Yemen's Cholera Outbreak
Faced with ongoing violence and humanitarian crises, war-torn Yemen is now experiencing the worst cholera outbreak in the world. As the poorest nation in the Arabian Peninsula, the epidemic is spreading rapidly; however, the U.N. children’s agency (UNICEF) and the World Health Organization (WHO) are working vigilantly to end Yemen’s cholera outbreak.

Cholera, which is spread through contaminated food and water, is a highly contagious bacterial infection. Although cholera is easily treatable, it can prove fatal within hours if left untreated. This is what makes the outbreak in Yemen so dangerous; because of the civil war, treatment can be difficult to find.

In just two months, more than 1,300 people have died in the outbreak, and 25 percent of the casualties are children. UNICEF has reported a suspected 200,000 cases, increasing at a rate of about 5,000 cases a day.

With the armed conflict over the past two years displacing more than 11 percent of Yemen’s population and wounding more than 45,000 people, the outbreak is considered a direct result of the war. Due to the civil war, 14.5 million people have lost access to clean water and sanitation. The impact on children is disproportionate because they are most prone to malnutrition, which makes them even more susceptible to cholera.

But susceptibility is not the only cause of this unprecedented outbreak; the epidemic also is widespread because of a lack of medical access. Most patients have difficulty reaching the few medical facilities within Yemen. Some travel hours to the Sabeen Hospital, which is already overcrowded from those wounded in the war. Of those treating the infected, an estimated 30,000 local health workers have not been paid their salaries in more than 10 months. The limited access to treatment is making Yemen’s cholera outbreak even more severe; humanitarian group Oxfam has called for a ceasefire, but its efforts were unsuccessful.

To slow the outbreak, UNICEF and the WHO are focusing their efforts on accessibility to clean water and sanitation development, as well as medical treatment. Rapid response teams are even going door-to-door to reach families, teaching techniques on storing water and how to protect against the disease.

The largest quantity of emergency oral cholera vaccines—one million doses—was recently approved for use in Yemen. The WHO plans to distribute the vaccine by going house-to-house in priority areas. UNICEF and the WHO have also received a grant of $66.7 million from Saudi Prince Mohammed bin Salman. This donation, according to UNICEF, “will make a great difference to thousands of children at risk of contracting this rapidly spreading disease.”

Although the war-torn nation faces a series of humanitarian crises, the efforts of UNICEF and the WHO against Yemen’s cholera outbreak are proving effective. With increasing funding and the approval of vaccines, the fight against cholera seems optimistic.

Kelly Hayes

Photo: Flickr

An outbreak of cholera in Somalia has resulted in a total of 28,408 cholera cases and 548 deaths thus far. In April 2017 alone, 2,745 cases of cholera were reported in Somalia by the Ministry of Health. From April 10 to 16, 28 cholera-related deaths were reported across 50 districts. The situation has been exacerbated by the worst drought experienced in decades, which has coincided with the cholera outbreak in Somalia.

Cholera is an acute diarrheal disease, which, if left untreated, can lead to death. It is caused by the bacterium Vibro cholerae. Consumption of contaminated food and water is the main cause of the disease. Malnourished children under the age of five are especially vulnerable.

Somalia is in the midst of a severe drought due to poor rainfall and a general lack of water. It has killed livestock and crops, leaving 6.2 of 12.3 million people in need of humanitarian assistance. The drought has greatly worsened the outbreak of cholera in Somalia.

Somalia’s humanitarian crisis is a combination of political conflict, food insecurity, displacement of people and limited health care. More than five million people are at risk of being affected by waterborne diseases, and three million people face food insecurity. The death rate has reached 14.1 percent among Somalis affected with cholera in Middle Juba and 5.1 percent in Bakool. Five hundred thousand Somalians have been internally displaced in search of water.

