- 1817 The first modern cholera pandemic. ...
- 1823 The first cholera pandemic dies down in the Caucuses before reaching Europe.
- 1826-37 The second cholera pandemic breaks out starting in Russia, then moving to Poland and subsequently the rest of Europe, North Africa and the eastern seaboard of North America.
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Seven cholera pandemics have occurred in the past 200 years, with the first pandemic originating in India in 1817. Additionally, there have been many documented cholera outbreaks, such as a 1991–1994 outbreak in South America and, more recently, the 2016–20 Yemen cholera outbreak.
Cholera can be life-threatening but it is easily prevented and treated. Travelers , public health and medical professional s and outbreak responders should be aware of areas with high rates of cholera, know how the disease spreads, and what to do to prevent it.
Mar 24, 2020 · In 2017, outbreaks of cholera broke out in Somalia and Yemen. By August 2017, the Yemen outbreak affected 500,000 people and killed 2,000 people. Sources . Cholera.
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- Vibrio cholerae Strains
- Epidemiology, Risk Factors, and Disease Burden
- Prevention and Control
- Water and Sanitation Interventions
- Hygiene Promotion and Social Mobilisation
- Oral Cholera Vaccines
Cholera is an extremely virulent disease that can cause severe acute watery diarrhoea. It takes between 12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water (2). Cholera affects both children and adults and can kill within hours if untreated. Most people infected with V. choleraedo not develop any symptoms, although the bacteria are present in their faeces for 1-10 days after infection and are shed back into the environment, potentially infecting other people. Among people who develop symptoms, the majority have mild or moderate symptoms, while a minority develop acute watery diarrhoea with severe dehydration. This can lead to death if left untreated.
During the 19th century, cholera spread across the world from its original reservoir in the Ganges delta in India. Six subsequent pandemics killed millions of people across all continents. The current (seventh) pandemic started in South Asia in 1961, and reached Africa in 1971 and the Americas in 1991. Cholera is now endemic in many countries.
There are many serogroups of V. cholerae, but only two – O1 and O139 – cause outbreaks. V. cholerae O1 has caused all recent outbreaks. V. choleraeO139 – first identified in Bangladesh in 1992 – caused outbreaks in the past, but recently has only been identified in sporadic cases. It has never been identified outside Asia. There is no difference in the illness caused by the two serogroups.
Cholera can be endemic or epidemic. A cholera-endemic area is an area where confirmed cholera cases were detected during the last 3 years with evidence of local transmission (meaning the cases are not imported from elsewhere). A cholera outbreak/epidemic can occur in both endemic countries and in countries where cholera does not regularly occur. In cholera endemic countries an outbreak can be seasonal or sporadic and represents a greater than expected number of cases. In a country where cholera does not regularly occur, an outbreak is defined by the occurrence of at least 1 confirmed case of cholera with evidence of local transmission in an area where there is not usually cholera. Cholera transmission is closely linked to inadequate access to clean water and sanitation facilities. Typical at-risk areas include peri-urban slums, and camps for internally displaced persons or refugees, where minimum requirements of clean water and sanitation are not been met. The consequences of a huma...
A multifaceted approach is key to control cholera, and to reduce deaths. A combination of surveillance, water, sanitation and hygiene, social mobilisation, treatment, and oral cholera vaccines are used.
Cholera surveillance should be part of an integrated disease surveillance system that includes feedback at the local level and information-sharing at the global level. Cholera cases are detected based on clinical suspicion in patients who present with severe acute watery diarrhoea. The suspicion is then confirmed by identifying V. choleraein stool samples from affected patients. Detection can be facilitated using rapid diagnostic tests (RDTs), where one or more positive samples triggers a cholera alert. The samples are sent to a laboratory for confirmation by culture or PCR. Local capacity to detect (diagnose) and monitor (collect, compile, and analyse data) cholera occurrence, is central to an effective surveillance system and to planning control measures. Countries affected by cholera are encouraged to strengthen disease surveillance and national preparedness to rapidly detect and respond to outbreaks. Under the International Health Regulations, notification of all cases of choler...
The long-term solution for cholera control lies in economic development and universal access to safe drinking water and adequate sanitation. Actions targeting environmental conditions include the iimplementation of adapted long-term sustainable WASH solutions to ensure use of safe water, basic sanitation and good hygiene practices in cholera hotspots. In addition to cholera, such interventions prevent a wide range of other water-borne illnesses, as well as contributing to achieving goals related to poverty, malnutrition, and education. The WASH solutions for cholera are aligned with those of the Sustainable Development Goals (SDG 6).
