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CARIBBEAN EPIDEMIOLOGY CENTRE
(CAREC/PAHO/WHO)
16-18 Jamaica Boulevard, Federation Park
P.O. Box 164, Port of Spain Republic of Trinidad and Tobago
Tel: 1 (868) 622-4261, Fax: 001 (868) 622-2792
CAREC CHOLERA Guidelines
November 19, 2010
Given
the current risk of the introduction of cholera into Caribbean
countries, guidelines for preparedness for the possible introduction of
cholera and response to the introduction of cases are as follows:
- Strengthen
surveillance for gastroenteritis, including increasing awareness of and
index of suspicion for cholera among health care providers
- Promotion
of good hygiene measures (hand washing, etc) for disease prevention and
control among the general public and health care providers
- Response
plans (including the identification of appropriate location(s) for the
treatment of cholera cases) for public health emergencies must be ready
for implementation if necessary
- Ensure
there are sufficient supplies for response to the possible introduction
of cholera cases, including stocks of Oral Rehydration Salts,
Antibiotics and IV Fluids (See attached documents on cholera infection
control and clinical management)
- Laboratories should ensure the availability of Cary Blair media for appropriate storage of stool specimens from suspected cases
- Should a suspected case of cholera be detected:
- A
case investigation should be done and an investigation form should be
completed (See attached Cholera chapter of the Caribbean Communicable
Disease Surveillance Manual for Public Health Action)
- A specimen should be collected and tested as outlined in point 7 below
- Appropriate
treatment should be administered using proper infection control (See
attached documents on cholera infection control and clinical
management)
- Contacts should be followed-up and monitored
Please note the following case definitions:
Clinical case definition:
(i)
in areas where the disease is not yet present, severe dehydration or
death from acute watery diarrhoea in patients aged 5 years or more or
(ii)in
areas where there is a cholera epidemic, acute watery diarrhea, with or
without vomiting in patients aged 5 years or more.
Case classification:
- Suspected case: clinically compatible disease
- Confirmed case: suspected case confirmed by laboratory.
Source for this case definition is the PAHO Epi Alert for Cholera release of 24 Oct 2010, available at:
http://new.paho.org/hq/index2.php?option=com_docman&task=doc_view&gid=10640&Itemid=1091
Please
note, that while the case definition refers to cases aged 5 years or
more, as part of your enhanced surveillance activities, a high index of
suspicion should be maintained for cases of all ages.
7. For stool specimen obtained from a suspected case –
- Send
an aliquot stored in Cary Blair media to CAREC for testing as outlined
in guidelines previously received (CAREC specimen collection and
shipping protocol attached)
- Perform routine Bacteriology work-up and submit the results to CAREC
OR
- For
laboratories which are able to perform isolation of Vibrio sp., send
the isolate to CAREC for further characterization as outlined in
guidelines previously received (See attached CAREC specimen collection
and shipping protocol)
- All
specimens sent to CAREC must be accompanied by the appropriately
completed CAREC Laboratory Investigation Form (See attached form)
8. Measures such as quarantine and embargo of merchandise are ineffective and unnecessary in controlling the spread of cholera.
9.
Should further guidance or assistance be required, CAREC can be reached
on either of the emergency numbers, which are available 24/7:
- For general technical assistance: 868-463-5857
- For laboratory specific issues: 868-782-2786
During office hours CAREC can be reached at the usual numbers: 868-622-4261 / 4262
Attachments
Laboratory Investigation Form
Specimen Collection and Shipping Protocol for Suspected Cholera Stool and Isolate Specimens
CAREC Surveillance Manual - Cholera Section
Infection control precautions in Cholera outbreaks
Recommendations for cholera clinical management
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