CHOLERA: the Death-Dealing Disease, Our Life-Saving Choices.
The year was 1854, and London was in the grip of yet another outbreak of cholera—an intestinal ailment characterized by severe diarrhea and dehydration. The disease struck with alarming speed. Many who awoke in good health were dead by nightfall. There was no known cure.
Some thought cholera was contracted by inhaling offensive odors from decaying organic matter. Their suspicions were understandable. The River Thames, which coursed through London, emitted a horrible stench.
Five years earlier, a physician named John Snow had suggested that cholera was caused, not by contaminated air, but by contaminated water. Another physician, William Budd, believed that a fungus-like living organism carried the disease.
During the 1854 epidemic, Snow tested his theory by studying the lives of those who had contracted cholera in the London district of Soho. ‘What do they have in common?’ he wondered. Snow’s investigation led to a startling discovery. All who contracted cholera in that district had obtained drinking water from the same street pump, and that water was contaminated by cholera-infected sewage!
That same year saw another medical milestone when Italian scientist Filippo Pacini published a paper describing the living organism that caused cholera. For the most part, however, his research was ignored, along with the findings of Snow and Budd. The cholera scourge raged on—that is, until 1858.
“THE GREAT STINK”
Parliament had been sluggish about building a new sewage system to clean up the Thames, but the heat wave that arrived during the summer of 1858 forced the issue. The stench from the river that flowed past the House of Commons was so overwhelming that the politicians were forced to hang drapes soaked in disinfectant over their windows in an attempt to disguise the smell. What came to be called the Great Stink pushed Parliament into action. Within 18 days, it ordered the building of a new sewage system.
Huge drains were constructed to intercept sewage before it reached the river and then to transport it to the east of London, where it eventually flowed into the sea on the ebb tide. The results were dramatic. Once all London was connected to the new system, the cholera epidemics ended.
By now, there was no doubt: Cholera was not caused by foul air but by contaminated water or food. Also clear was the key to prevention—SANITATION.
A LAW AHEAD OF ITS TIME
Thousands of years before cholera epidemics raged through London, Moses led the nation of Israel out of Egypt. Although they trekked through the Sinai wilderness for some 40 years, the Israelites remained free from epidemics such as cholera. How was that possible?
The nation was directed to bury human waste in a private place away from the camp so that the living area and water sources would not become contaminated. That regulation is recorded in the Bible at Deuteronomy 23:12, 13, which states:
“Set up a place outside the camp to be used as a toilet area. And make sure that you have a small shovel in your equipment. When you go out to the toilet area, use the shovel to dig a hole. Then, after you relieve yourself, bury the waste in the hole.”—“Contemporary English Version.”
STACKING THE STATS
Serious statistics like these from the World Health Organization (WHO) are vital to understanding the problem that is Cholera Disease and leaning towards the solution.
•>47%: of reported cholera cases in 2013 occurred in the Americas, mostly in Haiti
•80%: of cholera cases can be treated using only Oral Rehydration Salts (ORS)
•748 million: people in the world do not use improved sources of drinking water
NIGERIANS VOTE . . . TO STAY ALIVE!
The season of choices is upon us. Campaigns are in top gear. The drums beat, talk made cheap nibbles at the hearts and heads of citizens. But the politicians are not alone, because the headlines don’t lie.
•Cholera outbreak kills 20 in Rivers—Daily post. January 15, 2015
•Nigeria: Death Toll in Bayelsa Cholera Outbreak Hits 23—All Africa News. 28 January 2015
•No fewer than eight of 25 cases of cholera recorded in Anambra State in January 2015 have died—The Nigerian Observer. January 29, 2015
Sure! It is merely stating the obvious when said that Cholera is out on a massive campaign for Nigerian lives. Therefore the popular cliché to “vote wisely” must be kept close to our hearts today if we wish to live to vote right tomorrow. We must vote Cholera out today! But how?
