What is Cholera?
According to the World Health Organization, Cholera is a life-threatening but easily preventable and treatable disease. It is a bacterial diarrheal infection contracted by consuming water or food that has been contaminated with human feces containing the bacteria. The excessive watery diarrhea results in extreme dehydration that can quickly cause death. So, the extent of treatment is typically simply rehydration, IV fluids and/or antibiotics for extreme cases, and zinc supplementation for young children.
Major Cholera Outbreaks in 2017
The Journal of Infectious Diseases, Volume 218, Issue suppl_3, 15 November 2018, Pages S137–S140, https://doi.org/10.1093/infdis/jiy486
So What?
Seven major cholera pandemics (widespread outbreak) have occurred since the 19th century, while several nations experience cholera as an endemic (routinely occurring) phenomenon. Globally, cholera effects up to 4 million people and kills 143,000 annually. While much progress has been made--for a disease that is comparably simple and inexpensive to prevent and treat--we have a long way to go.
Fast Facts
- Cholera can kill within hours if left untreated.
- Up to 80% of cases can be successfully treated with oral rehydration solution (ORS).
- Safe oral cholera vaccines should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and for prevention in areas known to be high risk for cholera.
- A global strategy on cholera control with a target to reduce cholera deaths by 90% was launched in 2017.
- Typical at-risk areas of cholera include peri-urban slums with limited access to safe drinking water and a lack of proper sanitation.
- Cholera is a preventable disease provided that safe water and proper sanitation are made available.
- In most cases, though, symptoms are mild or absent and infected individuals become carriers with no symptoms.
- 54% of reported cases in 2016 occured in Africa.
- More than 2 billion people drink water from faecally contaminated water sources.
For more information on cholera, ORS & the vaccine, watch this video:
WHO: Cholera - Questions and answers (Q&A)
John Snow & The History of Epidemiology
"All that would be required to prevent the disease [cholera] would be such a close attention to cleanliness in cooking and eating, and to drainage and water supply, as is desirable at all times." -John Snow
According to the BBC, John Snow was a British surgeon and medical researcher who lived during the early-to-mid 1800’s. His contributions mark the beginning of a subcategory of public health called epidemiology (the study of the spread of disease) because of his work on one particular pandemic; the 1854 cholera outbreak in Soho, London. Snow challenged how not only cholera, but disease in general, was viewed by the general public as well as the authorities. He argued an early version of Louis Pasteur’s Germ Theory: He disputed that bad air or a rank odor caused the disease. Instead he presented it as a side effect of the cause. He demonstrated a basic understanding of the fecal-oral route of transmission of cholera and identified a specific (potential) source of the outbreak by mapping the infections/deaths. It is debated whether or not his removal of this so-called source, the Broad Street water pump handle, is what halted the outbreak. But, what is for sure, is that he revolutionized how we monitor disease through his legendary dot-map.
The Intersection of Public Health & Geography
Snow’s dot-map recorded the number and location of deaths at each household, the location of water pumps, which company supplied water to what pump or household, and which households used each water source. This map simultaneously serves as a proposal and proof of Snow’s revolutionary theory of disease transmission. His map created the model for how data on the transmission of disease is collected, organized, and displayed. This is where public health and geography intersect and the bedrock of Epidemiology is found. [1]
[1] McLeod, Kari. 2000. Our sense of Snow: The myth of John Snow in medical geography. Social Science & Medicine. 50: 923-935.
Worldwide Cholera Cases
Cholera & Social Determinants of Health
Mapping diseases also allows us to recognize patterns in not just biological, but social, factors of disease. This is especially relevant to cholera. We know how to prevent it, we know how to treat it, so why is cholera still such a problem? Social determinants of health. According to the U.S. Office of Disease Prevention and Health Promotion, social determinants of health are “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.” The major social determinants of health at play when it comes to cholera are water and sanitation at the institutional level and hygiene practices at the individual level. Poor performance in both of these areas are driven by poverty. [1]
[1] Zimbabwe Ministry of Health and Child Welfare Division of Preventive Services. October 19th, 2011. Intersectoral actions in response to cholera in Zimbabwe: From emergency response to institution building. World Conference on the Social Determinants of Health. Draft Background Paper 23.
