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Outbreak of Cholera in Somalia: A Public Health Concern


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

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10 Facts About Cholera: What It Is and What It Does


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

GAVI Launches Cholera Vaccine Campaign in Somalia

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

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Water Quality in the Democratic Republic of the Congo

Water Quality in the Democratic Republic of the Congo
Water quality in the Democratic Republic of the Congo is in need of improvement. Only 46 percent of the population has access to clean and safe drinking water. Although the DRC has an abundance of freshwater sources, pollution and accessibility are major issues in the country.

According to the World Food Programme, the DRC is one of the poorest countries in the world. Therefore, the country has a lack of infrastructure and insufficient water storage and treatment facilities. Poorly maintained water systems can be dangerous because old and rusted pipes can possibly pollute water. Some towns, especially in rural regions, do not have any water systems.

For instance, the isolated town of Kasongo once had a working water system but it broke down and was not been repaired for several years. Without running water, residents had to walk three miles to get water from the nearest stream. This trip can take up to two hours. This is common for rural towns in the Congo.

People in the rural regions who depend on direct water sources are more likely to drink unsafe water. Approximately 37 million people in rural areas are at risk of contracting a disease from contaminated streams and rivers. One of the most common illnesses caused by unsafe drinking water is Cholera. Every year, 20,000 people die from cholera.

UNICEF representative, Pierette Vu Thi says, “A child living in a Congolese village is four times more likely to drink contaminated water than someone in town. Yet, all children have equal right to survival and development of which drinking water is a vital component.”

There are many solutions being explored to improve water access and quality in the Congo. The state water company REGIDESO is tapping groundwater in order to install pumps in remote rural areas. This method is much cheaper and less difficult than installing water systems. But, old water systems are also being restored. In Kasongo, REGIDESO replaced their defunct water system. The old storage tank, engine and pump were repaired with new models. A network of pipes and taps were extended to provide more people with running water.

The water quality in the Democratic Republic of the Congo is poor especially for the Congolese in rural areas. However, with new initiatives, many more people will gain access to clean water without having to travel miles.

– Karla Umanzor

Photo: Flickr

The UN’s Role in the Haitian Cholera Outbreak of 2010

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

Hurricane Matthew’s Impact on Living Conditions in Haiti

Hurricane Matthew
Hurricane Matthew was a devastating category four hurricane sustaining winds of upwards of 140 mph when it first swept through into the Southern peninsula of Haiti on October 3-4, 2016.

Hurricane Matthew was the strongest natural disaster to hit the country in a decade, completely destroying towns and villages. Food reserves and roughly 300 schools have been damaged.

Haiti Liberte, a local news source of Haiti, estimates nearly two feet of rain impacted the area during Hurricane Matthew.

Reuters estimates that the death toll in Haiti is currently at 1,000 and rising, causing the community to create mass graves for their deceased. The death toll is continuing to rise due to the cholera outbreak in the wake of the devastation caused by Hurricane Matthew. Thousands are also displaced in the wreckage.

Cholera Rises in Aftermath of Hurricane Matthew

According to CNN, Haiti has the highest rates of Cholera worldwide. An estimated 10,000 people have died from the epidemic since 2010 when soldiers from the U.N. accidentally brought the disease to the area in the aftermath of an earthquake. The World Health Organization (WHO) reported in 2016 that 880 new cases each week arise out of Haiti.

With cholera projected to increase in the aftermath of Matthew, WHO is sending one million cholera vaccines to the area in hopes of preventing an outbreak of the waterborne disease.

Developmental Struggles to Haitian Economy

Haiti is the poorest country in the Americas and the Western hemisphere. The New York Times reported that, prior to the devastation left by Hurricane Matthew, Haiti was on the path of developing into a more prosperous country. Cell phone services were widely enabled in the community, and farmers and businesses were improving.

Forests, swamps and other forms of vegetation are now ruined. Roadways are blocked and destroyed and homes are no longer standing as they once were. Only the mounds of stones that were used as the foundation for homes still stand in Jérémie, Haiti.

Minister of commerce and industry in the Grand Anse department Marie Roselore Auborg of Jérémie stated, “Instead of going forward, we have to restart…This storm leveled all of the potentials we had to grow and reboot our economy.”

Widespread Famine

BBC reported from U.N. officials and the Haiti government that widespread famine will impact Haiti in the three to four months to come if the situation is not addressed properly and promptly. Haiti Interim president Jocelerme Privert states that “real famine” following the “apocalyptic destruction” made by Hurricane Matthew could prevail.

U.N. Secretary-General Ban Ki-moon is proactively responding to the crisis by investing $120 million in the three months following the hurricane to aid in the restoration of Haitian infrastructure and provide medical and famine relief.