Since cholera is caused by contaminated food or water, the key to prevention lies in taking adequate precautions regarding anything that enters the mouth. Purifying water and thoroughly cooking food are essential safety measures. It would help, however, to recount and reflect upon what I love to call the “ten points agenda of Cholera” as outlined by World Health Organization (WHO).
FACT I: Cholera is an acute diarrhoeal disease that can kill within hours if left untreated. It is an acute infection of the gut, caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae O1 or O139, which can lead to rapid dehydration if left untreated.
FACT II: There are 100 000–120 000 deaths due to cholera every year of which only a small proportion are reported to WHO. There also are an estimated 3–5 million cholera cases every year, contrasting with the 178 000–589 000 cases reported annually to WHO over the past five years.
FACT III: Up to 80% of cases can be successfully treated with oral rehydration salts (ORS). However, very severely dehydrated patients only require administration of intravenous fluids. Such patients also require appropriate antibiotics to diminish the duration of diarrhea, reduce the volume of rehydration fluids needed, and shorten the duration of V. cholerae excretion.
FACT IV: About 75% of people infected with Vibrio cholerae O1 or O139 do not develop any symptoms. Among the ones developing cholera, 80% have mild or moderate diarrhoea. Where sanitation facilities are not available bacteria are shed back into the environment, which is a source of further potential infection.
FACT V: Typical at-risk areas of cholera include peri-urban slums with limited access to safe drinking water and lack of proper sanitation. Risk of cholera is highest in areas where basic infrastructure is not available, as well as in camps for internally displaced population or refugees, where minimum requirements of clean water and sanitation are not met.
FACT VI: Surveillance is paramount to identify vulnerable populations living in hotspots. Surveillance should guide interventions and lead to timely prevention and preparedness activities. When seasonal occurrence can be anticipated, prevention and control must be enhanced and activities such as preparedness plans, training of healthcare staff and pre-positioning of supplies must take place.
FACT VII: Cholera is a preventable disease provided that safe water and proper sanitation are made available. Cholera control depends on far more than the prompt medical treatment of cases. The interplay of prevention,preparedness and response focusing on water safety and proper sanitation, together with an efficient surveillance system are paramount for mitigating outbreaks and diminishing case fatality rates.
FACT VIII: Once an outbreak is detected it is important to focus on treatment and control measures. The usual intervention strategy, in an outbreak, is to reduce deaths by ensuring prompt access to adequate treatment, and to control the spread of the disease by providing safe water, proper sanitation, and health education for improved hygiene and safe food handling practices by the community.
FACT IX: Safe and effective oral cholera vaccines are now part of the cholera control package. Two types of vaccines are WHO-prequalified. They are licensed in several countries and have shown to provide sustained protection of >50% against cholera among all age groups that lasts for two years in cholera endemic populations.
The vaccines should target vulnerable populations living in high risk areas. Vaccination should not disrupt the provision of other proven interventions to control or prevent cholera epidemics.
FACT X: Today, no country requires proof of cholera vaccination as a condition for entry. Past experience shows that quarantine measures and embargoes on the movement of people and goods are unnecessary.
HEALTHFUL-Words (This week’s Health Quote).
To conclude this week’s Episode, here is a quote to reflect on:
“Our world is one of terrible contradictions. Plenty of food but one billion people go hungry. Lavish lifestyles for a few, but poverty for too many others. Huge advances in medicine while mothers die everyday in childbirth, billions spent on weapons to kill people instead of keeping them safe” —Ban Ki-moon.
And so the curtain is drawn for this week. Until next week, it’s safe to say— Ishamali Azi!!!
Since You Are Here, Support Good Journalism
CrossRiverWatch was founded on the ideals of deploying tech tools to report in an ethical manner, news, views and analysis with a narrative that ensures transparency in governance, a good society and an accountable democracy.
Everyone appreciates good journalism but it costs a lot of money. Nonetheless, it cannot be sacrificed on the altar of news commercialisation.
Consider making a modest contribution to support CrossRiverWatch's journalism of credibility and integrity in order to ensure that all have continuous free access to our noble endeavor.