Dr. Adinnasir Abubakar, a cholera expert for the World Health Organization (WHO) emergencies program noted: “Ever since the drying up of the Shabelle and Juba rivers, people have been forced to move out and seek water in unfamiliar places.” The two rivers are Somalia’s perennial streams.

The Ministry of Health is working with the WHO to respond to this outbreak and implement preventive measures against cholera in Somalia. There have been integrated emergency responses in the Mogadishu, Bay and Gedo regions. Sixty health workers were trained by the Ministry of Health in cholera case management, surveillance, WASH (water, sanitation and hygiene) and risk communications.

The first oral cholera vaccination campaign began on April 18th and is set up to target 450,000 people over one year of age to fight cholera in Somalia. There are warnings by medical staff that the number of ill patients has exceeded hospital capacity in affected regions.

Cholera is a treatable and preventable disease. To prevent cholera deaths in Somalia, oral rehydration, antibiotics and intravenous feeding are needed. Somalia’s cholera outbreak is a wake-up call for the better implementation of water and sanitation infrastructure, promotion of hygiene practices and emergency aid need.

Aishwarya Bansal

Photo: Flickr

A cholera outbreak in Yemen was detected in October of last year. About 500 people have been killed by the outbreak since then. With more and more cases coming into the hospitals, a shortage of doctors, staff and medicine has arisen. With this shortage and increase in the spread, there has been concern for the treatment centers keeping up.

Cholera is a fatal bacterial disease of the small intestine, typically caused by an infected water supply. Yemen is a poor country already and has been in conflict for the past two years, making it vulnerable to an outbreak of this kind. Cholera in Yemen is of great humanitarian concern, especially with respect to its children.

Mothers have discovered their children sick with symptoms of cholera. It is only known that there is nothing to be done but what the treatment facilities must offer. Much like a young boy in Sana’a, Yemen’s capital, who was admitted to the hospitals after having an ill night. The mother soon caught the disease, and they both lay in rooms next to each other in one of the treatment centers. Cases like this are commonplace, but organizations are trying to contain this expanding epidemic.

According to Save the Children, as this disease disrupts children’s lives, its hospice needs continue to grow. With this alarming spread, organizations like UNICEF and others are aiding the treatment centers. Mohammed Zaid, a doctor at one of the treatment centers, said they were “urging the international organizations to scale up their responses.” These essential organizations are working hard to combat cholera in Yemen.

They are providing lifesaving services, expanding treatment for children with malnutrition and are working toward supporting displaced families with healthy water and resources.

With weak immune systems and poor living conditions, it seems that these children have hardly anything to look to, like an opportunity for education and development. But the hope these children can look to is national organizations, in duty to give these emerging, poverty areas, vital nourishment. That is the hope the world can give to them, maintaining relief to subdue cholera in Yemen.

Brandi Gomez

Photo: Flickr

Vibrio cholera is the type of bacteria that causes cholera, a diarrheal illness with symptoms that do not often appear in those suffering infection. Sometimes, the disease is more severe than others, which is why it is important to learn about it. Here are 10 facts about cholera.

10 Facts About Cholera

  1. It can take up to five days for an infected individual to display symptoms, but according to the World Health Organization (WHO), cholera can be fatal within a few hours of infection.
  2. Cholera was originally found in the Ganges delta in India during the 19th century.
  3. There have been six pandemics in which cholera spread to each continent.
  4. Warm and salty coastal waters are very conducive to growth of cholera.
  5. Cholera is transmitted through contaminated water, so impoverished and crisis-ridden areas are the highest risks for outbreak, according to the WHO.
  6. The Center for Disease Control and Prevention (CDC) estimates that there are 3-5 million cases of cholera each year and over 100,000 annual fatalities resulting from infection.
  7. The CDC estimates that one in 10 infected individuals will become severely ill with symptoms including diarrhea, vomiting and leg cramps.
  8. Good hygiene practices, like boiling water or drinking only bottled water and proper hand washing can help prevent cholera infection.
  9. There is an oral vaccine that is not routinely recommended. There are two others, but they are not available in the U.S. at this time.
  10. Treatment focuses on replacing fluids lost through diarrhea. According to the CDC, when treatment is given properly in a timely manner, less than one percent of patients die.

