Cholera outbreak management — DTM&H MCQ

Correct answer: E — Rapid establishment of oral rehydration therapy centres

The correct answer is E, rapid establishment of oral rehydration therapy centres. Cholera kills through rapid fluid and electrolyte loss leading to hypovolaemic shock, with death possible within hours if untreated. The single intervention proven to cut case fatality from the 4% seen here to the WHO target of below 1% is prompt, accessible rehydration, since outbreak deaths chiefly reflect delayed or absent access to treatment rather than lack of prevention. WHO states the case fatality rate in treatment centres should remain below 1% and that community access to oral rehydration solution is essential during an outbreak. Establishing ORT centres near affected populations shortens time to rehydration, the decisive survival factor, ahead of any upstream preventive measure. Why the other options are wrong: B. Mass antibiotic prophylaxis with doxycycline: antibiotics shorten diarrhoea duration and shedding once patients are already being rehydrated, but they do not correct dehydration itself, and mass prophylaxis risks resistance without lowering CFR. D. Water chlorination at household level: a WASH measure that reduces future infections but has no effect on the fatality of cases already ill, so it cannot rapidly correct an existing 4% mortality figure. C. Oral cholera vaccine campaign: OCV takes days to weeks to generate protective immunity and is preventive rather than curative, so it cannot reduce deaths among current cases in an ongoing outbreak. A. Isolation of all suspected cases: cholera transmits via the faecal-oral route through contaminated water and food, not primarily by droplet or close contact, so isolation does not address the fatality driver and diverts resources from treatment provision. Key point: when outbreak CFR exceeds the WHO 1% threshold, the priority is always to fix speed and access of rehydration treatment, not upstream prevention or transmission control.

Reference: WHO Fact Sheet: Cholera (updated December 2024), https://www.who.int/news-room/fact-sheets/detail/cholera