A cholera outbreak, which has resulted in a number of deaths and hospitalisations, has been reported in certain regions of South Africa. Here's what you need to know about cholera, how to limit your exposure and prevent further spread of the disease.

The National Department of Health has urged the public to take precautionary measures and maintain proper hand hygiene in the wake of an outbreak of diarrhoeal disease, and the rising number of laboratory-confirmed cases of cholera.

What is cholera?

Cholera is an acute diarrhoeal infection caused by ingestion of food or water that has been contaminated with the bacterium Vibrio cholerae. The bacteria affects both children and adults causing severe diarrhoea and dehydration and, if left untreated, can lead to death.

How does cholera spread?

Cholera is contracted when individuals drink water or eat food containing cholera bacteria. The bacteria can spread from an infected person if they handle food without washing their hands first or if they relieve themselves into a water source. Drinking unclean water or using it to wash food or other items also puts people at risk of infection. Hand hygiene and food safety are therefore extremely important in preventing the spread of cholera.

Cholera outbreaks are usually linked to inadequate sanitation and poor water quality, usually in developing countries and very often as a result of humanitarian crises.

Here's where to find credible information on cholera:

• Access updates on the cholera outbreak (see Media Alerts) and also general information on the disease through the National Institute for Communicable Diseases (NICD).
• Also access the NICD's FAQ on Cholera.
• See the National Department of Health's twitter feed.

Contaminated water key to cholera's spread

The NICD tells us that water contaminated with human faeces is the main way cholera spreads, either directly (through drinking contaminated water) or indirectly (through eating contaminated food).

Also, some individuals who are exposed to the cholera bacterium don't become ill and so don't know they've been infected. But because they shed cholera bacteria in their faeces for seven to 14 days, they can still infect others through contaminated water.

Food can become contaminated when it comes into contact with contaminated water. Dirty hands can also contaminate clean drinking water and food.

How to protect against cholera infection

1. Avoid known or suspected contaminated food, water and surfaces.
2. Wash hands thoroughly with soap and clean water before handling food or after using the bathroom.
3. Never drink water from unsafe sources such as rivers, dams, streams, unless boiled or disinfected first.
4. Water should be clean and safe to use: If you suspect that the water you are using or drinking is not clean then treat or sterilise it before use (methods listed below).

Cholera symptoms

According to the NICD it can take anything from a few hours to two to five days (usually two to three days) from when a person comes into contact with cholera-contaminated water or food, to when they first exhibit symptoms of illness.

• People generally become sick around 12 to 48 hours after exposure to the bacteria that causes the disease.
• Most people who are infected with cholera experience very mild illness with mild diarrhoea or they may not feel sick at all.

In more serious cases people experience a sudden onset of illness with:

• Severe diarrhoea - which is painless and watery, with flecks of mucus.
• Vomiting, usually early in the illness.
• Fever, mostly in children.
• Dehydration - which happens fast, and if untreated can be fatal.

How to protect against cholera or other bugs that may cause diarrhoeal illness

This information comes from the Gauteng Department of Health (adapted):

Water

If you are concerned about the water quality, treat the water like this:

• Boil it - pour out the water into a clean container and bring it to a boil for one minute.
• Or treat it with household bleach:
  • Add 1 teaspoon of household bleach (containing 3 to 5% chlorine concentration) to 20 litres of water, mix well and leave it to stand for at least 30 minutes before you use it.
  • The same applies to larger quantities - add 1 tablespoon of household bleach to 25 litres of water.
• Water should be stored covered, in clean containers.
• Contaminated food can also be a source of cholera infection, so make sure you wash food with clean, safe water and pay attention to food safety. Don't eat the food if you are worried about the source or how clean it may be.

Hands

Wash your hands with soap and water in the following instances:

• Before, during making and after you make food.
• Before and after you eat.
• Before and after feeding children.
• After you use the toilet or clean your child when they use the toilet.
• After taking care of someone who has diarrhoea.

Food

Wash your hands with soap and water before you begin cooking, and:

• Always cook food well and keep it covered afterwards.
• Peel your fruits and vegetables and avoid raw fruit and vegetables that you can't peel (peeling gets rid of any bugs on the skin). Ensure that food is very well cooked - especially fish or seafood.

Surfaces

• Always clean and disinfect surfaces regularly, especially in areas used for food preparation.
• Clean kitchenware with soap and clean water.
• Clean and disinfect toilets and areas that have been contaminated with faeces, with soap and clean water.
• Safely get rid of soapy water and dirty cleaning cloths.
• Wash your hands again with soap and water after you clean and disinfect surfaces.
• If you don't have soap and water use an alcohol based hand sanitiser with at least 60% alcohol.

Going to the toilet

• Use toilet facilities that are cleaned regularly and safely managed.
• Wash hands with soap and water after using the toilet.
• If you can't access a toilet, do not go to the toilet close to a body of water (make sure you are at least 30  meters away and bury the faeces).

Cholera treatment

Dehydration can happen extremely quickly, so rehydration is fundamental to avoid severe illness or death.

Most cases of cholera are mild and can be managed at home with fluids. Relatively or severely ill individuals should be admitted to hospital for intravenous fluid rehydration. Antibiotics may be prescribed for those who become extremely dehydrated.

• How do you make your own oral rehydration solution

The Department of Health advises that an oral rehydration solution can be made by boiling one litre of water and adding eight teaspoons of sugar and half a teaspoon of salt and mixing it well.

We are paying close attention to the cholera outbreak

At present, our records show that no Bankmed members have been admitted to hospital for a potential cholera diagnosis.

Where people contract a diarrhoeal illness and require treatment at home, they can access cover from their day-to-day benefits. Treatment for Scheme members who are admitted to hospital is covered from the risk benefits.