Cholera: Physicians call for mass vaccination as death toll rises

Vaccinologists and public health physicians have called for mass vaccination against cholera, stressing that it remains one of the cost-effective measures to control cholera outbreak.

They urged those who yet to be vaccinated against the food and waterborne disease to immediately do so, noting that the way it is spreading through Lagos communities and to other states calls for prompt, proactive and protective measures to stop the rising death rolls.

As of Saturday, June 15, 2024, according to the Lagos State Government, there were 15 confirmed fatalities from the outbreak.

The state Commissioner for Health, Prof Akin Abayomi, in a statement, disclosed that “350 suspected cases of cholera were reported in 29 wards across multiple Local Government Areas in Lagos State with 17 confirmed cases and 15 fatalities so far.”

Sequel to this, experts feared that the disease, which had killed several people in Lagos, may soon spread to other parts of the currently if not contained with vaccination and potable water, good sanitation and proper hygiene drive.

They called on the government at all levels to ensure adequate potable water supply and activate all disease emergency and surveillance units in the country to ensure that it does not snowball into a nationwide epidemic.

 According to the World Health Organisation, cholera is an acute diarrhoeal infection caused by eating or drinking food or water that is contaminated with the bacterium Vibrio cholerae.

 The WHO said that cholera remains a global threat to public health and is an indicator of inequity and lack of social development, with an estimated 1.3 to 4.0 million cases of cholera, and 21, 000 to 143, 000 deaths worldwide due to the infection.

The global health body stated, “Cholera is an extremely serious disease that can cause severe acute watery diarrhoea with severe dehydration. It takes between 12 hours and five days for a person to show symptoms after consuming contaminated food or water.

“It affects both children and adults and can kill within hours if untreated. Most people infected with Vibrio cholerae do not develop any symptoms, although the bacteria are present in their faeces for 1-10 days after infection.

“This means the bacteria are shed back into the environment, potentially infecting other people. Cholera is often predictable and preventable.

“It can ultimately be eliminated where access to clean water and sanitation facilities, as well as good hygiene practices, are ensured and sustained for the whole population.”

Speaking with PUNCH Healthwise, a Professor and Consultant Public Health Physician at the University of Ilorin Teaching Hospital, Kwara State, Tanimola Akande said vaccination is one of the cost-effective measures in the control of cholera epidemics.

The effectiveness of vaccination in the containment of cholera, Akande said, varies and depends on the type of cholera vaccine and the characteristics of the target population.

He, however, noted that cholera vaccination alone is not used for the control and prevention of the cholera epidemic but alongside other measures.

Speaking on the measures, Akande, who was at various times Head of the Department of Epidemiology and Community Health, University of Ilorin, Kwara State, said that important preventive measures include access to clean water and good sanitation.

He stated, “Water consumption should be from sources that are not contaminated with cholera, and there should be proper sanitation in the form of proper faecal waste disposal.

“Water sources should not be contaminated. There should also be an adequate surveillance system that can detect cases early and appropriate control measures, including treatment of cases.”

Advising the government and the masses on what should be done, Akande, who is also a vaccine expert, said, “The governments at all levels need to intensify efforts towards zero tolerance for open defecation.

“All buildings should have functional toilets or ventilated improved pit latrines. Also, the supply of potable water in all communities is essential.”

He added that the government will also need to intensify health education that promotes personal hygiene, insisting that food hygiene needs to be strengthened as well.

Also speaking, a Consultant Gynaecologist and Obstetrician at the Epe General Hospital, Epe, Lagos, Dr Cynthia Okafor, called for the total eradication of open defecation practice, saying that such practice is a risk factor that can worsen the situation.

She called on mothers to be vigilant, monitor their children and to seek immediate intervention in case they show any symptoms of cholera.

On the treatment of cholera, she said that there are currently three WHO pre-qualified oral cholera vaccines – Dukoral, Shanchol, and Euvichol-Plus, saying that all three vaccines require two doses for full protection.

According to her, dukoral is administered with a buffer solution that requires 150 ml of clean water for adults, which can be given to all individuals over the age of two years.

Okafor noted that there must be a minimum of seven days, and no more than six weeks, delay between each dose, emphasising that children aged two to five years require a third dose.

She noted that dukoral is mainly used for travellers, saying that two doses of it offer protection against cholera for two years.

“There are other ones called shanchol and euvichol-plus. They have the same vaccine formula but are produced by two different manufacturers. They do not require a buffer solution for administration.

“They are given to all individuals over the age of one year and there has to be a minimum of two weeks delay between each dose of these two vaccines. Two doses of Shanchol and Euvichol-Plus protect against cholera for at least three years, while one dose provides short-term protection,” she further explained.

Okafor, however, said vaccination should not disrupt the provision of other high-priority health interventions to control or prevent cholera outbreaks.