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Ebola: Information for U.S. Healthcare Workers and Settings

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Disease Name: Cholera


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Please review the Idaho Reportable Disease Rules (IDAPA 16.02.10) for the most up-to-date information.

Immunization for travelers

Vaccines may be considered for travelers to cholera-affected areas.  One vaccine is currently available, in the United States, for travelers.  Vaxchora was approved by the FDA in June, 2016.  Local availability may be limited.

Infectious Diseases. (2016). In Centers for Disease Control and Prevention. Retrieved from www.cdc.gov


Overview / Case Definition

Although rare in developed countries, there is an estimated 3-5 million cases of cholera and over 100,000 deaths reported each year around the world. Cholera is most likely to be found and spread in places with inadequate water treatment, poor sanitation, and inadequate hygiene.

According to the Centers for Disease Control and Prevention (CDC) cholera can be life-threatening but is easily prevented and treated. A number of pathogenic Vibrio species have been identified and are associated with a variety of clinical syndromes. CDC reports all confirmed cholera cases from the United States to the World Health Organization.

Vibrio cholerae is the causative agent of cholera, a potentially life-threatening diarrheal illness. V. cholerae is a gram negative, curved, motile bacillus which colonizes the epithelium of the small intestine, producing enterotoxin (cholera toxin: CT) and other toxins. These toxins ultimately lead to massive fluid loss into the intestine generating high-volume, watery diarrhea.

Although numerous serogroups have been described, only toxigenic serogroups O1 and O139 (Bengal strain) are associated with epidemic cholera and reportable to the World Health Organization. V. cholerae O1 has two biotypes; Classical and El Tor, and each has three serotypes, Inaba, Ogawa, and Hikojima. Serotype Hikojima is extremely rare. Infections with the El Tor biotype tend to be less severe. V. cholerae serogroup O1, serotype Ogawa is the strain associated with the 2010 Haitian cholera outbreak, and the 2013 Mexico outbreak. Nontoxigenic strains of V. cholerae O1 and serogroups other than O1 and O139 can cause diarrhea but are not associated with epidemics.


Restrictions

Daycare Facility

A person excreting Vibrio cholerae must not attend a daycare facility while fecally incontinent and must not work in any occupation that provides personal care to children in a daycare facility while the disease is in a communicable form, unless an exemption is obtained from the Department or Health District.

Food Service Facility

A symptomatic person excreting Vibrio cholerae must be managed under IDAPA 16.02.19, “The Idaho Food Code.”

Health Care Facility

A person excreting Vibrio cholerae must not work in any occupation that provides personal care to persons confined in a health care or residential facility while in a communicable form, unless an exemption is obtained from the Department or Health District. A person in a health care facility who has cholera must be managed under the “Guideline for Isolation Precautions in Hospitals,” as incorporated in Section 004 of these rules.

Household Contacts

A member of the household in which there is a case of cholera may not work in any occupations listed in Subsections 200.04 through 200.06 of this rule, unless approved by the Department or Health District. The household member must be asymptomatic and provide at least one (1) approved fecal specimen found to be negative on a culture by a licensed laboratory prior to being approved for work.


Reporting

Within one working day

Reportable by Healthcare and Labs:

Reportable by Food Service Facility:

Suspect Reportable:

Reporting Timeframe: Within one working day



Diagnosis / Testing

Since Vibrio species require special laboratory tests, alerting IBL that vibriosis is suspected is important. Because testing for Vibrio species on uncommon, all samples should be sent to IBL for evaluation. IBL will send all O1 and O139 isolates to CDC for enterotoxin testing and subtyping.  Contact IBL at (208) 334-2235 for further questions.

Suspected food samples:  V. cholerae serogroup O1 and O139 may be recovered from foods by methods similar to those used for recovering the organism from the feces of infected individuals. Pathogenic and non-pathogenic forms of the organism exist, so all food isolates should be tested for the production of cholera enterotoxin.  All food samples must be requested through SCPHD.  Please contact epidemiology staff at (866) 710-9775.


Treatment

CDC Travel Website:  http://wwwnc.cdc.gov/travel


Additional Information

Immunization for travelers

Vaccines may be considered for travelers to cholera-affected areas.  One vaccine is currently available, in the United States, for travelers.  Vaxchora was approved by the FDA in June, 2016.  Local availability may be limited.

Infectious Diseases. (2016). In Centers for Disease Control and Prevention. Retrieved from www.cdc.gov


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