Cholera is an easily treatable disease. The majority of people can be treated successfully through prompt administration of oral rehydration solution (ORS). The WHO/UNICEF ORS standard sachet is dissolved in 1 litre (L) of clean water. Adult patients may require up to 6 L of ORS to treat moderate dehydration on the first day. Severely dehydrated patients are at risk of shock and require the rapid administration of intravenous fluids. These patients are also given appropriate antibiotics to diminish the duration of diarrhoea, reduce the volume of rehydration fluids needed, and shorten the amount and duration of V. choleraeexcretion in their stool. Mass administration of antibiotics is not recommended, as it has no proven effect on the spread of cholera may contribute to antimicrobial resistance. Rapid access to treatment is essential during a cholera outbreak. Oral rehydration should be available in communities, in addition to larger treatment centres that can provide intravenous flu...
Health education campaigns, adapted to local culture and beliefs, should promote the adoption of appropriate hygiene practices such as hand-washing with soap, safe preparation and storage of food and safe disposal of the faeces of children. Funeral practices for individuals who die from cholera must be adapted to prevent infection among attendees. Further, awareness campaigns should be organised during outbreaks, and information should be provided to the community about the potential risks and symptoms of cholera, precautions to take to avoid cholera, when and where to report cases and to seek immediate treatment when symptoms appear. The location of appropriate treatment sites should also be shared. Community engagement is key to long term changes in behaviour and to the control of cholera.
Currently there are three WHO pre-qualified oral cholera vaccines (OCV): Dukoral®, Shanchol™, and Euvichol-Plus®. All three vaccines require two doses for full protection. Dukoral® is administered with a buffer solution that, for adults, requires 150 ml of clean water. Dukoral can be given to all individuals over the age of 2 years. There must be a minimum of 7 days, and no more than 6 weeks, delay between each dose. Children aged 2 -5 require a third dose. Dukoral® is mainly used for travellers. Two doses of Dukoral® provide protection against cholera for 2 years. Shanchol™ and Euvichol-Plus® are essentially the same vaccine produced by two different manufacturers. They do not require a buffer solution for administration. They are given to all individuals over the age of one year. There must be a minimum of two weeks delay between each dose of these two vaccines. Two doses of Shanchol™ and Euvichol-Plus® provide protection against cholera for three years, while one dose provides sh...
- Risk Factors
Cholera is a bacterial disease usually spread through contaminated water. Cholera causes severe diarrhea and dehydration. Left untreated, cholera can be fatal in a matter of hours, even in previously healthy people.Modern sewage and water treatment have virtually eliminated cholera in industrialized countries. The last major outbreak in the United States occurred in 1911. But cholera is still present in Africa, Southeast Asia and Haiti. The risk of cholera epidemic is highest when poverty, wa...
Most people exposed to the cholera bacterium (Vibrio cholerae) don't become ill and never know they've been infected. Yet because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water. Most symptomatic cases of cholera cause mild or moderate diarrhea that's often hard to distinguish from diarrhea caused by other problems.Only about 1 in 10 infected people develops more-serious signs and symptoms of cholera, usually within a few...
A bacterium called Vibrio cholerae causes cholera infection. However, the deadly effects of the disease are the result of a potent toxin called CTX that the bacterium produce in the small intestine. CTX binds to the intestinal walls, where it interferes with the normal flow of sodium and chloride. This causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes).Contaminated water supplies are the main source of cholera infectio...
Everyone is susceptible to cholera, with the exception of infants who derive immunity from nursing mothers who have previously had cholera. Still, certain factors can make you more vulnerable to the disease or more likely to experience severe signs and symptoms. Risk factors for cholera include: 1. Poor sanitary conditions. Cholera is more likely to flourish in situations where a sanitary environment — including a safe water supply — is difficult to maintain. Such conditions are common to ref...
Cholera can quickly become fatal. In the most severe cases, the rapid loss of large amounts of fluids and electrolytes can lead to death within two to three hours. In less extreme situations, people who don't receive treatment may die of dehydration and shock hours to days after cholera symptoms first appear.Although shock and severe dehydration are the most devastating complications of cholera, other problems can occur, such as: 1. Low blood sugar (hypoglycemia). Dangerously low levels of bl...
Cholera is rare in the United States with the few cases related to travel outside the U.S. or to contaminated and improperly cooked seafood from the Gulf Coast waters.If you're traveling to cholera-endemic areas, your risk of contracting the disease is extremely low if you follow these precautions: 1. Wash hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water are...
Feb 29, 2020 · The cholera epidemic was often blamed on immigrants, and nativist groups like the Know-Nothing Party would occasionally revive fear of disease as a reason to restrict immigration. Immigrant communities came to be blamed for the spread of the disease, yet the immigrants were really cholera's most vulnerable victims.
Cholera outbreaks can spread rapidly, cause many deaths, and quickly become a serious public health issue. It is nearly impossible to prevent cholera from being introduced into an area, but the spread of disease can be prevented through early detection, confirmation of cases, and a coordinated, timely, and effective response.
