The resurgence of cholera, despite being preventable and treatable, remains a significant global health threat, particularly highlighted by the 4,000 deaths in 2023, as noted by WHO Director-General Tedros Adhanom Ghebreyesus. Read here to learn more.
The global cholera burden worsened between 2022 and 2024, with the WHO reporting significant increases in both cases and deaths across various regions.
22 countries reported active outbreaks and 2,400 deaths had been recorded globally by August 2024.
Resurgence of Cholera
Several critical issues need to be addressed to manage this resurgence effectively:
Infrastructure and Sanitation
- Poor water, sanitation, and hygiene infrastructure are major factors contributing to cholera outbreaks.
- Regions with inadequate access to clean drinking water and sanitation systems are particularly vulnerable, as it is often spread through contaminated water.
- Investment in robust water and sanitation infrastructure, particularly in high-risk regions, is crucial. This includes developing safe drinking water supplies, sanitation facilities, and public education on hygiene practices.
Vaccination Campaigns
- Oral cholera vaccines (OCVs) are effective in controlling outbreaks, but access to vaccines remains uneven, especially in areas prone to conflict or political instability.
- Expanding vaccine coverage in cholera-endemic areas and during outbreaks is critical. The WHO’s stockpile of OCVs could be more efficiently distributed if there is better coordination between international organizations and local governments.
Timely and Adequate Medical Response
- While the disease is easily treatable with oral rehydration salts (ORS) and, in severe cases, intravenous fluids, access to healthcare remains limited in many affected regions. Rapid identification and treatment are essential to prevent deaths.
- Strengthening healthcare systems in vulnerable regions, ensuring that healthcare workers are adequately trained to handle cholera outbreaks, and improving the supply chains for ORS and other necessary treatments.
Climate Change
- Increasingly frequent extreme weather events, such as floods and droughts, are exacerbating conditions that lead to outbreaks.
- Warmer temperatures, particularly in coastal areas, create environments conducive to the growth of Vibrio cholerae, the bacterium that causes cholera.
- A global climate strategy that includes health considerations, such as preparing for and mitigating the impact of climate-related disasters, can help reduce the spread of the disease.
Public Awareness and Education
- Panic and misinformation can worsen the impact of cholera outbreaks. Community-level education about how to prevent and manage cholera can make a significant difference in controlling the disease’s spread.
- Governments and health organizations should focus on public education campaigns, teaching communities about the importance of hygiene, safe water, and early treatment.
Political Instability and Conflict
- The outbreaks often coincide with regions facing political instability and conflict, which hampers both prevention efforts and access to medical care.
- International agencies and local governments must collaborate to ensure access to healthcare even in conflict zones. Creating protected humanitarian corridors for aid workers can ensure the delivery of essential services.
What is Cholera?
It is a life-threatening, acute diarrheal infection caused by the bacterium Vibrio cholerae.
- The disease is characterized by severe watery diarrhoea, which can lead to dehydration and death if untreated.
- Cholera primarily affects impoverished areas with poor sanitation and inadequate access to clean drinking water.
Causes of Cholera
- Bacterium: It is caused by Vibrio cholerae, which is typically found in water or food that has been contaminated by faecal matter.
- Transmission: The bacteria are usually spread through contaminated drinking water or food, often in regions without proper sanitation or water treatment systems. Person-to-person transmission is rare but can occur through direct contact with contaminated sources.
- Conditions for Outbreak: Natural disasters, wars, and refugee crises often exacerbate the risk of outbreaks by damaging infrastructure, water systems, and sanitation facilities.
History of Cholera
The disease has a long history, with recorded outbreaks dating back to ancient times, but its modern history is marked by several devastating pandemics.
- First Cholera Pandemic (1817-1824): The first pandemic began in the Bengal region of India and spread to Southeast Asia, the Middle East, and East Africa. It was primarily driven by trade and colonial expansion.
- Subsequent Pandemics: Over the 19th century, six major cholera pandemics spread globally. These pandemics wreaked havoc in Europe, particularly in London, where the connection between water supply contamination and cholera was first clearly understood.
- John Snow’s Discovery (1854): During the third pandemic in London, Dr John Snow made a landmark discovery by tracing an outbreak to a contaminated water pump in Soho, which laid the groundwork for modern epidemiology and waterborne disease prevention.
