Cholera

Suspect cholera in children over 2 years old who have acute watery diarrhoea and signs of severe dehydration. Cholera outbreaks are particularly seen in the rainy season. Cholera classically causes profuse diarrhoea (rice-water stool) with a characteristic odour and vomiting. It leads rapidly to severe dehydration and patients may be shocked.

For all children with suspected cholera

• Assess and treat dehydration and shock with either PLAN A, B or C Acute Gastroenteritis. Children with cholera often need large amounts of IV fluids. Several litres is not unusual.
• Give Azithromycin 20 mg/kg (max 1g) single dose or Erythromycin 12.5mg/kg qds for 3 days to shorten disease and reduce infectivity
• Guardian advice
1. Give accurate directions regarding volumes of ORS to give.
2. Advise about sanitation precautions.
3. Treat the guardian with Doxycycline 300mg stat.
4. Complete a case-based surveillance reporting form or inform nurse in charge of reporting cases

When there is a Cholera Outbreak (with a laboratory confirmed index case)

• All suspected cases should be managed in the health centres
• Admission or Attendance in Hospital should be avoided as far as possible
• If you see a child with suspected cholera
1. Manage as detailed above
2. See in isolation room in A+E
3. After stabilization transport should be arranged back to Health Centre
4. Details of the DHO designated driver can be found in Room 6 of adult OPD
5. Complete a case-based surveillance reporting form or report to nurse in charge of this
6. Out of hours transport back to health centre may be difficult
• Isolate
• Transport to health centre as soon as possible

When there is no confirmed cholera outbreak

• If you see a child with suspected cholera
• Manage as detailed above but also send a stool sample for culture (special bottle)