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Cholera in the Developing World

In the 1800s, cholera emerged from its place of origin in India and ravaged the world. Millions have died in the seven cholera pandemics that have occurred since the first appearance of the disease. While it has been eradicated in some regions, others continue to suffer from recurring epidemics.

Cholera is rarely seen in industrialized countries due to proper sanitation systems. Additionally, the World Health Organization (WHO) states that up to 80 percent of cholera cases can be “successfully treated with oral rehydration salts.” However, the bacteria that causes cholera can easily “continue to thrive” in areas with poor sanitation and overcrowded housing. While the developed world may not face the threat of cholera, in recent years, developing nations have seen deadly outbreaks.

Cholera is an “acute diarrheal disease,” which, in severe cases, can cause “profuse watery diarrhea,” vomiting, and muscle cramps. The Centers for Disease Control and Prevention reports that even more severe symptoms include “acute renal failure, severe electrolyte imbalances and coma.” The disease is potentially fatal just hours after developing symptoms.

The severity of cases often varies, says the WHO. Of those infected with the bacteria, 75 percent do not develop symptoms. While this may seem like a non-issue, the bacteria continue to exist in their fecal matter for up to two weeks. Without proper sewage sanitation, others may come in contact with the bacteria as well.

The remaining 25 percent of people infected do develop symptoms. However, 80 percent of those with symptoms only have mild or moderate ones. The other 20 percent of people experience serious, potentially deadly symptoms.

In 2008, the Vietnamese city of Hanoi experienced a cholera outbreak that produced upwards of 2,490 cases. The outbreak was attributed to sewage from septic tanks contaminating lakes where people sometimes wash food. Additionally, street food stalls and “dog meat” restaurants were closed down due to improper sanitation. Thirty lakes in Hanoi had to be sanitized due to the presence of cholera bacteria.

A cholera outbreak in Haiti, which began in 2010, has claimed 8,562 lives, according to the New York Times. Although relief efforts have reduced the number of cases, “clean drinking water and sanitation remain as scarce as when the epidemic began.” The number of cholera treatment centers has shrunk from 120 to 40, and the number of patients dying in treatment centers is rising. Doctors fear that the rainy season will cause the number of cases to skyrocket.

Medical News Today reports the ominous prediction that a cholera outbreak will strike Iraq. “Cholera is endemic in northern Iraq” already, says the report, and with the number of displaced people and refugees rising, the risk is even higher. Syrian refugee camps are overflowing with people, putting the water and sanitation standards at stake.

Two oral cholera vaccines exist, though the WHO has never recommended the vaccine “due to its low protective efficacy and the high occurrence of severe adverse reactions.” The best way to handle an outbreak, says the WHO, is to provide “prompt access to treatment, and to control the spread of the disease by providing safe water, proper sanitation and health education.”

These solutions, however, need to be applied in areas with the greatest need. The United Nations has come under fire for its response to the cholera outbreak in Haiti. The UN has failed to raise the amount of money necessary for vaccinations. While that would provide some immediate relief, Haiti also lacks the $2 billion necessary to construct safe water and sanitation services. Lasting relief is still in the distant future for the slowly recovering nation.

– Bridget Tobin

Sources: WHO 1, WHO 2, Medical News Today, IRIN, CDC, The New York Times
Photo: Medical News Today