Interagency diarrhoeal disease kits - information note

For 100 severe cholera cases (cholera treatment unit), plus 400 moderate cholera cases (oral rehydration unit), and 100 adults plus 100 children affected by Shigella dysentery.

February 2009

Background

For several years "cholera kits", each composed differently, were used by the agencies working in crisis situations. The content of the kits therefore varied from one to another. At field level, during diarrhoeal diseases outbreaks, this variety of kits could create confusion among the health and logistic staff. In an effort to provide clarity and cooperation, the current Interagency Diarrhoeal Disease Kit has now been agreed upon by the major agencies working in crisis situations.

Structure and content

The kit contains four separate modules. For preparedness, we advise ordering a full kit, although each module can also be ordered separately, according to the local availability of the different components.

The full kit provides treatment for:

  • 100 severe cases of cholera in a cholera treatment centre (CTC) taking into account that patients with severe dehydration need IV fluids and antibiotics at the beginning of the treatment and oral rehydration salts (ORS) during the recovery phase. The drugs consist of: IV fluids for 100 severe adult cases, and antibiotics for 65 adults and 60 children.
  • 400 mild or moderate cases of cholera in an oral rehydration unit (ORU).
  • 100 adults and 100 children affected by Shigella dysentery.

Note:

  • This kit does NOT include sprayers for disinfection and chlorine.
  • This kit does NOT contain the material to physically set up a CTC and equip the staff.

Breakdown per module

Basic module:
  • Drugs
    • ORS, as well as Ringer Lactate for ten severe cases only (with an average of eight litres per patient)
    • Cholera: Doxycycline (65 adults), Erythromycin (60 children); zinc tablets (250 children)
    • Shigella: Ciprofloxacin (100 adults and 100 children); zinc tablets (100 children)
    • Disinfectant.
  • Renewable supplies, including culture swabs
  • Equipment
  • Documents on diarrhoeal disease management in emergencies.
ORS module:
  • ORS for 400 cholera patients with no - or with moderate - dehydration. This material covers the needs for two ORUs.
Infusion module:
  • Ringer Lactate with IV giving sets for 90 severe cholera cases (with an average of eight litres per patient)
  • In case of local purchase infusion AND giving set have to be ordered.
Support module:
  • Non-medical items necessary for running a cholera treatment centre (CTC).

Logistics summary


Weight (kg) Volume (m3) Price (EUR)
Basic module 744 2.55 2319
ORS module 78 0.20 281
Infusion module 850 1.50 886
Support module 140 1.60 691
Total: Full kit 1812 5.85 4177
  • The shelf life of all components of the kit is of a minimum of three years, except for culture swabs with Cary Blair; no cold chain is required.
  • Soap can usually be purchased on the local market: one bar of soap (100 g) per patient should be foreseen.
  • The full inventory list can be found in annex.

Essential definitions and information for planning purposes

WHO case definition for cholera
  • In an area where the disease is not known to be present, a patient aged 5 years or more develops severe dehydration or dies from acute watery diarrhoea.
  • In an area where there is a cholera epidemic, a patient aged 5 years or more develops acute watery diarrhoea, with or without vomiting.
WHO case definition for shigella dysentery
  • Diarrhoea with visible blood in the stool.
Attack rate
  • AR = ((total number of cases)/(population)) x 100
  • AR varies according to different situations, i.e. for cholera
  • High risk populations (e.g. refugee camps with malnutrition): 5-8%
  • Endemic areas (open settings): 0.2%
Rationale for "Infusion" and "ORS" modules

The proportion of severe cases among cholera patients is 20%: out of 500 cholera patients, 100 are severe cases who need IV treatment in a CTC. The remaining 400 patients are mild or moderate cases and are treated as outpatients in an ORU.

This kit does not contain any supplies for bacteriology except culture swabs. A specific enteric disease bacteriology kit has been developed and should be ordered separately, provided there is a laboratory with existing capacities to use the supplies efficiently. The enteric disease bacteriology kit contains material for collection and transport of stool samples and laboratory reagents for diagnosis of outbreak-prone enteric pathogens. Delivery time for the entire disease bacteriology kit is approximately 6 weeks. Furthermore, a new immunochromatographic dipstick test for the diagnosis of cholera, to be used in field conditions, is now available on the market.

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