A total of 44 laboratory-confirmed cases of cholera have been seen at Jubilee District Hospital, the Gauteng health department said in an update on the outbreak in the Hammanskraal area.

By 6pm on Thursday, 203 patients had been seen at the hospital, including 22 patients who have been transferred to other health facilities in Tshwane.

There are 74 patients admitted for treatment due to gastrointestinal infection.

On Thursday, the Free State reported its first cholera death while Gauteng fatalities rose to 21.

Cholera is an acute diarrhoeal infection characterised, in its severe form, by extreme watery diarrhoea and potentially fatal dehydration. Most cholera infections are, however, asymptomatic or mild.

Contaminated water or food are the main drivers of infection, but person-to-person transmission is a contributor.

Drinking water that has been contaminated at its source or during storage can result in infections.

Foods and vegetables exposed to fertiliser or water that contains human excretions can also cause infections.

How to protect yourself

Drinking and cooking with good quality water and good hygiene practices prevent cholera. These are guidelines from the national health department:

• The simplest and most cost-effective method is chlorination of water in a storage container using household bleach. Add one teaspoon (5ml, or one cap full if bottle has a screw cap) of household bleach to 20 to 25 litres of water, thoroughly mix solution with water and allow to stand for at least two hours or overnight.
• In an outbreak situation, boiling is also effective in prevention, but there is a potential for microbial regrowth if the boiled water is stored beyond one or two days. Filtration may be necessary in addition to boiling water by using a piece of clean white cloth to cover the opening of a 20 or 25 litre water container. Pour water through the clean cloth into the container. Clean the cloth and make sure it is always clean for future use.
• Wash hands with soap and clean water before preparing and eating food, and after going to the toilet. Wash all surfaces and equipment used for food preparation with soap and clean water.
• Cook food thoroughly. Avoid uncooked food, especially shellfish and meat. Eat food while it is still hot.
• Wash and peel all fruit and vegetables before eating, especially when eaten raw.

Seek medical care immediately when symptoms present and use an oral rehydration solution or correction fluid to avoid dehydration.

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