A legally notifiable disease in Singapore. Notify Ministry of Health (Form MD 131 or electronically via CD-LENS) not later than 24 hours from the time of diagnosis.
Antibiotics shorten the duration of excretion of the V. cholerae bacteria as well as decrease the severity of the diarrhoea. The following regimens have been used:
- Tetracycline 500 mg qds for 3 days
- Doxycycline 300 mg single dose
- Ciprofloxacin 1 gm single oral dose or 250mg oral daily for 3 days
- Norfloxacin 400 mg bd for 3 days
- Pregnant women and children: Single dose oral Azithromycin 25mg/kg up to a maximum of 1g or erythromycin 12.5 mg/kg up to a maximum of 500mg every 6 hours for 3 days (doxycycline and tetracycline are not recommended).
Cholera is spread mainly by contaminated food and water. Only rarely is there person-to-person spread. Persons with asymptomatic infection play a role in transmitting V. cholerae.
Contact precautions must be observed when handling infectious patients, i.e. wearing plastic apron if splash is anticipated and washing of hands before and after handling patients, as well as proper disposal of stools and vomitus and decontamination of instruments after use on patient.
A modified killed whole-cell oral vaccine (containing 01 and 0139 serotypes) showed promise as a safe, effective, and affordable vaccine for endemic regions in a cluster-randomized, double-blind, placebo-controlled phase 3 trial. However, durability of protection is yet to be established.
Three components of public health have largely prevented outbreaks of cholera in Singapore:
- Hygienic disposal of human waste
- An adequate supply of safe drinking water
- Good food hygiene.
In the event of an outbreak:
- All acute cases and carriers will be isolated and treated at the Communicable Disease Centre (CDC) at Tan Tock Seng Hospital.
- Contacts and implicated food handlers with or without diarrhoea will be screened for cholera infection at the CDC.
- Epidemiological investigations will be carried out by the Communicable Diseases Division, MOH to trace the source of infection.
- Closure of implicated food outlets will be initiated if necessary.
- Any outbreak will be notified to the public as well as the WHO.
Two oral cholera vaccines which provide higher level protection (85%) against V. cholerae 01 have recently become available in a few countries. One vaccine contains genetically-engineered live attenuated Vibrio cholerae 01 strain (CVD 103 HgR) and the other contains inactivated Vibrio cholerae 01 plus the B subunit of cholera toxin. The latter (Dukoral, Aventis Pharma) is now registered in Singapore.
The risk of cholera for general travellers is very small. Cholera vaccine for travellers is only indicated for those travelling > 1 month in cholera endemic areas and for refugee/aid workers in countries with cholera.
No vaccine is available against V. cholerae 0139.