These 10 facts about cholera show that preventative measures that can be taken to reduce chances of infection. They also enumerate the symptoms to look out. The CDC is currently investigating outbreaks to learn more about cholera, and the U.S. Agency for International Development provides countries with water and sanitation supplies to help prevent spread. The above facts can shed some light on what these organizations are doing to combat cholera and why what they are doing is important.

Helen Barker

Photo: Flickr

One of the world’s leading organizations in the fight for global health has just begun to carry out a nationwide campaign in Somalia to fight cholera. Gavi, the Vaccine Alliance, issued a press release on March 15 announcing its comprehensive strategy to stop the spread of cholera among Somali citizens. This Gavi cholera vaccine campaign seeks to save potentially thousands of lives in the drought-stricken African country.

According to the Centers for Disease Control, the southern half of the continent (where Somalia resides) is home to the bulk of cholera cases reported worldwide, and those cases have a higher likelihood of causing death than in other regions. This is primarily due to the lack of access to safe, clean water and sanitation as the disease-causing bacteria, Vibrio cholerae, thrives in public water sources and is spread through the waste products of those infected.

The situation in Somalia has been worsened by an ongoing harsh drought, which has forced people to use contaminated water and has hastened the spread of the disease.

Notorious for its contagiousness, cholera infected over 170,000 people globally in 2015. Year to date, more than 10,500 cases of cholera have been reported across 12 regions of Somalia, resulting in nearly 270 fatalities. The spread of the epidemic has been swift, with 400 new cases appearing in a single day in early March.

The Gavi cholera vaccine campaign plans to reduce these alarming numbers by delivering 953,000 doses of oral vaccine to a population of more than 450,000 people at risk of being infected. Administration of the vaccines will be completed by the Somali government, focusing on the regions of Somalia with the highest concentration of cases: Banadir, Beledweyne, and Kismayo. The doses will be administered over two waves, the first taking place from March 15-19, and the second from April 18-22.

The campaign marks an alliance between the United Nations Children’s Fund (UNICEF), the World Health Organization (WHO) and Gavi, who has provided the vaccines themselves as well as an additional $550,000 to support the program.

“Cholera is a major health issue in Somalia. The current drought has worsened the situation for many. Therefore we’re very glad to have the support of Gavi to implement the first oral cholera vaccine campaign in Somalia,” said Dr. Ghulam Popal, Somalia’s WHO representative.

Recognizing that cholera is not bound by political borders, Gavi is also launching a simultaneous vaccine campaign of 475,000 doses in South Sudan. This latest campaign is another step in realizing Gavi’s continuous mission to save lives and protect the health of all people in lower-income countries.

Dan Krajewski

Photo: Flickr

Cholera in Haiti
According to the United Nations International Children’s Emergency Fund (UNICEF), Haiti has one of the highest rates of cholera in the world. Over the past several years, cholera in Haiti has become a major cause of death among children and adults.

In 2010, a devastating outbreak of cholera in Haiti followed an earthquake that shook the region. However, according to an article in the New York Times, the U.N., via the office of then Secretary-General Ban Ki Moon, has also admitted to playing a role in the cholera outbreak. Reportedly, peacekeepers traveled to the region after leaving Nepal, where cholera was rampant.

Furthermore, after Hurricane Matthew hit the area in 2016, the prevalence of the disease was exacerbated and has proven to be difficult to contain. By 2016, more than 9,000 Haitians had been reported dead due to the epidemic.

Cholera is a water-borne disease, and inadequate access to clean water greatly heightens the likelihood of infection. CNN reports that researchers have found that only one in three people residing in Haiti had access to clean water before Hurricane Matthew, and since the disaster access had slipped to one in four.

