Prevention of cholera

In the absence of explicit threat of introduction of cholera decisive role belongs to the activities regulated by instructions and rules on sanitary protection of territories (see) of import and spread of quarantine and other infectious diseases. Are also important obsecenities activities: protection of sources of water supply, sanitary supervision of the preparation, storage and sale of food products at enterprises of public catering, fighting flies, removal and disposal of sewage and garbage, instilling sanitary skills to the population.
In a number of organizational activities include: developing a comprehensive plan in case of introduction of cholera, training of health workers, medical and sanitary-epidemiological institutions, familiarizing them with the diagnosis, treatment and measures of struggle with cholera.
Attention should be given to equip sanitary-bacteriological laboratories taking into account the need bulk of research, training premises and transport for hospitalization of patients with cholera, diarrhoeal diseases and persons associated with them, the creation of a stock of medicines, bacterial preparations and disinfectants.
When you use explicit threat of introduction of cholera from neighbouring countries, all of these activities should be conducted with great severity, especially in the areas bordering with disadvantaged by cholera States. Critically important, as is the timely identification of patients with gastrointestinal diseases and polls makeshift hospital admission with their subsequent bacteriological examination. The dead bodies of suspected cholera disease, are subject to opening and bacteriological research. You should check the readiness of all parts of the medical institutions and establishments of sanitary-epidemiological service.
Special attention should be paid to the protection of water sources, control over the content of residual chlorine in tap water (not less than 0.2-0.3 mg per 1 l in the peripheral network), bacteriological examination of water running water, open reservoirs, rivers, and especially in those cases when the latter originate abroad. In some cases shown vaccination of the population.
After bringing the cholera on this or that territory deploy a complex of anti-epidemic measures, including measures for the early detection and hospitalization of patients and vibrionaceae, and persons who come into contact with them, break ways and factors of transfer and the creation of immunity of the population to infection. In some cases, to the disadvantaged by cholera settlements impose quarantine (see).
Activities in respect of the sources of infection in the system of measures of struggle with cholera play a leading role. Given the polymorphism of clinical manifestations with cholera, it is important to ensure early, active (by household crawls) identify not only clearly cholera patients, but also patients with any acute intestinal diseases. These people put (pharmaceutical hospitalization) in special hospitals or departments, isolated from hospitals for patients with established disease. For persons having contact with patients, create insulators that carry out health surveillance, bacteriological examination and emergency prevention. Persons traveling outside of the hearth (disadvantaged by cholera town), previously sent to observator for a period of maximum incubation period (6 days)during which they are subjected to bacteriological examination and emergency prevention (see Observation).
In the mentioned institutions, strict anti-epidemic regime, excluding the possibility of nosocomial infection and removal of infection outside the institutions or hearth. Transport of patients and persons associated with them, by special machines, exposed disinfected after each flight.
An important measure is an emergency prophylaxis with antibiotics prescribed to individuals at risk of infection (persons having contact with sick or fibrinoliticeski in the hearth or had contact with infected objects in the external environment, the personnel involved in the cholera outbreak, and others).
Great importance of sanitary-hygienic measures aimed to break the mechanism of transmission of infectious origin. Cleaning the territory of the settlement, removal and disposal of sewage and garbage, protection of waters from pollution by sewage, fighting flies allow you to restrict garagemate population. Avoid water outbreaks of cholera reinforce control over the water, enter giperplazirovannah and more frequent than usual, bacteriological examination of water and determination of residual chlorine at various points of the water supply network. For people who use under normal conditions, the water of open reservoirs, will get disinfected water. In schools, at enterprises, hostels provide uninterrupted round-the-clock supply boiled water. At the enterprises of public catering important strict sanitary-and-hygienic mode, excluding the possibility of infection. Children in institutions appropriate to transfer to year-round stay.
Vaccination in General complex of anti-epidemic measures plays an auxiliary role. The currently applied killed vaccine does not provide a significant reduction of morbidity. According to the Committee on international quarantine who (1965), cholera vaccines when parenteral introduction protect not more than 50% of vaccinated, and for a limited period. Still unresolved is the issue of effectiveness with outbreaks of cholera El tor vaccine, prepared from classical cholera vibrios. When examining the effectiveness of vaccines derived from classical and strains of Vibrio El tor, the Philippines, in areas prone to cholera El tor, it is established that a single injection of the vaccine protects in the first 2 months. after immunization about 50% of vaccinated. The duration of immunity, established vaccine El tor, did not exceed 6 months. The vaccine from classical strains of Vibrio cholerae created immunity for 3-4 months.
With the purpose of increasing intensity and duration of immunity in most countries it is considered expedient to introduce the vaccine two - and even three times. However, the re-introduction of the vaccine does not guarantee against the disease.
Known cases of cholera people, received on 8 vaccinations for 6 months.
Currently studying the possibility of oral method of immunization.
On the role of bacteriophage (see) as a means of prevention have different opinions.
When bacteriophage, prepared by the method of A. G. Nikonov, during the outbreak of cholera in Eastern Pakistan (1958) and Afghanistan (1960) received prophylactic effect. However, there is evidence of low efficiency of the drug.