Cholera in young children in an endemic area [letter]

WHOs manual for treatment of diarrhea states that Cholera should be suspected when acute watery diarrhea causes severe dehydration in a child above 2 years of age (it occurs infrequently below this age) or in an adult in an area where cholera is known to be present. To ascertain the validity of this recommendation for children aged up to 2 years in a cholera endemic area we investigated between March and July 1992 181 children. 56 (30.9%) had bacteriologically confirmed cholera while the remaining 125 had non-cholera diarrhea. Among cholera children both sexes were equally affected. Severe dehydration occurred more in cholera cases than in non-cholera cases (35.7% vs. 8%). The average duration of predominant breast feeding was similar in the 2 groups (4.7 vs. 4.4 months since birth). Children with poor nutritional status had an increased risk of having cholera as well as non-cholera diarrhea. Isolation of Vibrio cholerae increased with increasing age as well as with poor nutritional status (table). The youngest child with cholera was aged 60 days. Oral rehydration therapy alone was effective in treating 34 children with cholera with no or some dehydration and 115 children with non-cholera diarrhea with similar dehydration. 2 children with cholera initially on oral rehydration developed severe dehydration because of severe purging and vomiting and required intravenous Ringers lactate in addition to the 30 children (including 20 cholera cases) who had severe dehydration. Furazolidone was also administered for the severely dehydrated cases. None of the children died and the hospital stay was on average 48 hours. This study establishes that in a cholera endemic area about 1/3 of the admitted children up to the age of 2 years could have cholera and even children below the age of 6 months are not spared despite the fact that the average duration of predominant breast feeding was about 4.7 months since birth. Additionally children with poor nutritional status run a high risk of having cholera. From this hospital-based study it appears that cholera occurs frequently in children aged below 2 years in a cholera endemic area and cholera should be suspected even in this age group. (full text) (2 references cited in original document)