Moreover, the U.N. has acknowledged that inadequate funding has made it increasingly difficult to manage the vast number of cases of cholera in Haiti. However, there have been various emergency teams that have donated both time and money to assist the cause. These teams have worked to provide clean drinking water and other useful resources for the country’s residents.

In its global health initiative called the “New Approach,” the U.N. recently developed a trust account specifically for raising funding for Haiti and ultimately reducing the prevalence of cholera, according to The New York Times. So far, only a handful of countries, including Britain, South Korea and France have offered to donate money to the trust account. Other countries, such as Canada and Japan, have provided funding outside of the actual trust account.

Lael Pierce

Photo: Flickr

The UN Commits to New Efforts in the Fight Against Cholera in Haiti
The United Nations Secretary-General, Ban Ki-moon, recently issued an apology for the organization’s role in instigating the 2010 cholera outbreak in Haiti. Expressing his regret, the Secretary-General admitted: “we simply didn’t do enough with regard to cholera and its spread in Haiti.” In attempts to make amends, the U.N. is escalating its role in eradicating cholera in Haiti.

In 2010, U.N. peacekeepers introduced cholera in Haiti. The outbreak took a terrible toll, affecting 788,000 Haitians and taking the lives of 9,000 others. In the aftermath, the U.N.’s slow response tarnished its reputation. Now, the U.N. has recognized the necessity of making amends and leading a public health movement to eradicate the disease.

Action in the fight against cholera has not always been adequate, but progress is underway. International efforts have resulted in a 90 percent decrease in cases since the original outbreak. In the current period, the number of reported cases is lower than in the same period of 2015 and 2014. Rapid response resource teams had once decreased from 70 to 32, but the U.N. has redistributed resources to now supply 88 teams.

Through the use of material assistance packages and increased funding, the U.N. has intensified its efforts to reduce and eliminate cases of cholera. The organization has taken steps to improve access to care, address long-term water concerns and improve health care systems. For example, nearly $200 million has been raised to overhaul water and sanitation infrastructure. Additionally, recent vaccination efforts reached 729,000 people, helping to halt the spread of cholera.

A significant initiative to combat cholera is the U.N.’s Water Capture and Distribution project. Efficient and safe water transport is crucial in the eradication effort, as only 42 percent of Haitians have access to potable water. The endeavor will transport clean water through 5,000 meters of underground pipes and benefit 60,000 people. By using underground pipes, the project will help prevent potential future contamination and destruction of infrastructure. The U.N. hopes to replicate this project and bring safe water to 100,000 people across the country.

The recent gains in the fight against cholera in Haiti show the potential of proper funding and political will. The Secretary-General’s apology should act as the beginning, not the end, of a committed and sustained effort to the people of Haiti.

McKenna Lux

Photo: Flickr

Haitian Cholera Outbreak
The Haitian cholera outbreak in 2010 became endemic, after at least a century of the disease not posing a threat.

Spread through contaminated water, the infectious disease causes dehydration and severe diarrhea. It can even lead to death if left untreated, sometimes in just a few hours. The outbreak transpired just after a fatal earthquake occurred in the country.

The United Nations (U.N.) sent peacekeepers to Haiti to help with the damage but failed to screen them for cholera or build them sufficient toilet facilities. As a result, cholera-infected wastewater flowed into Haiti’s main river — a main source for washing, cooking, cleaning and drinking. By 2011, over 470,000 cases of cholera were reported, with 6,631 connected deaths.

Immediate Response

Within days of the Haitian cholera outbreak, the Ministry of Public Health and Population (MSPP), along with the Centers for Disease Control and Prevention (CDC) and its partners, established a national surveillance system to track cases of the disease.

Treatment and prevention materials were also quickly developed, and thousands of healthcare workers were trained. Together, the organizations reduced the initial mortality rate of four percent to less than one percent, saving an estimated 7,000 lives.

