Slide1: with Dr. Mike Magee


Slide2: Dealing with Cholera


Comes in 3 waves• From the immediate strike • Delayed, but result of injuries or complications of injuries • From diseases / illness from breakdown  of water / sanitation infrastructure - One disease first on lips of health leaders: Comes in 3 waves • From the immediate strike • Delayed, but result of injuries or complications of injuries • From diseases / illness from breakdown of water / sanitation infrastructure - One disease first on lips of health leaders Key Lessons About Loss of Life After a Disaster Cholera • Not a disease of the past • Continues to cause suffering and death - 130,000 cases / 2,200 deaths reported to WHO in 2005 - True numbers are much higher - Poor surveillance / fear of sanctions lead to underreporting • Risk intensified during manmade and natural disasters Sources: Drazen JM, Klempner MS. Disaster, Water, Cholera, Vaccines, and Hope. N Engl J Med. 2005;352:827. World Health Organization Global Task Force on Cholera Control. “Cholera Unveiled.”


Slide4: Educating Ourselves About Cholera • Curved bacterium called Vibrio cholerae • Thrives in watery environment - Temperature, nutrients, salt concentration • Humans exposed through contaminated water • Without access to clean water or antibiotics, death in 24 hours - Massive fluid loss due to destruction of intestinal lining - First outward sign is sudden, explosive diarrhea • Disease can spread very rapidly - Fecal contamination of water supply - Human population lacking resources and knowledge Sources: Drazen JM, Klempner MS. Disaster, Water, Cholera, Vaccines, and Hope. N Engl J Med. 2005;352:827. Shapin S. Sick City. The New Yorker. November 6, 2006.


Slide5: Where Does Cholera Exist? Almost completely a Third World disease • Only 5 U.S. cases in 2004 - 4 were proven to be acquired outside U.S. • Millions of cases, 120,000 deaths - Africa, Asia, Latin America Where it started • First well-described epidemic in India in 1817 • Rapid spread through Southeast Asia and Middle East - John Snow: It spread along the great tracks of human intercourse – colonialism and trade • Second pandemic (late 1820s) hit Europe and Americas • English lost 20,000 lives in 1833 and 30,000 in 1854 Sources: Shapin S. Sick City. The New Yorker. November 6, 2006. World Health Organization. Weekly epidemiological record. 2006;81:297-308.


Slide6: • Many blamed a disturbance to the environment, like bad air • Prejudice and bias added to the confusion No One Knew the Causes or How to Prevent It “Medical opinion was unanimous in agreeing that the intemperate, the imprudent, the filthy were particularly vulnerable ... To die of cholera was to die of suspicious circumstances.” Charles Rosenberg Author, The Cholera Years Such was the state of human understanding just a century and a half ago. Sources: Rosenberg C. The Cholera Years. University Of Chicago Press; Reprint edition (July 15, 1987). London.


Slide7: Important Discoveries John Snow • Tracking and mapping - Connected deaths in London neighborhood to a water pump - 1848 and 1854 epidemics Robert Koch • In 1883, identified Vibrio cholerae under the microscope - Provided scientific basis for advancements in water, sanitation and public health surveillance for next 100 years Cholera outbreaks are now considered synonymous with failed development Sources: Shapin S. Sick City. The New Yorker. November 6, 2006. Nobelprize.org. “Robert Koch: Biography.” Available at: http://nobelprize.org/nobel_prizes/medicine/laureates/1905/koch-bio.html.


Slide8: Why Do Cholera Epidemics Continue to Occur? Same answer as 150 years ago: Because human infrastructure fails Cholera is mainly a disease of the developing world 1/6 lack access to clean, safe water 2/5 lack access to proper sanitation These are linked Sources: World Health Organization Global Task Force on Cholera Control. “Cholera Unveiled.” Available at: http://whqlibdoc.who.int/hq/2003/WHO_CDS_CPE_ZFK_2003.3.pdf. Shapin S. Sick City. The New Yorker. November 6, 2006. Guerrant RL. Cholera – Still teaching hard lessons. N Engl J Med. 2006;354:2500-2502.


Slide9: What’s To Be Done? Build water and sanitation infrastructure in high-risk areas Focus on surveillance and response capabilities - Early warning systems - Rapid investigation of suspected outbreaks - Task forces and emergency supplies 3) Explore and focus on new vaccine strategies If cholera continues to exist, we, as humans, have simply failed Sources: World Health Organization Global Task Force on Cholera Control. “Cholera Unveiled.”


Slide10: Release Date: 3/7/2007 www.healthpolitics.org Dealing with Cholera