SEMINAR PRESENTATION

ON

CHOLERA IN NIGERIA

PRESENTED

BY

MOHAMMAD UMMI FATIMA

MATRIC NUMBER

21/02/MB/2/026

MONTH/YEAR

In partial fulfilment of the requirement for the award of the degree of

B.SC MICROBIOLOGY.

DEPARTMENT OF BIOLOGICAL SCIENCE

FACULTY OF SCIENCE AND COMPUTING

AHMAN PATIGI UNIVERSITY .

ABDULLAHI DAUDA

(SUPERVISOR)

________________

Date/Signature
 TABLE OF CONTENTS

I ACKNOWLEDGEMENT

II CONTENTS

III ABSTRACT

CHAPTER ONE

1.1 INTRODUCTION
1.2 OVER VIEW OF CHOLERA IN NIGERIA

CHAPTER TWO

1.3 WHAT IS CHOLERA

1.4 WHERE IS CHOLERA FOUND

1.5 HOW THOSE PERSON GET CHOLERA

2.1 HOW LONG AFTER INFECTION DO THE SYMPTOMS APPEAR

CHAPTER THREE

2.2 EPIDEMIOLOGY OF CHOLERA IN NIGERIA

2.3 RISK FACTORS OF CHOLERA

2.4 DIAGNOSIS OF VIBRIO CHOLERA

2.5 EMERGING ANTIMICROBIAL RESISTANCE VIBRIO CHOLERAE STRAINS

CHAPTER FOUR

3.1 SIGN AND SYMPTOMS OF CHOLERA

3.2 TREATMENT OF CHOLERA

3.3 PREVENTION AND CONTROL OF CHOLERA

3.4 WHAT PROBLEMS CAN CHOLERA CAUSE

CHAPTER FIVE

3.5 CONCLUSION

4.1 REFERENCES.
 ACKNOWLEDGEMENT

All glory and adoration be to Almighty Allahu for sparing my life to

complete this program in good healthy status,may him continue to
increases all my ramifications.

My sincere appreciation and gratitude goes to my parents and family

member for their support financially morally, may Almighty God reward
them abundantly.

ABSTRACT

Cholera caused by Vibrio cholerae remains endemic and recurrent in Nigeria resulting in
morbidity and mortality on annual basis. Vibrio cholerae O1 and non-O1/O139 are reported
causative agents of the disease outbreak in Nigeria and some of these strains circulating the
country acquired multidrug resistance potential. Several factors including socioeconomic and
environmental among other factors drive this trend. Some regions in the country have been
identified as hot spots most especially the north where insurgency has exacerbated outbreaks
and management/control difficult. Surveillance and response to cholera outbreaks has been
suboptimal which in turn has always increased the number of fatalities. Coordinated and
harmonized approach involving all needed components (education, WASH, vaccination,
surveillance, human capacity building and strengthening capacity of laboratories) has been
advocated as a viable option to tackle the scourge.

CHAPTER ONE
1.1 INTRODUCTION

Cholera is a gastrointestinal disease cause by V. Cholerae. The disease

is a rife in developing countries with poor healthcare system, poor
infrastructure, lack of excess to portable drinking water, high level of
illiteracy, political instability among other factors (kolo et al .2013,
Ajayi and Smith 2019). The estimated global burden of the diseases
about 4.3 million cases and 143,000 death per year of which Africa
shares a greater chunk. The recurrent outbreaks nature of cholera
disease in endemic countries most especially Nigeria makes the
disease major health problem ( oyedeji et al. 2013, Smith and Ajayi
2019). According to WHO, cholera endemic population is that in which
choler has been confirmed from culture of faecal samples in at least
three of the past 5 years ( Clemens et al. 2017). Cholera is said to
have originated Ganges delta of India which overtime has circulated
around the world resulting in several pandemics ( Broeck et al. 2007).
In Nigeria the first documented outbreaks was in late 1970 with an
estimated 22,931 cases and 2,945 deaths (ujah et al. 2015). Beyond
this, Nigeria has continued to witness outbreaks of cholera of various
proposed