- Seventh Pandemic (1961-present): The current pandemic started in Indonesia and is caused by a strain known as El Tor. It has spread across many regions and is still active in parts of Africa and South Asia.
Modern Issues Related to Cholera
Despite significant advances in medical science and public health infrastructure, the disease remains a major public health issue in several parts of the world, particularly in regions with poor access to clean water and sanitation.
- Global Burden: The disease continues to be a threat in many developing countries, especially in sub-Saharan Africa, South Asia, and parts of the Middle East. According to the World Health Organization (WHO), there are approximately 1.3 to 4 million cases of the disease each year, leading to 21,000 to 143,000 deaths globally.
- Urbanization and Slums: Rapid urbanization, particularly in developing countries, has created densely populated urban slums with inadequate sanitation, which are hotspots for outbreaks.
- Natural Disasters and Conflicts: The destruction of infrastructure due to earthquakes, floods, and wars increases the risk of the disease. For instance, the devastating outbreak in Haiti after the 2010 earthquake was linked to contaminated water sources exacerbated by the breakdown of sanitation facilities.
- Climate Change: Rising global temperatures and more frequent flooding events have been linked to increased outbreaks. Warming waters may facilitate the spread of Vibrio cholerae, especially in coastal regions.
- Vaccination: There are oral cholera vaccines (OCVs) available, such as Dukoral and Shanchol, that have proven effective in preventing outbreaks. However, vaccination coverage remains low in high-risk regions due to logistical challenges, and vaccination alone is not enough to prevent outbreaks without improvements in sanitation and water access.
- Antibiotic Resistance: There is growing concern over the antibiotic resistance of Vibrio cholerae strains, which complicates treatment options. This resistance highlights the need for better antimicrobial stewardship and continued research into new treatment methods.
Key Steps in Cholera Prevention and Control
- Water, Sanitation, and Hygiene (WASH): Improving access to clean water and proper sanitation is the most effective method of disease prevention. Public health initiatives must focus on water treatment, sewage management, and hygiene education.
- Surveillance: Early detection and rapid response to outbreaks can help prevent their spread. Many countries are adopting modern disease surveillance systems, including mobile apps for real-time reporting.
- Oral Rehydration Solutions (ORS): The use of ORS is a life-saving intervention for treating dehydration caused by the disease. WHO recommends widespread use of ORS in cholera-prone areas to reduce mortality.
- Vaccines: Currently there are 3 pre-qualified Oral Cholera Vaccines (OCV)- Dukoral, Shanchol, and Euvichol-Plus. All three vaccines require two doses for full protection.
Conclusion
Cholera remains a significant public health challenge in the 21st century, especially in regions affected by poor sanitation, natural disasters, and conflict.
While vaccines and rehydration therapies have reduced death rates, improving water quality and sanitation infrastructure is crucial to eradicating the disease in the long term.
Ongoing global efforts continue to focus on these preventive measures to mitigate the devastating effects of the disease worldwide.
A multi-faceted approach that includes improving infrastructure, expanding vaccination efforts, ensuring timely healthcare, addressing climate change, and increasing public education is necessary to manage and prevent outbreaks.
International coordination and robust political will are essential in combating the resurgence of this easily preventable and treatable disease.
By addressing these critical areas, global efforts can drastically reduce cholera-related deaths and work towards the ultimate goal of cholera elimination.
Frequently Asked Questions (FAQs)
Q. How is the cholera disease transmitted?
Ans: It is spread by eating or drinking food or water contaminated by the faeces of an infected person. This occurs more often in underdeveloped countries lacking proper water supplies and sewage disposal. It is not likely that cholera is spread directly from one person to another.
Q. Is cholera treatable?
Ans: It is highly treatable, but because dehydration can happen quickly, it’s important to get cholera treatment right away.
Q. What are the three stages of cholera?
Ans: The stage of inflammation (2 to 12 hours after the onset of disease) is followed by the second stage, that of fusion of villi, ” resulting in a tremendous decrease of surface area “. The third stage, that of villus repair, is, so far, theoretical and is thought to take place more than 7 days after the onset of the disease.
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-Article by Swathi Satish
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