Contaminated water and food are the main sources of transmission of the bacterium Vibro Cholerae, and a lot can be done to keep the transmission at a minimum. The measures include ensuring a safe water supply; improving sanitation; health education through all media; thorough cooking of high-risk foods especially seafood before consumption. Important messages such as the importance of purifying water, washing of the hands after defecation before and after food preparation, and recognition of the signs of cholera, are passed through the media during outbreaks The long-term prevention of cholera will require improved water and sanitation facilities, but these improvements are limited in areas where cholera is endemic.

Data and Surveillance Systems

Creating a data and surveillance system with prompt reporting contributes to the rapid containment of cholera epidemics. In Nigeria where cholera is a seasonal disease, especially during the rainy season, surveillance systems can provide an early alert to outbreaks, leading to coordinated response and plan.

Multisectoral Approach

This approach is paramount to efficiently controlling a cholera outbreak. Sectors such as health, water and sanitation, agriculture, communication/information, and education are key sectors that need representation when formulating a cholera containment committee. They play vital roles in educating the public on outbreaks and controls.

Water Supply and Sanitation

As widely known, cholera is usually transmitted through contaminated water or food. This is the reason why outbreaks can occur sporadically in any part of the world where public water supply; public sanitation, are inadequate.

• Public Water Supply: Improvements in the public water supply are one of the best approaches for protecting against cholera and other waterborne epidemics, yet it is unrealistic for many impoverished populations most affected by cholera. Water gotten from public supply should be properly treated with chlorine or boiled before use.
• Public Sanitation: Individuals need to make sure that their environments are also tidied up (cleaned) every time, making sure that there is no room for still water around their environment. For persons who do not have access to a portable toilet, it is important using latrines or burying your feces is better than defecting into open grounds, springs, streams, or rivers. Also, it is quite important to clean latrines and their surfaces with disinfectant.

Household disinfectant or bleach solution should be used to clean areas that may have contact with fecal matter, especially from persons with diarrhea.

Personal Hygiene, Food Preparation, and Health Education

Human behavior related to personal hygiene and food preparation contribute greatly to the occurrence and severity of cholera outbreaks. Health education aimed at behavioral change is an important component of cholera prevention and control.

• Water Hygiene: Safe water includes water that has been treated with chlorine or boiled properly. Make sure water is kept in a clean and safe container. Practice the use of safe water. It is important to note that only safe water can be used to brush one’s teeth, as well as wash and prepare food. Also, keep all kitchen and home utensils clean by washing with soap and safe water, and let dry completely before reuse.
• Food Hygiene: Food needs to be cooked thoroughly and kept properly. Also, it is important to keep our hands washed after using the latrine/toilet before cooking.

Vaccination – Cholera Vaccines

Cholera vaccination is the use of vaccines to protect and also treat people from cholera diseases.  These vaccines are very effective in the prevention of cholera among disease, which is one of the most common communicable diseases in Nigeria, and Africa at large.

During the first six months after cholera vaccination, these vaccines can provide up to 85% protection from the disease, which helps to reduce acute cholera by about 50% - 60% during the first year; then after a two-year continuous intake, the vaccines help to decrease the disease by a further 50%. The moment the people in cholera endemic areas are vaccinated using these vaccines, it is likely to help protect others who are yet to be immunized against cholera (herd immunity).

The World Health Organization (WHO) recommends the use of cholera vaccines in combination with other measures among those at high risk. Oral vaccines are the most common form of vaccine available in protecting people against cholera.

With oral vaccines, two or three doses are typically recommended, and the duration of protection is two years in adults and 6 months in children aged 2 – 5 years. A single dose of this vaccine is available for those who might be traveling to endemic areas where cholera is common. However, since it does not provide 100% immunity from the disease, food hygiene precautions are also recommended when visiting areas where there is a high risk of becoming infected with cholera. Although the protection observed has been described as “moderate”, herd immunity (as explained above) can multiply the effectiveness of these vaccines.

Currently, there are three types of qualified oral vaccines recommended by the World Health Organization (WHO) namely Dukoral, Shanchol, and Euvichol. All these three vaccines require two doses for full protection. Dukoral is administered with a buffer solution that, for adults, requires 150ml of clean water. Dukoral has been licensed for children two years and above.

In administering Dukoral, there must be a minimum of 7 days, and no more than 6 weeks, delay between each dose. Children between the ages of 2 – 5 require a third dose for full protection. Also, two full doses of Dukoral would protect an adult for 2 years against cholera.

Shanchol and Euvichol are essentially the same vaccines 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. There must be a minimum of two weeks delay between each dose of these vaccines. Two doses of Shanchol, as well as Euvichol, protect against cholera for 3 years, while a single dose provides short-term protection.