1.2 OVERVIEW OF CHOLERA IN NIGERIA

 NIGERIA
NIGERIA

CHOLERA OVERVIEW IN COUNTRY

Cholera was first reported in Nigeria in 1970. Since 1990, large outbreaks were
reported in 1991, 1996, 1999 and from 2009 to 2011.
Between 2004 and 2016, a total of 154,910 cases and 5,127 deaths were reported
(CFR ≈ 3.3%).
The largest outbreaks were reported in the northern states of the country. In the
north, outbreaks often spread from Nigeria to neighbouring countries around Lake
Chad (Niger, Chad and Cameroon) and in the south along the Gulf of Guinea.
A multi-sectoral study, linking water, sanitation, hygiene and health sectors, was
carried out in the four countries of the Lake Chad basin, and especially Nigeria. This
study aimed to propose an integrated WASH and Health response by first describing
the epidemiology of cholera in the Chad Lake Basin and secondly by suggesting
actions of prevention, preparedness and response to cholera epidemics. The Lake Chad
Basin is a specific area with a climate typical of Sudan and the Sahel. The lakeside area
and the lake’s tributaries as well as a marked seasonality structure the
agriculture,pastora and transhumance activities that take place here. In this essentially
rural space, cross-border communication channels attract commercial activities.
Population displacements occur between the several major agglomerations where
dense neighbourhoods have structural difficulties with water conveyance and
sanitation.
According to date from Nigeria notably, the presence of open wells on a large scale
is significantly associated with cholera. The local transmission mechanisms are less
well known, but late access to care, combined with population displacements
(particularly across borders) and funeral traditions are factors of vulnerability in the
spread of the disease that have been described since the first epidemics. The
analysis of the epidemiological surveillance system led to the proposal of a set of
national as well as sub-regional focuses for work on early warning systems.
Community surveillance and cross-border cooperation are the two main issues.
Hence, based on the analysis, recommendations were proposed in the most at-risk
areas. The suggested solutions shall build bridges between the emergency/outbreak
response and development programs. The study and its findings are accessible
online:” water, Sanitation, hygiene and cholera epidemiology: An integrated
evaluation in the countries of the Lake Chad basin (2011). Finally, understanding
cholera epidemiology and being informed on outbreaks and dynamics is critical for
the neighbouring countries. Nigeria is both in the Lake Chad epidemiological basin
(Niger, Cameroon and Chad), and in the South Guinea Gulf epidemiological basin
( Benin, Ghana and Togo).
 CHAPTER TWO

1.3 WHAT IS CHOLERA

Cholera is an acute diarrheal illness caused by infection of the intestine with the
toxigenic bacterium called vibrio cholerae. Cholera is also called Blue death (Because
the severe dehydration caused the body to take an a desiccated blue gray tone.
VIBRIO CHOLERAE

Vibrio cholera, a curved Gram-negative bacillus belongs to the family,

Vibrionaceae and shares some characteristics with the family,
Enterobacteriaceae [7. The species V. cholera comprises both
pathogenic and nonpathogenic strains. Vibrio cholera O1 and O139 are
the only serotypes responsible for the disease defined clinically and
epidemiologically as cholera [8, 9]. Vibrio cholera O1 is divided into
classical and El Tor biotypes, and into three serosubtypes-Ogawa,
Inaba, and Hikojima. Vibrio cholera O139 has characteristics in
common with the El Tor biotype but differs from O1 in its
polysaccharide surface antigen [10]. Cholera cases are confirmed
through the isolation of Vibrio cholera O1 or O139 from stools in any
patient with diarrhea [11]. Other serovars of V. cholera are generally
termed non-O1, non-O139 strains. They are non-choleragenic, usually
cause a milder form of gastroenteritis than O1 and O139, and are
normally associated with sporadic cases and small outbreaks rather
than with epidemics and pandemics [12]. Vibrio cholerae 01 Eltor is
the commonest strain in Nigeria [13–16].