However, thousands of people continue to become sickened each year by cholera. Haiti’s water and sanitation infrastructure require major improvement for any significant, long-term progress to be made.

The U.N.’s Reaction

After denying any responsibility for over five years, the U.N. has now officially admitted to a role in the Haitian cholera outbreak.

The deputy spokesman for the Secretary-General, Farhan Haq, recently sent out an email saying, “over the past year, the U.N. has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera.” He wrote that a “new response will be presented publicly within the next two months, once it has been fully elaborated, agreed with the Haitian authorities and discussed with member states.”

Although this statement fails to put blame on the U.N. or to indicate a change in its legal position — that it is absolutely immune from legal actions — it does represent a significant step forward for the U.N.

Looking Forward

Haiti launched a National Plan to eliminate cholera from the country in 2013. The 10-year-long plan focuses on water and sanitation, health and preventing further infections.

However, the plan is terribly underfunded. The U.N. Office for the Coordination of Humanitarian Affairs (OCHA) pledged over $125 million toward this program, $19 million of which was received; the plan is anticipated to top a total of $2.2 billion in investments.

Nigel Fisher, Special Representative of the U.N. Secretary-General in Haiti said, “It’s a big challenge. We have to raise literally billions of dollars. And this requires sustained support and commitment. That’s what we are here for. We, all of us partners, have a moral obligation to stay the course with cholera. Not just to lower the incidence of cholera, but to eliminate it from Haiti.”

Alice Gottesman

Photo: Flickr

Cholera Outbreaks in IraqCholera outbreaks are not altogether uncommon in Iraq. The bacterial infection is endemic to the region and reported cases usually spike every two to three years around November. Due to this regularity, the Iraqi Ministry of Health has developed a multidimensional approach to combating these outbreaks—but this year has been different.

An unprecedented at-risk population has emerged, as more than 250,000 Syrian refugees have fled their homes to Iraq at the same time that Iraqis are becoming internally displaced by the ongoing conflict with ISIS in the north. Funding has been diverted away from municipal services to pay for defense, and authorities have been unable to fully address community wells that have been contaminated by sewage from flood drainage.

More than 2,000 cases of cholera have been reported over the last three months, including six that have been fatal. One in five of these cases affect young children, and many are being diagnosed in the 62-refugee and Internally Displaced Person camps across the country.

Health officials may also face being inundated with additional patients due to the millions of Shi’ite Muslims expected to make their pilgrimage to Iraq in observance of Arbaeen, a ritual marking the end of mourning over the death of Hussein. When these travelers return home, there is a good chance they will take the bacteria with them, and this will compound an outbreak that has already spread to Syria, Kuwait and Bahrain.

“There is, unfortunately, a high risk that cholera will reach more areas affecting marginalized and displaced children, women and their families, in particular,” UNICEF Representative in Iraq, Peter Hawkins, said. In response, the Health Ministry, UNICEF and the World Health Organization are ramping up their campaigns to vaccinate refugees, treat patients and educate communities on practices that will reduce the risk of transmission.Cholera_outbreaks

In late October, health officials trained 1,300 vaccinators and 650 social mobilizers to carry out a first-phase vaccination deployment. Since early November, more than 91 percent of targeted Syrian refugees received the oral vaccine and will receive a second dose by the end of December. The second round will guard against cholera for at least five years. It was a desperately needed victory for Iraq, but the World Health Organization stressed that vaccinations should not divert attention from other prevention measures.

“We need to intensify health promotion and education to help communities protect themselves,” WHO Representative, Atlaf Musani, said.

To that end, UNICEF has supported a massive public education campaign. Cholera prevention methods are being sent out on social media, in text messages, by volunteers taking pamphlets door to door and on billboards in affected areas. People are being urged to use water only from protected sources and to get seen by a doctor as soon as symptoms of cholera present themselves.

