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Disease Prevention and Control / Communicable Diseases / Cholera

Cholera Outbreak: Assessing the Outbreak Response and Improving Preparedness

(WHO Global Task Force on Cholera Control, 2004)

Cholera Outbreak

WHO E-Book (89 pp, PDF)
Introduction   |   Cholera: general
1. Outbreak detection
Keywords: early detection, rapid verification and response
2. Outbreak confirmation
Keywords: case definition, laboratory confirmation
3. Organization of the response
Keywords: cholera coordination committee, plan of action
4. Management of the information
Keywords: clarifying rumours, partnership with media
5. Case management: treatment
Keywords: assessment of the patient, rehydration, education
6. Reduction of mortality
Keywords: cholera treatment units, supplies, training of professionals
7. Hygiene measures in health-care facilities
Keywords: isolation of patients, disinfection, hand-washing
8. Involvement of the community to limit the spread of the disease
Keywords: health education, appropriate messages-,cultural acceptability
9. Control of the environment: safe water
Keywords: chlorination, water quality testing, boiling water
10. Control of the environment: safe food
Keywords: preparation of food, hygiene in marketplaces, cooked food
11. Control of the environment: sanitation
Keywords: improved sanitation, education on hygiene
12. Funeral practices
Keywords: hygienic handling of corpses, restrictions on feasts
13. Surveillance
Keywords: information for action, descriptive epidemiology
14. Involvement of international partners
Keywords: project proposals, coordination of international partners
1. Tool for evaluation
2. Outline of the assessment report
3. Essential rules in a cholera treatment unit
4. Chlorine dilution according to use
5. Methods for household water treatment
6. Key messages for health education
7. Preparation and use of the 1% chlorine stock solution to disinfect water
8. Rules for safe preparation of food to prevent cholera
9. Matrix for coordination of cholera control activities

PAHO Cholera Page
WHO Cholera Page


Cholera outbreak response generally focuses on medical aspects that are important for lowering mortality. However, a more comprehensive response is needed to limit the spread of the disease. As the outbreak response is often led by medical professionals, other aspects, such as environmental or communication issues, might tend to be neglected.

This document offers a framework for the assessment of a cholera outbreak response, which will help to:

  • provide a comprehensive overview of the outbreak response;
  • pinpoint the main strengths and weaknesses of the response;
  • improve preparedness for and response to future outbreaks; and
  • provide accurate recommendations based on WHO official guidelines.

It is intended primarily for

  • technical staff of ministries of health;
  • health professionals in WHO country offices; and
  • consultants responsible for undertaking a cholera outbreak assessment.

When can it be used?

This document can be used at the end of the outbreak, for retrospective evaluation which is essential to plan for improved prevention and response in the future. Additional tools are given in Appendices 1 and 2 to help with the evaluation report.

The document can also be used during an outbreak to check whether any of the aspects of cholera control has been overlooked.

Structure of the Document

The document contains a general section on cholera, plus 14 technical sections, each with the following format:

  • Keywords: Reflecting the principal topic(s) covered.
  • Assessment of the outbreak: Listing the questions that should be addressed during the evaluation.
  • Useful comments for improved preparedness: Particularly useful if there are recurrent outbreaks of cholera on a seasonal basis (usually in the rainy season).
  • Tips: Highlighting the main issues relating to cholera outbreaks.

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