About 75% of people infected with V. cholera do not develop any

symptoms, although the bacteria are present in their faeces for 7-14
days after infection and are shed back into the environment,
potentially infecting other people. Among people who develop
symptoms, 80% have mild or moderate symptoms, while around 20%
develop acute watery diarrhoea with severe dehydration [17]. In
severe infections, more than one quart of water and salts is lost per
hour. The stool looks gray and has flecks of mucus in it- termed “rice
water stools”. Within hours, dehydration can become severe, causing
intense thirst, muscle cramps, and weakness. Very little urine is
produced and the eyes may become sunken, and the skin on the
fingers may become much wrinkled. If dehydration is not treated, loss
of water and salts can lead to kidney failure, shock, coma, and death.
In people who survive, symptoms usually subside in 3 to 6 days. Most
people are free of the bacteria in two weeks. The bacteria remain in a
few people indefinitely without causing symptoms.

The most important virulence factor associated with V. cholera O1 and

O139 is the cholera toxin (ctx). The ctx genes (ctxA and ctxB) encoding
the production of the cholera toxin have been sequenced and these
have enabled development of deoxyribonucleic acid (DNA) probes and
polymerase chain reaction (PCR) methods for detection of the
organism [18–23]. In addition to cholera toxin, choleragenic strains
of V. cholera possess the ability to adhere to, and colonise, the small
intestine (colonisation factor), which has been ascribed to a toxin co-
regulated pilus (TCP). Genes encoding major virulence-associated
factors are found in clusters [24]. It has been shown that ctx genes
form part of a filamentous bacteriophage designated CTX phage
[25, 26]. The pilus colonisation factor is also known to act as a
receptor for the CTX phage [27, 28] and is encoded by the tcpA gene
that is part of the V. cholera pathogenicity island [29, 30].

A complex cascade of regulatory proteins that control expression of V.

cholera virulence determinants has been reported. For instance, in
responding to the chemical environment at the intestinal wall, the
organism produces the TcpP/TcpH proteins, which, together with the
ToxR/ToxS proteins, activate the expression of the ToxT regulatory
protein. ToxT then directly activates expression of virulence genes
that produce the toxins, causing diarrhea in the infected person and
allowing the bacteria to colonise the intestine [31, 32]. Although
reports on characteristics of Nigerian strains are insufficient [13]
implied that Vibrio cholerae from bi-weekly surveillance cultures for a
period of eight months were concordant with strains analysed at the
onset of their study. It may therefore be assumed that pathogenic
potential and characteristics of V.cholerae in Nigeria are similar to
those that have been studied elsewhere.
 THE DISEASE

Cholera is contracted through the consumption of contaminated water or food. The duration of
incubation before the onset of disease manifestation is less than 24 hours to 5 days.

The manifestation of the disease is dependent on infecting biotype, inoculum size, Special Edition
on Neglected Tropical Diseases 26h host immunity and other host factors (Edward and Stephen
2000). Profuse watery diarrhea with vomiting is a classical hallmark of cholera, which results in rapid
fluid loss leading to dehydration, which in most cases if not promptly arrested results in death.

Other symptoms include loss of skin elasticity, leg cramps, low blood pressure, metabolic acidosis,
feeling of thirst, increased heart rate and irritability (Nicholas et al. 2007, Saulat 2016). Complications of
cholera disease include hyponatraemia, acidosis, hypocalcaemia and electrolyte disturbances (Clemens
et al. 2017). After the consumption of contaminated food or water, the bacterium passes through the
acidic barrier of the stomach and colonizes the epithelium of the small intestine via toxin-coregulated
pili (TCP) and other colonization factors. Studies in Nigeria, have confirmed the presence of tcp genes in
the isolates (Oyedeji et al. 2013; Adewale et al. 2016). Cholera ensues from the production of an array
of factors including cholera toxin, repeats in toxin and haemolysin (Manneh-Roussel et al. 2018). Host
nutritional and genetic factors play roles in determining host susceptibility to cholera. It has been
documented that the ABH histo-blood group antigens sets of cellular secreted glycoproteins and
glycolipids are key determinants of host susceptibility to V. cholerae, since they seem to affect host cell
receptor specificity for toxin and pathogen binding (Nelson et al. 2009).

