholera seeps through to the borehole, so this could still contaminate the borehole in the future!” Not good news for those living near contaminated streams and rivers! Helpful Information For The Recognition, Treatment And Prevention Of Cholera
Fact file on Cholera
Now that cholera is in our midst, it would be useful to have more than a passing
knowledge of the disease. We are quoting liberally from Wikipedia which can be found
at the website: http://en.wikipedia.org/wiki/Cholera
Cholera, sometimes known as Asiatic or epidemic cholera, is an infectious gastroenteritis caused by enterotoxin-producing strains of the bacterium Vibrio cholerae. Transmission to humans occurs through eating food or drinking water contaminated with cholera vibrios. The major reservoir for cholera was long assumed to be humans themselves, but considerable evidence exists that aquatic environments can serve as reservoirs of the bacteria. (This makes it compulsory that we keep our dams, rivers Main characteristic is exhaustive diarrhea
Vibrio cholerae is a Gram-negative bacterium that produces cholera toxin, an enterotoxin,
whose action on the mucosal epithelium lining of the small intestine is responsible for the
disease's infamous characteristic, exhaustive diarrhea. In its most severe forms,
cholera is one of the most rapidly fatal illnesses known, and a healthy person's blood
pressure may drop to hypotensive levels within an hour of the onset of symptoms;
infected patients may die within three hours if medical treatment is not provided.[1] In a
common scenario, the disease progresses from the first liquid stool to shock in 4 to 12
hours, with death following in 18 hours to several days, unless oral rehydration therapy is
provided.[3][4]
Symptoms
The incubation period is the period from infection until symptoms occur. In cholera this
is usually 24-72 hours. The severity of symptoms depends on the dose, i.e. the number of
bacteria ingested. Some otherwise healthy individuals may not develop any symptoms at
all. Of those who do, only a small proportion develop severe disease.
The principal symptom of infection is diarrhea, which is watery and brown at first, but
quickly changes to large volumes of pale fluid stools ('rice-water stools'). In the most
severe cases dramatic fluid loss from the continuous diarrhea can lead to hypovolemic
shock and collapse within 1 to 4 hours. Depending upon the treatment provided,
unconsciousness and death can occur anytime from 12 to 18 hours afterwards, although
some individual cases may persist for several days.
Fever is not a prominent feature of cholera.
Writer Susan Sontag wrote that cholera was more feared
than some other deadly diseases because it dehumanized
the victim. Diarrhea and dehydration were so severe that
the victim could literally shrink into a wizened caricature
of his or her former self before death. Other symptoms
include nosebleed, rapid pulse, dry skin, tiredness,
abdominal cramps, nausea, leg cramps, and vomiting.
Treatment
In most cases cholera can be successfully treated with oral rehydration therapy.
Prompt replacement of water and electrolytes is the principal treatment for cholera, as
dehydration and electrolyte depletion occur rapidly. Oral rehydration therapy or ORT
is highly effective, safe, and simple to administer. In situations where commercially
produced ORT sachets are too expensive or difficult to obtain, alternative home made
solutions using various formulas of water, sugar, table salt, baking soda and fruit
have proven effective.
In severe cases the administration of intravenous rehydration solutions may be necessary.
Antibiotics shorten the course of the disease, and reduce the severity of the symptoms.
However Oral rehydration therapy remains the principal treatment. Tetracycline is
typically used as the primary antibiotic, although some strains of V. cholerae exist that
have shown resistance. Other antibiotics that have been proven effective against V.
cholerae include cotrimoxazole, erythromycin, doxycycline, chloramphenicol, and
furazolidone.[6] Fluoroquinolones such as norfloxacin also may be used, but resistance
has been reported.[7] Recently Hemendra Yadav reported his findings at the All India
Institute of Medical Sciences, New Delhi, that Ampicillin resistance has again decreased
in the V.cholerae strains of Delhi.
The success of treatment is greatly impacted by the speed and method of treatment.
If treated quickly and properly, the mortality rate is less than 1%, however,
untreated the mortality rate rises to 50–60%.[10][11]
Prevention of Cholera
Although cholera can be life-threatening, prevention of the disease is straightforward
if proper sanitation practices are followed. In the first
world, due to advanced water treatment and sanitation systems, cholera is no longer a
major health threat. The last major outbreak of cholera in the United States occurred in
1910-1911 .[12][13] Travelers should be aware of how the disease is transmitted and
what can be done to prevent it. Good sanitation practices, if instituted in time, are usually
sufficient to stop an epidemic. There are several points along the transmission path at
which the spread may be halted:
Proper sterilization in hospital
Cholera hospital in Dhaka. Sterilization: Proper disposal and treatment of the germ
infected fecal waste produced by cholera victims (and all clothing and bedding that come
in contact with it) is of primary importance. All materials (such as clothing and bedding)
that come in contact with cholera patients should be sterilized in hot water using
chlorine bleach if possible. Hands that touch cholera patients or their clothing and
bedding should be thoroughly cleaned and sterilized.
Sewage: Treatment of general sewage before it enters the waterways or underground
water supplies prevents undiagnosed patients from spreading the disease. Sources:
Warnings about cholera contamination posted around contaminated water sources with
directions on how to decontaminate the water.
Water purification: All water used for drinking, washing, or cooking should be
sterilized by boiling or chlorination in any area where cholera may be present. Boiling,
filtering, and chlorination of water kill the bacteria produced by cholera patients and
prevent infections from spreading. Water filtration, chlorination, and boiling are by far
the most effective means of halting transmission. Cloth filters, though very basic, have
significantly reduced the occurrence of cholera when used in poor villages in Bangladesh
that rely on untreated surface water. Public health education and appropriate
sanitation practices are important to help prevent and control transmission.
A Vaccine
A vaccine is available in some countries (not the US), but this prophylactic is not
currently recommended for routine use by the US Centers for Disease Control and
Prevention (CDC). During recent years, substantial progress has been made in developing
new oral vaccines against cholera. Two oral cholera vaccines, which have been
evaluated with volunteers from industrialized countries and in regions with endemic
cholera, are commercially available in several countries: a killed whole-
cell V. cholerae O1 in combination with purified recombinant B subunit of cholera toxin and a live-attenuated live oral cholera vaccine, containing the genetically manipulated V. cholerae O1 strain CVD 103-HgR. The appearance of V. cholerae O139 has influenced efforts in order to develop an effective and practical cholera vaccine since none of the currently available vaccines is effective against this strain. The newer vaccine (brand name: Dukoral), an orally administered inactivated whole cell vaccine, appears to provide somewhat better immunity and have fewer adverse effects than the previously available vaccine. This safe and effective vaccine is available for use by individuals and health personnel. Work is under way to investigate the role of mass vaccination. Sensitive surveillance and prompt reporting
Sensitive surveillance and prompt reporting allow for containing cholera epidemics
rapidly. Cholera exists as a seasonal disease in many endemic countries, occurring
annually mostly during rainy seasons. Surveillance systems can provide early alerts to
outbreaks, therefore leading to coordinated response and assist in preparation of
preparedness plans. Efficient surveillance systems can also improve the risk assessment
for potential cholera outbreaks. Understanding the seasonality and location of outbreaks
provide guidance for improving cholera control activities for the most vulnerable. This
will also aid in the developing indicators for appropriate use of oral cholera vaccine.
To summarize: in combating cholera the saying, “cleanliness is next to godliness” is the
first line of defence against this dreaded disease.

Source: http://www.leeuwenkloofsafety.co.za/News/Borehole-water-Cholera.pdf