Posts Tagged ‘Cholera’

Travel Bulletin Dominican Republic: Cholera Taking Hold

Friday, May 27th, 2011 by

Source: Associated Press

Dominican physicians report that cholera has been reported in 28 of the country’s 32 provinces, and the number of new cases has risen about 50% over the last two weeks, according to the Dominican Health ministry. Since the outbreak began in November, there have been over a thousand cases and fourteen deaths, and there are fears that the situation may worsen with the onset of the hurricane season. The Dominican Republic shares the island of Hispaniola with Haiti, where the cholera epidemic has sickened over 250,000 and killed nearly 5,000. Cholera is a water-borne illness, which is spread through contaminated drinking water and food. Travelers should take strict precautions to avoid exposure and should seek treatment immediately with the onset of diarrhea.

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Travel Bulletin Africa: Cholera outbreaks affect central African countries

Tuesday, October 12th, 2010 by

The current wave of cholera outbreaks affecting Central Africa started a few months ago. As of  October 3rd, 40,468 cases and 1,879 deaths have been reported in four countries (Cameroon, Chad, Niger and Nigeria). Seasonal factors, such as the flooding brought on by the rainy season, as well as poor hygiene conditions and population movements in the area contribute to this unusually high incidence of cholera. Nevertheless this area known to be endemic for cholera is regularly affected by small outbreaks.

The World Health Organization (WHO), with international and national health partners, is providing technical support to the ministries of health at the country and sub-regional levels. WHO is working to strengthen surveillance activities. Supplies for case management and chlorination of water have also been dispatched to some of the affected areas. The Ministries of Health of the four affected countries are planning to organize a cross border meeting in Abuja in order to reinforce the surveillance and revise the preparedness and response plans to cholera epidemics in the localities around Lake Chad.

Breakdown by country:

Cameroon: 7,869 cases including 515 deaths (case fatality rate -CFR 6.5%) have been reported in 6 regions (Centre, Extreme Nord, Littoral, Nord, Ouest, Sud Ouest) between May 6th and October 3rd. The majority of cases (97%) are reported from the Extreme Nord region. Preventive and control measures are ongoing. A Cholera Command and Control Centre has been set up in Maroua in the Extreme Nord region by the Ministry of Health with the support from WHO as health cluster lead and in close collaboration with other health and water and sanitation partners. The role of the Centre is to provide technical coordination for partners in the areas of epidemiological and laboratory surveillance, case management, social mobilization, logistics and infection control/water and sanitation in treatment centers. The system should also provide immediate alerts of new outbreaks.

Chad: 2,508 cases including 111 deaths (CFR 4.4%) are reported in 12 health districts in 6 regions between July 13th and October 3rd. Prevention and control measures are being implemented by national authorities with support from several partners (Médecins Sans Frontières (MSF), National Red Cross, Oxfam, The International Rescue Committee (IRC), International Medical Corps (IMC), UNICEF, WHO).

Niger: 976 cases including 62 deaths (CFR 6.4%) have been reported in Diffa, Maradi, Tahoua and Zinder regions between July 3rd and October 1st. Preventive and control measures are ongoing.

Nigeria: 29,115 cases including 1,191 deaths (CFR 4.1%) have been reported between January 4th and October 3rd, in 144 LGAs in 15 States including the Federal Capital Territory (FCT). The outbreak is still ongoing and spreading to new geographical areas. Severe flooding and displacement of large numbers of people have occurred, aggravating the situation.

Copyright © 2010, World Health Organization

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Cholera: Still a big killer, no effective vaccine

Thursday, September 16th, 2010 by

On the quiet London street corner of Broadwick and Lexington stands the John Snow pub with a commemorative plaque honoring the medical detective work of Mr. Snow, who identified the Broad Street water pump as being responsible for an outbreak of cholera that ravaged thousands in 1855.  Today, all patrons of the John Snow can enjoy a pint of local ale, and even more importantly, a refreshing glass of crystal clear, pathogen-free water. It was John Snow who first discovered that cholera, the most feared diarrhea-associated illness in the world, was conveyed by water.

Cholera is caused by the bacteria Vibrio cholera, a powerful pathogen. Untreated cases can lead to dehydration and death within hours of infection.  Cholera is most commonly acquired from drinking water in which the bacteria is found naturally or into which it has been introduced from the feces of an infected person.  The disease can also be acquired from contaminated fish, shellfish or vegetables that have been rinsed with contaminated water.

Cholera outbreaks occur yearly in developing countries.  In 2007, 53 countries reported 177,963 cholera cases and over 4,000 deaths to the World Health Organization Last month, the worst cholera epidemic in almost twenty years broke out in Nigeria.  Nearly 800 people have died, and the epidemic is now spreading to the neighboring countries of Cameroon, Chad and Niger where hundreds of others have succumbed to the illness.

Further east, monsoon flooding that has displaced 18 million people in Pakistan has raised fears of a massive cholera outbreak. Next door, India reports almost seven hundred patients from the state of Orissa have been treated for cholera. Thirty nine patients have been reported dead, and local official N.B. Jawala reports that over 50 new patients are being seen daily with severe symptoms.  ‘We are struggling to prevent the disease from spreading,” he added, “but the patients do not come to the hospital for treatment.”  Indeed, since cholera infection is most often asymptomatic or results in only mild symptoms, the management of a cholera outbreak can be an epidemiologist’s nightmare.  

Travelers who follow tourist itineraries and who observe food safety recommendations are at very low risk. The risk, however, is real for those who drink untreated water or eat poorly cooked or raw seafood in cholera-endemic areas, primarily sub-Saharan Africa, India and China.  Those travelling to developing countries where access to good medical care (intravenous fluid and electrolytes) is limited are at the greatest risk of acquiring and succumbing to the illness. There is no vaccine for cholera available in the United States, and the CDC does not recommend either of the two vaccines available outside the United States because of the low risk of cholera to U.S. travelers and the brief and incomplete immunity that the vaccines confer. Without any medical silver bullets at hand, it appears that this ancient illness is not going away anytime in the near future.

Photo by ell brown.

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