1.4 WHERE IS CHOLERA FOUND

The cholera bacterium is usually found in water or food that has been contaminated by
faeces (poop) from a person infected with cholera bacteria. Cholera is most likely to occur
and spread in places with inadequate water treatment, poor sanitation, and inadequate
hygiene. Cholera bacteria can also live in the environment in brackish rivers and coastal
water.

1.5 HOW THOSE PERSON GET CHOLERA

A person can get cholera by drinking water or eating food contaminated with cholera
bacteria. In an epidemic, the source of the contamination is usually the faeces of an
infected person that contaminates water or food. The disease can spread rapidly in areas
with inadequate treatment of sewage and drinking water. The infection is not likely to
spread directly from one person to another therefore casual contact with an Infected person
is not a risk factor for becoming ill.

2.1 HOW LONG AFTER INFECTION DO THE SYMPTOMS APPEAR

It usually takes 2_3 days for symptoms to appear after a person ingests cholera bacteria,
but the time can range from a few hours to 5 days.

CHAPTER THREE
 2.2 EPIDEMIOLOGY OF CHOLERA IN NIGERIA

Epidemiology of Cholera in Nigeria

Cholera is endemic in Nigeria with recurrent outbreaks annually some of which are sporadic and
seasonal mostly during the wet season. Several outbreaks have been recorded since 1970 with
various outcomes of morbidity and mortality as shown in Table

I. Outbreaks are not limited to specific regions of the country, however some states have been
identified as hotspots of the disease (Adagbada et al. 2012, NCDC, 2019). The northern part of
Nigeria has recorded more and severe outbreaks than other regions of country overtime. Cholera
cases reported between 2004 and 2014 in Nigeria had five states (Bauchi, Borno, Katsina, Gombe
and Kano) contributing 66% of the entire cases (UNICEF, 2015). Already known underlying factors
such as absolute poverty, illiteracy, poor sanitation and hygiene that drives cholera in any
endemic location is largely at play in this region. However, these factors have been amplified as a
result of the protracted unrest initiated by the terror group Boko Haram, banditry, farmers and
herders crisis causing residents of affected communities to flee to overcrowded internally
displaced person (IDP) camps which becomes epicenters of outbreaks (Leckebusch and
Abdussalam, 2015, Abubakar et al. 2016, Talha, 2016, Denue et al. 2018).

Table 1: Some Cholera Outbreaks, Cases and Death in Nigeria 1970-2018

2.3 RISK FACTORS OF CHOLERA

For a cholera outbreak to occur, two conditions have to be met: there must be
significant breaches in the water, sanitation, and hygiene infrastructure used by
groups of people, permitting large-scale exposure to food or water contaminated
with Vibrio cholera organisms; and cholera must be present in the population.
Cholera has been proven to be transmitted through fecal oral route via
contaminated food, carriers of the infection and inadequate sanitary conditions
of the environment. The principal mode of transmission however remains
ingestion contaminated water or food.

In Nigeria, the 1996 cholera outbreak in Ibadan (Southwest) was attributed to

contaminated potable water sources . Street vended water and not washing of
hands with soap before eating food possible reasons for the 1995-1996 cholera
outbreaks in Kano state.

Drinking water sold by water vendors was also connected with increased risk of
contracting the disease. In Katsina, the outbreak the disease was linked to faecal
contamination of well water from sellers.

The recent 2010 outbreak of cholera was speculated to be directly related with
sanitation and water supply. The hand dug wells and contaminated ponds being
relied on by most of the Northern states as source of drinking water was a major
transmission route during the outbreak. Perhaps, these wells were shallow;
uncovered and diarrhoea discharge from cholera patients easily contaminate
water supplies.
Another factor that may greatly contribute to risk of cholera transmission is a population
movement which enhances the spread of the infectious agent to others and different sites.

