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22nd November 1998

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Cholera comes to Colombo

* How you can get it
* Preventing cholera: dos and don'ts
* Remember:

City eating houses are sealed as the deadly disease spreads. Faraza Farook and Nilika de Silva report.

Colombo, Lanka's most populous city has already buried four victims of cholera. Hitherto known only in locations where the density of population was so low that the germ could be contained easily, this time around the cholera virus has thrown the health authorities into a panic, as the deadly disease spreads in the city.

While 430 cases were reported last year, this year's reports upto November showed a dramatic three fold increase. Even the deaths reported showed a similar rise.

This time Cholera has been detected in densely poluted areas: will it explode?Health authorities say the monsoonal rains are the cause for the outbreak. Compared to the previous year there is an upsurge in the spread of cholera. Early this year there was an outbreak in the Polonnaruwa-Dambulla districts and many pilgrims were affected. The disease particularly tends to follow the movements of masses of people such as pilgrims, so special precautions must be taken on the occasion of widely attended religious festivals.

According to Deputy Chief Medical Officer of Health Dr. Pradeep Kariyawasm 38 cases out of the suspected 92 have been diagnosed positive in Colombo and the suburbs.

Public Health Inspectors (PHI) are expected to visit eating houses at least once a week, but when The Sunday Times spoke to some of the eating houses they said that the PHIs visit only once a month or so. Presently there are 28 PHIs in Colombo, although 48 positions exist. Although there are trainee PHIs helping to overcome the situation, there seems to be a shortfall in the number of cadres.

Dr. Kariyawasam says they have started to superchlorinate the water and also close down tube wells in hotels. Although hotels in Colombo are not supposed to have tube wells, most of the smaller hotels do. When the PHIs make inspection visits, these wells are all closed and the employees maintain that they don't use them any more.

At least 24 eating houses have been closed down in the Colombo Municipality according to the Provincial Director of Health Services Dr. Nihal Jayatilleke.

"These eating houses are closed only for a short period, until they maintain the standards, and then are allowed to open again."

Cholera is an acute infection involving the lower part of the small bowel. It is caused by a short, curved red shaped germ which produces a powerful poison or endotoxine. The disease is mostly spread by contaminated food or water and by faeces and flies. There are two strains of cholera, namely Cholera Vibrio and Cholera El Tor Ogawa.

Speaking of the symptoms commonly seen in cholera, G.P Dr. S.O. Wijesinghe said patients with cholera may initially have an abdominal pain with gradual onset of fever or mild diarrhoea followed by low grade temperature. This can turn to sudden violent purging. The stools are loose, watery and greyish brown in colour. Sometimes nausea and vomiting accompanies diarrhoea. All this sudden loss of fluid causes severe dehydration and this results in death. Dr. Wijesinghe stressed that contact history is very important in treating the patient, e.g if the patient has come into close contact with a carrier of the disease.

"Children and elderly people would be particularly vulnerable to the disease because their immunity is low."

Other signs to look out for are a feeling of oppression and pain in the lower abdomen followed by muscle spasm like heat cramps, the patient beginning to suffer from intense thirst, the tongue becoming white and dry, the skin becoming wrinkled, the eyeballs sunken, cheeks hollow and breathing growing somewhat laboured and difficult.

Because of the lack of fluids in the body, the blood pressure falls and the temperature may be even subnormal. Unless the fluid is quickly replaced, death may result from collapse of the circulation. With proper treatment the patient usually begins to recover about the third day of the illness.

A correct diagnosis is most important in cholera, for its treatment is different from that of other conditions it may resemble. Uncooked food and particularly fruits and vegetables, specially if washed in contaminated water, or human excreta used as a fertilizer for soil are leading causes in spreading the infection.

Flies feeding on excreta may directly transfer the germs to the food. The disease may spread from person to person by way of direct contact. The infected person remains a danger to others until the organisms disappear from the stools, usually in 7-14 days.

The patient must be isolated during the infectious period and contacts must be examined daily. All things which come in contact with the patient must be disinfected immediately.

How you can get it

People could acquire infection from the following:

1. Water which is contaminated at its source. e.g: Faecally contaminated water entering an incompletely sealed well or during storage.

2. Fruits and vegetables grown at or near ground level irrigated with water containing human waste or freshened with contaminated water.

3. Food which was contaminated during or after preparation. e.g.: milk, cooked rice, lentils, potatoes, beans, eggs and meat. Seafood such as shellfish, crabs and prawns can spread the disease if not properly cooked.

Preventing cholera: dos and don'ts

To prevent cholera :

* Drink only water from a safe source or water that has been disinfected (chlorinated), preferably boiled cooled water.

* Cook food or reheat it thoroughly and eat while it is still hot.

* Avoid uncooked food unless it can be peeled.

* Wash your hands after any contact with excreta and before preparing or eating food.

* Dispose of human excreta (including children's stools) promptly and safely.

Cholera need not spoil your holiday. If you are going on holiday:-

* Drink only water that has been boiled or disinfected with chlorine.

* Avoid ice, unless you are sure that it is made from safe water.

* Eat food that has been thoroughly cooked and is still hot when served.

* Avoid raw seafood and other raw foods.

* Boil unpasteurised milk before drinking it.

* Ice cream from unreliable sources is frequently contaminated and causes illness. If in doubt avoid it.

* Be sure that meals bought from street vendors are thoroughly cooked in your presence and does not contain any uncooked food.


* With proper treatment cholera is not fatal.

* Take patients with suspected cholera immediately to the nearest health institution for treatment.

* Give increased quantities of fluids (if available, oral rehydration salt solution) as soon as diarrhoea starts.

* Vaccination is not recommended.

* Avoid partaking of meals prepared outside the home whenever possible.

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