France and the U.S. have pledged to send aid to Haiti. The American Red Cross is providing $6.9 million to aid in relief efforts as well.

– Haylee M. Gardner

Photo: Flickr

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Alternatives to Antibiotics for Cholera Treatment

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

Haiti’s Cholera Pandemic: Fighting for a Place in the Public Eye

Cholera_Pandemic
With the eyes of the world’s worries turned towards Africa’s Ebola crisis, many have not noticed that since 2010, cholera has infected over 730,000 people and killed over 9,000 Haitians.

Never declared an official state of emergency, the cholera pandemic in this island country has gone unnoticed by entire sectors.

The virus came to the country through the United Nations, when volunteers from Nepal practiced unsafe sewage disposal at a base in a rural area of the country. Groups and activists are currently fighting to have the United States take responsibility for bringing the pandemic into Haiti.

The outbreak began in September of 2010, ten months after the devastating earthquake in January of that year.

Nongovernmental organizations, such as Doctors Without Borders and the United Nations worked toward stemming the spread, and aid poured in. Tolls were worst from 2010 to 2012, but after that, death tolls were being cut almost in half annually. With the launch of 2013’s “10 Year Plan for the Elimination of Cholera in Haiti,” and 2014’s Total Sanitation Campaign, eradication of the disease seemed within reach.

However, in the first quarter of 2015, the number of cholera cases in the country tripled in comparison to the first quarter of 2014. The resurgence seems to have started in the slum of Martissant in September of 2014. Exhausted medical volunteers, who have not been paid in months, work tirelessly in Cholera Treatment Centers (CTCs), administering an oral rehydration solution and IV drips as patients lay in “cholera cots,” which have holes in the bottom with a bucket underneath to accommodate severe diarrhea experienced by cholera patients.

Efforts to fight the disease have been largely prevention-based, with an emphasis on sanitation through the use of various levels of disinfectant and the provision of chlorine to the population. However, to many Haitians, public outreach efforts seem not only redundant but unhelpful. Not surprisingly, being told to “wash your hands” and “keep yourself clean” by glossy pamphlets and foreign officials while your family members are dying does not offer much comfort. Citizens know what to do, but cholera still lingers.

At this point, a shift is being made towards the use of vaccinations, as one called Shanchol in particular gains favor for repeatedly demonstrating its effectiveness. For example:

  • In 2012, it was used to fight a cholera outbreak in Guinea and was found to provide 86% of the population protection early on.
  • According to a current study conducted in Dhaka, Bangladesh, it provided 58% protection to individuals who received it along with soap, chlorine and hand washing instructions (and 53% when administered independently.)
  • In its Calcutta trial, whose results were published in 2011, it was shown to give 65% protection.

When compared to other forms of cholera vaccination, it is impressive because it is supposed to last at least five years; it is two-dose regimen costs only $3.70 (and the Bill & Melinda Gates Foundation is working to bring prices down even lower); it is ingested orally rather than injected, and it is able to enter the gut and prevent transmission.

The battle against the disease is ongoing, as is the legal fight between several Haitian organizations and individuals and U.N. representatives to hold the United Nations accountable for bringing “U.N. Cholera” to the country.

However, even with what some are calling the “fight for justice,” and the relative lack of awareness of the pandemic in light of the African Ebola crisis, there is hope for the cholera victims of Haiti in more ways than one.

With the rise of the Shanchol vaccine, a resurgence of cases that brought with it a resurgence of awareness, an impassioned population and the tireless volunteers or long-unpaid workers working to combat the disease, cholera is facing some formidable foes.

– Em Dieckman

Sources: GizModo, Miami Herald, New York Times, The Atlantic
Photo: Flickr

10 Facts About the Haiti Earthquake

Haiti Earthquake facts
Haiti was thoroughly unprepared when the 7.0 magnitude earthquake hit on January 12, 2010. The earthquake devastated the island, leaving millions homeless. Below are the 10 most important facts about the Haiti earthquake.

 

Top Haiti Earthquake Facts

 

1. Haiti Pre-Earthquake

Even before the earthquake, Haiti was one of the poorest countries in the world. Haiti ranked 145 out of 169 countries in the UN Human Development Index. Over 70 percent of the population was living under the poverty line.

2. Human Toll

Death toll estimates vary anywhere from 220,000 to 316,000. Over one million people were initially displaced, and about 500,000 remain homeless today.

3. Damaged Infrastructure

Despite being built upon a major fault line, Haiti had no building codes and therefore no way to ensure buildings are safe from earthquakes. As a result, Haiti’s infrastructure was demolished. Nearly 300,000 homes were badly damaged or destroyed. The earthquake struck near the capital city of Port-au-Prince, destroying many of the most important government buildings, hospitals and roads.