For Intense, all the surviving residents that fled a two month outbreak in Kebbi state (North-north)
became indices for subsequent infection in the north and southern part of neighbouring state.
Additional overcrowding increases risk of contact with vomitus, excreta, and contaminated water
or food. Since early detection and containment of cases (isolation facilities) are paramount in
reducing transmission ,poor

Access to health services and poor diagnosis may become major barrier to controlling the
infection.

Lack of safe water and poor sanitation are important risk factors. All these features have
contributed

Greatly to cholera infections in Nigeria.

2.4 DIAGNOSIS OF VIBRIO CHOLERA

In outbreaks situation diagnosis of Vibrio cholerae O1 or O139 from stool samples using
lipopolysaccharide detection comes in handy, however isolation of pathogen is important for
outbreaks confirmation and antimicrobial susceptibility testing. Most of the laboratories in
developing countries with requisite facilities can isolate V. Cholerae. Samples are expected to
 be transported with Cary Blair transport media and then on the arrival to the laboratory they
are cultured onto non selective and selective media like tthiosulfate bile citrate bile salt
sucrose (TCBs) Agar plate. Enrichment of stool sample in alkaline peptone water aid a better
recovery of the pathogen. Isolates are identified by biochemical characterization and are
serotyped using monovalent antisera. When available direct dark field microscopy of rice-
water stool could reveal the presence of Vibrio cholerae bacteria.

2.5 ANTIMICROBIAL RESISTANCE VIBRIO CHOLERAE STRAINS

In the management of cholera infection, severe cases require administration of antibiotics

to patients. With the emergence of antibiotic resistant V. cholerae strains implicated in

outbreaks, mortality could spike. Studies in Nigeria has revealed multi-drug resistant

(MDR) V. cholerae strains isolated during outbreaks. Marin et al. (2013) reported atypical

El Tor and Non-O1/Non-O139 V. cholerae strains of the 2010 cholera outbreak that were

MDR with reduced susceptibility to chloramphenicol and ciprofloxacin. Similarly,

Oyedeji et al. (2013) also reported V. cholerae strains isolated in Gombe state during the

2010 outbreak to be resistant to Augmentin, cotrimoxazole and amoxicillin. However

Adewale et al. (2016) reported unique clones of V. cholerae O1 El Tor with Haitian type

CtxB allele implicated in outbreaks from 2007 to 2013 to be susceptible to

fluoroquinolones and tetracycline, which are currently used for treating cholera cases in

Nigeria. This implies that resistance of V. cholerae to antibiotics is emerging and proactive

measures to combat the trend should be initiated. The circulation and dissemination of

antibiotic resistance potential by V. cholerae is amplified by the presence of mobile genetic

elements (plasmids). In the study of Olukoya et al. (1995) on the 1992 cholera outbreak in

Nigeria, they identified V. cholerae isolates harboring conjugative plasmid ranging from

4.5kb to 150kb with resistance to ampicillin, penicillin, cloxacillin, cotrimoxazole,

streptomycin and tetracycline. Beyond the environment being a reservoir of V. cholerae

that facilitates outbreak (Smith et al. 2015), it also serves as a source of antibiotic resistant

V. cholerae strains with plasmids. Okoh (2012) reported that several V. cholerae strains

isolated from water samples in Elele community, Rivers State Nigeria were resistant to
 amoxicillin, cotrimoxazole, nitrofurantoin, gentamicin, tetracycline, ampicillin and

chloramphenicol with plasmid sizes of 1.19kb and 1.06kb.

CHAPTER FOUR

3.1 SIGN AND SYMPTOMS OF CHOLERA.

People with cholera often will have mild symptoms, or no
symptoms at all, and get better on their own. About 1 in 10
people will develop severe symptoms that can be life-threatening.

Early symptoms of cholera include:

 Watery diarrhea, sometimes described as "rice-water stools"

because they are milky white

 Vomiting

 Leg cramps

 Restlessness or irritability

Symptoms usually appear 2-3 days after someone drinks or eats

something containing cholera bacteria. Symptoms can show up
within a few hours or up to 5 days.