Jan 23, 2018 · In August 1854, Soho in London was struck with a severe cholera outbreak. Cholera is a gastrointestinal infection caused by the bacterium Vibrio cholerae.It is still prevalent in areas with inadequate sanitation and poor food and water hygiene and remains a major global public health problem today.
- Plague of Justinian—No One Left to Die
- Black Death—The Invention of Quarantine
- The Great Plague of London—Sealing Up The Sick
- Smallpox—A European Disease Ravages The New World
- Cholera—A Victory For Public Health Research
Three of the deadliest pandemics in recorded history were caused by a single bacterium, Yersinia pestis, a fatal infection otherwise known as the plague. The Plague of Justinian arrived in Constantinople, the capital of the Byzantine Empire, in 541 CE. It was carried over the Mediterranean Sea from Egypt, a recently conquered land paying tribute to Emperor Justinian in grain. Plague-ridden fleas hitched a ride on the black rats that snacked on the grain. The plague decimated Constantinople and spread like wildfire across Europe, Asia, North Africa and Arabia killing an estimated 30 to 50 million people, perhaps half of the world’s population. “People had no real understanding of how to fight it other than trying to avoid sick people,” says Thomas Mockaitis, a history professor at DePaul University. “As to how the plague ended, the best guess is that the majority of people in a pandemic somehow survive, and those who survive have immunity.”
The plague never really went away, and when it returned 800 years later, it killed with reckless abandon. The Black Death, which hit Europe in 1347, claimed an astonishing 200 million lives in just four years. As for how to stop the disease, people still had no scientific understanding of contagion, says Mockaitis, but they knew that it had something to do with proximity. That’s why forward-thinking officials in Venetian-controlled port city of Ragusa decided to keep newly arrived sailors in isolation until they could prove they weren’t sick. At first, sailors were held on their ships for 30 days, which became known in Venetian law as a trentino. As time went on, the Venetians increased the forced isolation to 40 days or a quarantino, the origin of the word quarantine and the start of its practice in the Western world. “That definitely had an effect,” says Mockaitis. READ MORE: How Rats and Fleas Spread the Black Death
London never really caught a break after the Black Death. The plague resurfaced roughly every 20 years from 1348 to 1665—40 outbreaks in 300 years. And with each new plague epidemic, 20 percent of the men, women and children living in the British capital were killed. By the early 1500s, England imposed the first laws to separate and isolate the sick. Homes stricken by plague were marked with a bale of hay strung to a pole outside. If you had infected family members, you had to carry a white pole when you went out in public. Cats and dogs were believed to carry the disease, so there was a wholesale massacre of hundreds of thousands of animals. The Great Plague of 1665 was the last and one of the worst of the centuries-long outbreaks, killing 100,000 Londoners in just seven months. All public entertainment was banned and victims were forcibly shut into their homes to prevent the spread of the disease. Red crosses were painted on their doors along with a plea for forgiveness: “Lord hav...
Smallpox was endemic to Europe, Asia and Arabia for centuries, a persistent menace that killed three out of ten people it infected and left the rest with pockmarked scars. But the death rate in the Old World paled in comparison to the devastation wrought on native populations in the New World when the smallpox virus arrived in the 15th century with the first European explorers. The indigenous peoples of modern-day Mexico and the United States had zero natural immunity to smallpox and the virus cut them down by the tens of millions. “There hasn’t been a kill off in human history to match what happened in the Americas—90 to 95 percent of the indigenous population wiped out over a century,” says Mockaitis. “Mexico goes from 11 million people pre-conquest to one million.” Centuries later, smallpox became the first virus epidemic to be ended by a vaccine. In the late 18th-century, a British doctor named Edward Jenner discovered that milkmaids infected with a milder virus called cowpox se...
In the early- to mid-19th century, choleratore through England, killing tens of thousands. The prevailing scientific theory of the day said that the disease was spread by foul air known as a “miasma.” But a British doctor named John Snow suspected that the mysterious disease, which killed its victims within days of the first symptoms, lurked in London’s drinking water. Snow acted like a scientific Sherlock Holmes, investigating hospital records and morgue reports to track the precise locations of deadly outbreaks. He created a geographic chart of cholera deaths over a 10-day period and found a cluster of 500 fatal infections surrounding the Broad Street pump, a popular city well for drinking water. “As soon as I became acquainted with the situation and extent of this irruption (sic) of cholera, I suspected some contamination of the water of the much-frequented street-pump in Broad Street,” wrote Snow. With dogged effort, Snow convinced local officials to remove the pump handle on th...
- Dave Roos
Jul 19, 2019 · The 1849 London Outbreak . While Cholera has existed in Northern India for centuries (and it is from this region that regular outbreaks are spread) it was the London outbreaks that brought cholera to the attention of British physician Dr. John Snow.