The National Institute of Communicable Diseases (NICD) has confirmed the diagnosis of cholera in a returning traveller from Zimbabwe. The patient commenced with diarrhoea on 29th September and was admitted to a Tshwane hospital on 1 October with profuse watery diarrhoea and dehydration. The diagnosis was confirmed by the NICD on 2 October 2018.
Provincial and district health authorities acted swiftly to investigate the case. On the morning of 02 October, the patient’s household was visited to provide health information, assess household contacts and conduct an environmental health assessment. Household surfaces were decontaminated and borehole and tap water samples were taken for investigations. Household contacts are currently under surveillance.
Cholera is usually transmitted through drinking water or food contaminated with cholera. However, cholera can also be transmitted following direct contact with the infective material (stool or vomitus). Transmission within households is not uncommon. There is currently no risk to community members from this case.
The NICD has confirmed that the infecting isolate is a toxin-producing V. cholerae serotype Ogawa, and is resistant to most first-line antibiotics, including tetracycline, cotrimoxazole, doxycycline and ciprofloxacin. The isolate is susceptible to azithromycin.
The mainstay of cholera treatment is a fluid replacement. Mild-to-moderate cases may be treated with oral rehydration fluid. Severe cases require admission and intravenous administration of fluid. Antibiotic treatment is given and may reduce disease severity, and reduce the risk of transmission.
The public is urged to drink water from safe water sources, ensure good hand hygiene before and after using the toilet, and before and after handling food.
The cholera outbreak in Zimbabwe is ongoing, with 7,148 suspected cases and 49 deaths reported. While the outbreak is concentrated in the densely populated suburbs of Harare, cases have been reported from at least 6 other provinces. An oral cholera vaccination campaign has been launched in Harare.
South African healthcare workers are advised to suspect cholera in an individual with acute onset of watery diarrhoea in an area at risk of cholera importation. Health care workers are referred to material on the NICD website.
[link url="http://www.nicd.ac.za/index.php/notification-of-imported-cholera-case-in-gauteng-province/"]NICD material[/link]
[link url="http://www.nicd.ac.za/wp-content/uploads/2017/03/CHOLERA-ALERTforHCW_20181004_finalJT.pdf"]NICD cholera treatment guidelines[/link]