During a cholera outbreak, people with acute watery diarrhea (3

or more loose stools a day) should seek care.

Later symptoms
Losing body fluids quickly from diarrhea and vomiting can cause
dehydration. Patients with severe cholera may have lost more
than 10% of body weight by the time they seek medical care.

If untreated, severe dehydration can lead to kidney failure, shock,

coma, and death.

Symptoms of dehydration include:

 Rapid heart rate

 Loss of elasticity in the skin

 Dry mucous membranes

 Low blood pressure

With early and proper treatment, even people with severe cholera
can survive.
3.2 TREATMENT OF CHOLERA

Oral Rehydration Therapy

The most important treatment for cholera is rehydration therapy
to replace fluids lost through diarrhea and vomiting. Rehydration
therapy can include ORS, intravenous fluids, and electrolytes.
With timely rehydration therapy, more than 99% of cholera
patients survive.
ORS
Many people can be completely rehydrated by drinking ORS,
which is made with a pre-packaged powder of salts and minerals
and mixed with water that has been boiled or treated.

ORS powder is available in many pharmacies and stores. During

cholera outbreaks, governments and nongovernmental agencies
often distribute ORS powder.

If you think you might have cholera, start drinking ORS

immediately, including on your way to a healthcare facility.

Some people who are severely dehydrated may require fluids

through an IV. They still should drink ORS as soon as possible.
Other fluids
If you don't have ORS, you can drink safe water, broth, or other
fluids. Do not drink fluids with a high sugar content
like juice, soft drinks, or sports drinks. Sugary drinks can
make diarrhea worse.

Babies with watery diarrhea should continue to be fed breast milk

or formula to help them stay hydrated.

Antibiotics
In addition to rehydration therapy, antibiotics may be
recommended for severely ill patients and others depending on
their symptoms and medical conditions. Antibiotics can help
decrease how long someone is sick.
However, antibiotics should be used along with aggressive
rehydration.
Such as ...
 Ciprofloxacin
 Doxycycline
 Erythromycin
  Ampicillin
 Azithromycin
 Trimethoprim / Sulfamethoxazole

Zinc supplementation for children

When available, children ages 6 months to 5 years with suspected
cholera should be started on zinc supplementation immediately.

3.3 PREVENTION OF CHOLERA

1. Drink and use safe water

Use bottled, chlorinated, boiled, or filtered water.

Piped water, drinks sold in cups or bags, and ice may not be safe.

 Use bottled water with unbroken seals to drink, brush your

teeth, wash and prepare food, and make ice or beverages. If
bottled water is not available, use water that has been
properly chlorinated, boiled, or filtered.

 If treating with a chlorine product:

o Treat your water with one of the locally available

chlorine treatment products for drinking water and
follow the instructions on the label.

 If boiling:

o If a chlorine treatment product isn't available, boiling is

an effective way to make water safe. Bring water to a
rolling boil for 1 minute.

o Note: Boiled water is at risk for recontamination and

should be safely stored in a clean, covered container.

 If filtering:
 o Use a filter with a pore size of less than or equal to 0.3
microns and treat the water with a disinfectant such as
chlorine, chlorine dioxide, or iodine.

o Note: Filtered water is at risk for recontamination and

should be safely stored in a clean, covered container.
Additional treatment with a chlorine product is
recommended.

2. Wash your hands often with soap and safe water...

 Before, during, and after preparing food

 Before and after eating food or feeding your children

 After using the toilet

 After cleaning your child's bottom

 After taking care of someone who is sick with diarrhea

Note: If you don't have access to soap and safe water, use an
alcohol-based hand sanitizer with at least 60% alcohol.

3. Use toilets

Flush or bury poop.

 Use toilets or safely managed sanitation facilities to get rid

of poop. This includes disposing of your children's poop.

 Wash your hands with soap and safe water after going to the
bathroom.

