About one third of deaths are in children under 5 years of age, one quarter in children 5-14 years, and the remainder in adults. Since 1995 only El Tor has been active in Bangladesh. Marked dehydration causes severe weakness with poor skin turgor, sunken eyes and cheeks. The lips are cyanotic, skin is cold, temperature is subnormal and respiration rapid and shallow, with a tachycardia, and hypotension.
Asymptomatic infection is frequent.
Public health strategies Prevention of cholera and other enteric diseases comprises basic sanitary and hygiene measures including treated water supplies, improving water delivery and sewage control, supplying handwashing facilities, latrines, or boiling water and adequate hygiene in foodhandling. On one hand it is important to continue to support these recommendations because they are efficient when properly applied, but on the other hand it is recognized that, most of the times, they are difficult to be properly implemented. Moreover, these problems are now compounded by the emergence of antibiotics-resistant bacterial strains, which means that efforts to develop effective vaccines, which would be considered as a complementary action, are therefore essential. The original parenteral killed cholera vaccine is no longer recommended. Since then, progress has been made and new oral cholera vaccines are now under consideration for use in public health.