Few days ago, The Nigeria Centre for Disease Control and Prevention (NCDC) raised an alarm about the increasing trend of cholera cases as the rainy season progresses. From January 1st to June 11th, 2024, there have been 1,141 suspected cases and 65 confirmed cases, resulting in 30 deaths across 96 local government areas in 30 states.

The states most affected, contributing to 90% of the cases, include Bayelsa, Zamfara, Abia, Cross River, Bauchi, Delta, Katsina, Imo, Nasarawa, and Lagos.

Cholera is an acute diarrhoeal disease caused by the ingestion of Vibrio cholerae, a gram-negative rod-shaped bacterium. This disease is primarily waterborne and potentially life-threatening, characterised by acute profuse, painless watery diarrhoea (often described as “rice water stools”), sudden onset, and sometimes accompanied by vomiting, nausea, and fever. Severe cases can lead to death within hours due to dehydration, although about 80% of infected individuals may exhibit mild or no symptoms at all.

Risk Factors and Transmission

Cholera is transmitted through the ingestion of food or water contaminated with Vibrio cholerae. Contamination can occur at various points, such as the source, during transportation, or storage at home. In Nigeria, common vehicles of transmission include beverages prepared with contaminated water, street-vended food, ice, and even commercial bottled water. Cooked vegetables and fruits washed with untreated wastewater also pose a risk.

The disease spreads more easily in areas lacking adequate sanitation and clean water supply. Practices such as open defecation, improper refuse disposal, and inadequate hand hygiene further exacerbate the risk. People living in slums, rural areas dependent on unsafe water sources, and overcrowded places like refugee camps are particularly vulnerable.

Cholera Symptoms

Cholera symptoms can appear as soon as a few hours or up to five days after infection. While many cases are mild, some can be severe and life-threatening. Here’s what you need to know:

Common Symptoms

Watery Diarrhea: About one in 20 people infected will experience severe, watery diarrhea that can quickly lead to dehydration.
Vomiting: Accompanying the diarrhea, vomiting is also a common symptom.

Mild Symptoms: Many infected individuals may have minimal or no symptoms but can still spread the infection.


Signs and Symptoms of Dehydration

Dehydration from cholera can progress rapidly and include the following signs:

Rapid Heart Rate: An unusually fast heartbeat.
Loss of Skin Elasticity: Skin that does not return to its original position quickly when pinched.
Dry Mucous Membranes: Dryness in the mouth, throat, nose, and eyelids.
Low Blood Pressure: A drop in blood pressure.
Thirst: An intense need to drink fluids.
Muscle Cramps: Painful contractions in the muscles.
If dehydration is not treated promptly, it can lead to shock and death within a matter of hours. Immediate medical attention and rehydration are crucial to prevent these severe outcomes.

Preventive Measures and Response

The NCDC, alongside the National Cholera Technical Working Group and various partners, including WHO and UNICEF, is providing extensive support to combat the outbreak. Efforts include:

Risk Communication: Educating the public on preventive measures.
Active Case Search: Identifying and managing new cases promptly.
Laboratory Diagnosis and Case Management: Ensuring accurate diagnosis and effective treatment.
Provision of Response Commodities: Supplying necessary medical and sanitation supplies.
Water, Sanitation, and Hygiene (WASH) Interventions: Implementing measures to ensure safe water and proper sanitation.
Awareness Campaigns: Disseminating information in English and local languages through jingles and other media.

Recommendations for the Public
To reduce the risk of cholera, the NCDC advises the public to:

  1. Ensure Safe Drinking Water: Boil water before drinking and store it in clean, covered containers.
  2. Practice Good Hand hygiene: Wash hands frequently with soap under clean running water, or use alcohol-based hand sanitisers if soap and water are unavailable.
  3. Ensure Food Safety: Cook food thoroughly, protect it from contamination, and reheat leftovers before consumption.
  4. Avoid Unsafe Practices: Refrain from open defecation, dispose of refuse properly, and regularly clear sewage.

Healthcare workers are encouraged to adhere to standard safety precautions and report suspected cases promptly. State governments should prioritise actions to provide communities with access to safe water, sanitation, and proper hygiene facilities.