If you don't have access to a toilet:

 Poop at least 30 meters (100 feet) away from any body of

water, including wells, and then bury your poop.

 Dispose of plastic bags containing poop in latrines or at

collection points if available. Or bury the bags in the ground.

 Do not put plastic bags in chemical toilets.

  Dig new latrines or temporary pit toilets at least a half-meter
(1.6 feet) deep and at least 30 meters (100 feet) away from
any body of water.

4. Boil it, peel it, or leave it

Peel raw fruits and vegetables and cook other food thoroughly.

 Eat foods that have been thoroughly cooked and are still hot
and steaming, or fruits and vegetables that you have peeled
yourself.

 Avoid eating raw vegetables and fruits that can't be peeled.

 Be sure to cook seafood, especially shellfish, until it is very

hot all the way through.

5. Clean up safely
Thoroughly clean toilets and surfaces contaminated with poop.

 Clean and disinfect kitchenware and areas where you

prepare food with soap and safe water. Allow them to dry
completely.

 Bathe and wash clothes or diapers 30 meters (100 feet) from

drinking water sources.

 Clean and disinfect toilets and surfaces contaminated with

poop. Clean surfaces with a soap solution to remove poop,
then disinfect using a solution of 1 part of household bleach
to 9 parts of water.

 When finished cleaning, safely dispose of soapy water and

disinfection solutions by pouring them into a drain, toilet, or
latrine.

 Dirty rags can be cleaned with hot water and soap and
allowed to fully dry. Wash your hands again with soap and
safe water after cleaning and disinfecting.

3.4 WHAT PROBLEMS CAN CHOLERA CAUSE

Diarrhea and vomiting from cholera can make your body lose large amounts of important substance

 Electrolytes.

 Fluidity.

 Sodium.

 Potassium.

When your body doesn’t have enough of those things, you get dehydrated and may develop:

Dry mucous membranes (such as in the eyes, nose and mouth).

 Fast heart rate.

 Hypokalemia (low potassium levels in the blood).

 Hypotension (low blood pressure).

 Loss of the natural stretchiness in skin.

 Untreated, severe dehydration from cholera can lead to:

 Kidney failure

 Coma.
  Shock.

CHAPTER FIVE

3.5 CONCLUSION

Although Limited epidemiological information and studies exist

regarding the extent of infection and characteristics of circulating
strains in Nigeria, there is clearly a link of proverty, dirt
environment and lack of social amenities Including the provision of
good water source. These factors definitely imparted much on the
frequency and severity of the disease as well as its epidemic
potential. In addition, it appears that the clonality of the circulating
strains has implications on infection control and management of the
 disease. This is an important area that needs to be addressed and
since there are no epidemiologic information of the population
structure of circulating strains, it therefore seems, at least for now
that cholera will maintain its challenging transmission role.
However, we suggest that epidemiological studies should be
directed at collecting detailed information on the sources of
infection and transmission mode. Public Health education should be
strengthened and authorities in disease control should establish a
channel for communication and reporting. Contact tracing strategies
should also be introduced. Lastly, National laboratory should
establish data bank for native strains to facilitate comparative
analysis with strains from other countries.

4.1 REFERENCES

Nigeria References

Adagbada AO, Adesida SA, Nwaokorie FO, Niemogha M, Coker AO.

Cholera Epidemiology in Nigeria: an overview. Pan African Medical
Journal 2012; 12:59

Federal Ministry of Health Nigeria. Weekly Epidemiology Report.

2011.

Nigeria Centre for Disease Control. Situation Report. Cholera

Outbreak in Nigeria. 29 October 2018

Oyedeji KS, Nwaokorie FO, Bamidele TA, Ochoga M, Akinsinde KA,

Brai BI, et al. Molecular Characterization of the Circulating Strains
of Vibrio cholerae during 2010 Cholera Outbreak in Nigeria. J Heal
Popul Nutr. 2013; 31(2):178–84.

World Health Organization. Nigeria. Borno, Adamawa and Yobe

States Declare End of Cholera Outbreaks. 21 January 2019.