The City of Cape Town's health department says only one case of cholera, in Khayelitsha, has been confirmed and two adults are being monitored for suspected cholera, allaying fears that Zimbabwe's cholera outbreak may have spread to the city.
Virginia Azevedo of the city's health department said laboratory tests had confirmed that the strain of cholera identified in the Khayelitsha patient was different from the one responsible for the cholera outbreak in Zimbabwe.
The World Health Organisation says Zimbabwe's cholera epidemic has claimed more than 1,500 lives since August and a further 29,000 suspected cases have been reported.
Azevedo said the cholera case in Khayelitsha, a woman in her mid-20s, was an isolated instance that should not be seen as a "flare-up". One patient had been admitted to the GF Jooste Hospital with cholera. Two adults, neighbours of the cholera patient, were being monitored.
None of the three had travelled to Zimbabwe, she said.
Executive director of city health Ivan Bromfield said health officials had visited the home to assess hygiene and contain the spread of the disease.
Azevedo said a 10-year-old child had gone to Karl Bremer with suspected cholera, but cholera was not confirmed.
She said diarrhoea was common at this time of the year, and isolated cases of cholera were not a cause for concern. The city was monitoring water and sewage sources in informal settlements and had not picked up any trace of cholera.
Keith Cloete of the provincial Health Department said they and the city were following up all cases of suspected cholera and taking precautions. Health services were on "high alert", he said.
Azevedo urged people to wash their hands with soap to minimise the risk.
- Cape Times
Virginia Azevedo of the city's health department said laboratory tests had confirmed that the strain of cholera identified in the Khayelitsha patient was different from the one responsible for the cholera outbreak in Zimbabwe.
The World Health Organisation says Zimbabwe's cholera epidemic has claimed more than 1,500 lives since August and a further 29,000 suspected cases have been reported.
| None of the three had travelled to Zimbabwe |
None of the three had travelled to Zimbabwe, she said.
Executive director of city health Ivan Bromfield said health officials had visited the home to assess hygiene and contain the spread of the disease.
Azevedo said a 10-year-old child had gone to Karl Bremer with suspected cholera, but cholera was not confirmed.
She said diarrhoea was common at this time of the year, and isolated cases of cholera were not a cause for concern. The city was monitoring water and sewage sources in informal settlements and had not picked up any trace of cholera.
Keith Cloete of the provincial Health Department said they and the city were following up all cases of suspected cholera and taking precautions. Health services were on "high alert", he said.
Azevedo urged people to wash their hands with soap to minimise the risk.
- Cape Times
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Cholera outbreak
An outbreak of cholera which originated in Zimbabwe and subsequently spread to South Africa is continuing in both countries. The majority of cases occurring in South Africa are Zimbabweans seeking healthcare in Musina and nearby Madimbo in Limpopo Province. A clinical case definition is now in use to identify cases of cholera in Musina and Madimbo and only limited laboratory testing is conducted as required. Laboratory confirmation should still be sought for all suspected cases of cholera in Limpopo Province outside the aforementioned areas and in all other provinces in SA.
As of 13 December 2008, a total of 844 cases and 8 deaths (CFR= 1%) has been reported from Limpopo Province. In addition, 25 laboratory-confirmed cases of cholera have been identified from several other provinces including Gauteng (n=17), Mpumalanga (n=1), KwaZulu Natal (n=2), Northwest (n=2), Northern Cape (n=1, Eastern Cape (n=1) and Western Cape (n=1) Provinces. To date case investigation has been completed on 24/25 cases, all of whom were individuals with a history of recent travel to Zimbabwe and/or close contact with a cholera case.
The current outbreak strain of V. cholerae O1 has been further characterized by the Enteric Diseases Reference Unit, NICD as Vibrio cholerae O1 serotype Ogawa biotype El Tor. Isolates received to date are resistant to co-trimoxazole, nalidixic acid and chloramphenicol. Aggressive rehydration therapy in the severely dehydrated patient with intravenous Ringer’s lactate according to standard protocols for cholera remains the mainstay of treatment and is the most important lifesaving measure. Antibiotic treatment should be used only in those patients who have signs of severe dehydration. Antibiotics have NOT been shown to affect final clinical outcome, but may shorten the length of time the patient has diarrhoea and decrease volume of stool, thus decreasing the volume of fluids required for rehydration. Where antibiotic treatment is indicated, guidelines for this outbreak should be followed (Table 1).
Table 1. Antibiotic treatment for severe cholera cases in current outbreak
Patient group Drug of choice
Non-pregnant adults Doxycycline - 300mg as a single dose
OR
Tetracycline – 500mg QID for 3 days
Children
Age = 8 years Tetracycline for 3 days
Children
Age < 8 years Ciprofloxacin for 3 days (note clinical response may be poor due to nalidixic acid resistance).
Signs of severe dehydration indicating a requirement for intravenous therapy include: lethargy/decreased level of consciousness, sunken dry eyes, absent tears, very dry mouth, poor drinking, reduced skin turgor (skin pinch returns slowly).
All provinces in South Africa need to remain on high alert to ensure early detection of cases and prevention of transmission. All suspected cases should be immediately notified and investigated. Stool or rectal swab samples should be sent in transport medium and a specific request made to the laboratory for cholera testing. In areas where cholera patients have been identified, it is essential to inform local populations of hygienic measures they can take, in order to reduce the likelihood of a local outbreak.
These measures would also be appropriate for travellers to Zimbabwe and include:
* Always use clean/disinfected water for drinking, food preparation and washing of utensils. Where safety of water is not known water can be made safe for use as follows:
o by boiling water vigorously for 3 minutes and then allow it to cool. Water should then be stored in a suitable, clean container with a lid.
o OR Mix 1 teaspoon or capful of household bleach with 20-25 litres of water and let it stand for at least 2 hours (preferably overnight).
Bottled water may not always be safe. Only use bottled water from a reliable source and only if the bottles are properly sealed.
* Wash hands with clean/disinfected water before and after handling food, and after using the bathroom.
* Human waste should be disposed of in a manner that does not contaminate water sources.
* Store food under hygienic conditions.
Note: raw water sources (rivers, dams etc.) should not be regarded as safe for consumption. Even if Vibrio cholerae O1 is not isolated from the water, faecal contamination is an indication that water is not safe for human consumption. Current laboratory methods are not sensitive enough to reliably identify the absence of Vibrio cholerae in water.
Source:
Communicable Disease Control Directorates in all provinces, National Department of Health Communicable Disease Control
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