4. Effect on Children

Over 4,000 schools were damaged or destroyed, amounting to about a quarter of the island’s schools.

5. Cholera

Unrelated to the earthquake and significantly exacerbating the problem, a cholera outbreak occurred in Haiti in October 2010. As of June 2013, 8,173 people have died from cholera in Haiti with 664,282 cases total.

6. Foreigners Caught in the Quake

Ninety-six UN peacekeepers died in the earthquake, along with 122 American citizens.

7. International Response

The international community proved to be remarkably empathetic towards the crisis in Haiti. From 2010 to 2012, international donors raised an eye-popping $6.43 billion for Haitian reconstruction. In addition, USAID contributed $450 million in aid to Haiti.

8. Reconstruction Effort

So far, aid organizations have rebuilt about 21,000 houses and made 100,000 temporary shelters. Fifty percent of the rubble has been removed and 650 schools have been repaired. In addition, the American Red Cross has provided 369,000 people with clean water, 2.4 million with health and hygiene education and three million with cholera treatment and prevention.

9. Obstacles to Reconstruction

The road to reconstruction has been bumpy. Issues with transparency and oversight have made it difficult to track where the reconstruction funds have gone. Seventy-five percent of all foreign aid has gone directly to NGOs that spent the money inefficiently and with few results. Experts say that it will be another 10 years before “serious results” can finally be seen.

10. The Future of Haiti

Only half of the money that international governments promised has been paid. In addition, half the money that American donors raised has yet to be spent, and the American Red Cross still has $150 million left to use on “long-term projects.”

Though many of these facts about the Haiti earthquake make the situation seem dismal, there is hope that the reconstruction effort can right this ship. Though it will be many years before Haiti is finally on calm seas again, long-term plans have been set in motion to ensure that Haitian reconstruction is going forward as quickly and as efficiently as possible.

– Sam Hillestad

Sources: CNN, DEC, Geography, Huffington Post, Miami Herald

 

 

 

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Controlling Cholera: Vaccination vs. Sanitation

The cholera crisis in South Sudan continues to worsen, as do fears of a probable outbreak in Syrian refugee camps in Iraq. The World Health Organization (WHO) reports that 2,400 people have been infected and 62 have been killed so far. As these numbers rise, the demand for a more comprehensive international response grows. This urgent situation polarizes aid providers into two camps: those advocating for widespread vaccination and those directing their focus toward sanitation.

Cholera is highly contagious and fast-acting. It spreads through bacteria-contaminated food and water, and is most common in places with poor water quality and sanitation. Many at-risk areas lack a widespread and comprehensive strategy for cholera prevention. The effectiveness of vaccines overshadows this issue, especially during time sensitive periods when outbreaks have already begun.

A study by The New England Journal of Medicine about a cholera outbreak in Guinea shows that two doses of a particular vaccine were able to protect people with 86 percent effectiveness.

Doctors Without Borders and the Guinean Ministry of Health were able to vaccinate 75 percent of the affected population, thereby containing the outbreak. Similar results were observed in a larger trial in Kolkata. Another benefit is that the vaccine is inexpensive – at approximately $3 per two doses – making it affordable to patients in vulnerable developing countries.

Successes like those seen in Guinea and Kolkata have encouraged the use of vaccination to control future cholera outbreaks and provide quick, inexpensive protection.

However, vaccines are not always suitable for settings with weak health systems. They require refrigeration – often up to the point of delivery – which, in some areas is impossible. Developing countries often must deal with unreliable electricity, transportation issues, high temperatures and deliveries to remote, rural  communities. Also, it is necessary to mix the vaccine with clean water – a scarce commodity in the poor areas where cholera is most likely to take hold.

Factors such as these have created debates over how best to allocate resources. Instead of spending them solely on vaccines, some argue that resources should be used to develop and strengthen basic water and sanitation infrastructure. Vaccinations, though effective, can only reach a percentage of the population, while proper sanitation benefits all.

Also, vaccinations are often implemented only after an outbreak has begun, rather than as a preventative measure. Water and sewage facilities play a major role in preventing cholera once they have been implemented. The WHO has endorsed the use of re-hydration solutions and antibiotics for the treatment of cholera, rather than advocating for vaccination alone.

Access to clean water and sanitary conditions are necessary to effectively control and eliminate cholera. It may be a challenge to focus on these basic needs when the research behind vaccines is so promising. Though providing better hygiene infrastructure for communities will not only help prevent diseases, but also set the foundation for growth in other areas such as health and development.

It is hopeful that both vaccination and sanitation will be used in tandem to provide a multifaceted, integrated approach to preventing and controlling cholera in the future.

– Mari LeGagnoux

Sources: The Guardian 1, The Guardian 2, New England Journal of Medicine
Photo: The Guardian