Primary school children at a refugee camp in Dohuk were taken from regular classes to learn how to properly wash their hands and blow their noses. Officials are hoping that by reaching students, the information will get back to families as well. “Families can protect themselves in simple ways,” Hawkins said.

For communities already infected, or at risk of infection, health officials and UNICEF have undertaken an aggressive treatment campaign. Bottled water has been distributed to 37,000 people, community wells capable of serving 15,000 people have been built, 820,000 packets of rehydration salts are being given out and 3.1 million water treatment tablets will reach households across the country. Some schools have even delayed the beginning of classes for at least a month.

As with most humanitarian missions, the fight against Cholera outbreaks in Iraq is being hampered by a limited budget. If UNICEF is to continue supporting the Iraqi government, a $12.7 million funding gap will need to be filled. For the most vulnerable patients, this funding will mean life or death.

Ron Minard

Sources: WHO, Reuters, UN, UNICEF

Photo: Islamic Relief, Pixabay

Alternatives to Antibiotics for Treatment of Cholera
There has been a recent surge in the number and severity of cholera cases in certain parts of the world including Haiti, India and South Sudan. In the face of an epidemic, the World Health Organization and its affiliates have mobilized their efforts to distribute efficient treatment and sanitation services to the populations affected by cholera.

The treatment of cholera, like any other bacterial disease, relies on a standard antibiotic therapy accompanied by a steady oral rehydration course for the patients. Cholera — caused by the bacterium Vibrio cholerae — causes severe diarrhea and nausea, and could be potentially fatal as the body gets severely dehydrated. In fact, as many as 142,000 deaths are caused annually as a consequence of cholera.

The disease has long been associated with poverty, with the scientific literature to support the correlation as well. The association arises from the causative agent of the disease: the bacteria causing symptoms of cholera thrives in unsanitary water, which is unfortunately widely used as drinking water in impoverished areas. Once they enter the human body, the bacteria have a very short incubation period, causing them to spread quickly and efficiently. The exceptionally virulent bacteria then release toxins, which cause the symptoms of cholera.

To treat these symptoms, antibiotics are typically administered to the patients in tandem with rehydration salts. The antibiotics that function to kill the bacteria are typically of the tetracycline family. The tetracycline-derived antibiotics, however, have become notorious for their rapid decline in clinical efficacy due to antibiotic resistance.

The mode of action of the tetracycline antibiotics is inhibition of protein biosynthesis in the target bacterium. This is accomplished by blocking the bacterial ribosomes, which are the site for protein synthesis. However, many bacteria, including strains of V. cholerae, have developed antibiotic-resistant genes, which efflux the antibiotics from the cell and render them useless.

This resistance to previously one of the most effective, safe and broad-spectrum antibiotics has spurred research into discovering viable alternatives. One of these alternatives is to manufacture a molecule that inhibits toxin production directly. This approach aims to stop the process of bacterial biosynthesis right where it begins: at genetic transcription.

The process of producing cholera toxin also begins with a transcribed gene, which is then translated to a protein toxin. The current objective is to isolate elements within the bacterial DNA that regulate this process, which are called promoters, as well as inhibitors for the promoter. The inhibitory elements can bind to the promoter which, in turn, would stop the transcription process for the specific gene altogether.

For the inhibition of the cholera toxin-producing gene, a class of molecules labeled toxT transcription inhibitors have been identified. These not only inhibit the process of toxin production but also down-regulate the production of colonization factors. The action of toxT, therefore, can stop the production of disease-causing toxins as well as prevent the bacteria from forming large colonies.

These studies depict a different yet successful possibility of approaching the antibiotic resistance issue. The efficient manufacturing and safety of small molecule inhibitors for mainstream pharmaceuticals remains a challenge for the future; however, the current research results are indicative of a positive outcome.

Atifah Safi

Sources: United Nations, NIH, American Society for Microbiology, WHO
Photo: Mother Earth Living