How to Prevent Transmission of Cholera?
Health Education and public awareness regarding spread of disease, availability of treatment and precautions at domestic level and cooperation are important to control an outbreak.
To Prevent Cholera

1. Safe drinking water supply
   • Disinfection of public water sources
   • Chlorination of well water
   • Tanker use for water supply
   • Distribution of chlorine tablets for domestic use
   • Use of boiled water if required.
   • Avoid uncooked food unless it is peeled or shelled or washed and disinfected.
   • Wash hands before preparing or eating food.
   • Wash hands after using toilet or any contact with excreta.
2. Dispose off human excreta promptly and safely.
3. Inter Departmental coordination.

Three simple rules for Cholera Prevention

1. Eat freshly prepared food.
2. Drink safe water (chlorinated or boiled)
3. Wash your hands with soap after defecation and before meals.

More than 90% of sporadic cases are mild and 9% cases require Oral rehydration therapy. And 1% cases require hospitalization & IV therapy.

Vaccination for Cholera
Parental vaccine consist of 2 equal doses, injected subcutaneously at an interval of 4 to 6 weeks. The protective value of currently available vaccines is about 50 percent for a period of 3–6 months.
Oral Vaccine
Vaccine consisting of killed whole–cell V. cholerae 01 in combination with a recombinant B–sub unit of cholera toxin. It is given orally in two dose schedule, 10–14 days apart. The vaccine confers 50–60 percent protection for atleast 3 years.

Though vaccine is available it is not used for routine immunisation and not used for prevention and control of epidemics.

Control of Cholera
It is now considered, that the best way to control cholera is to develop and implement a national program for the control of all diarrheal diseases because of similarities in the epidemiology.

Notification
Cholera is a notifiable disease locally, nationally and internationally. Health workers at all levels (particularly those who are closest to the community, such as community health workers, and multi – purpose workers) should be trained to identify and notify cases immediately to the local health authority.

Composition of ORS – bicarbonate
Ingredient	Quantity
Sodium Chloride Sodium Bicarbonate Potassium Chloride Glucose (Dextrose) Potable Water	3.5g 2.5g 1.5g 20.0g 1 liter

The inclusion of trisodium citrate in the place of sodium bicarbonate can make the product more stable. Packets of oral re–hydration mixture are now freely available at all primary health centers, sub–centers and hospitals. If the WHO mixture of salts is not available, a simple mixture consisting of table salt (5g) and sugar (20g) dissolved in one liter of drinking water may be safely used until the proper mixture is obtained.

Guidelines for oral re–hydration therapy (for all ages) during the first four hours.

Age	Weight	ORS (Solution in ml)
Under 4 months	Under 5	200 – 400
4 – 11 months	5 – 7.9	400 – 600
12 – 23 months	8 – 10.9	600 – 800
2 – 4 years	11 – 15.9	800 – 1.200
5 – 14 years	16 – 29.9	1.200 – 2.200
15 years or over	30 or over	2.200 – 4.000

The patient’s age should only be used if the weight is not known. The approximate amount of ORS required in ml, may also be calculated by multiplying the patient’s weight (expressed in kg) by 75.

Amount of Diarrhea	Amount of Oral Fluid
Mild diarrhea (not more than one stool every two hours or longer, or less than 5 ml stool per kg per hour.	100 ml/kg body weight per day, until the diarrhea stops.
Severe diarrhea (more than one stool every 2 hours, or more than 5 ml of stool per kg per hour).	Replace stool losses volume for volume. If not measurable, give 10 – 15 ml/kg body weight per hour.