Cholera is a familiar name for an ailment that is not well understood in modern western society. It was eradicated in many developed nations years ago, though cholera has recently made a comeback across the globe due to changing weather patterns, increased globalism, and other factors that are not well understood.
Cholera is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.
Cholera was last common in the U.S. in the 19th Century, before modern water and sewage treatment systems prevented its spread via contaminated water. Today, only 5-10 cases of cholera are reported annually in the U.S., and half of those are contracted abroad. Due to its waterborne nature, rare cases of cholera outbreaks can occur in the U.S. due to contaminated seafood.
In spite of its extreme rarity in the U.S. and Western Europe, cholera outbreaks are still a serious health problem in other parts of the world. The World Health Organization documents over 150,000 cases each year.
Cholera is most common in places with poor sanitation systems, overcrowding, active war zones, and famine. Cholera is still considered an epidemic in parts of Africa, South Asia, and Latin America.
Tropical climates that never get cold enough to kill bacteria combine with wet soil and unsanitary groundwater to mix with most drinking water supplies, allowing a single case of cholera to spread to entire communities and preventing the bacteria from ever being truly eradicated from regions with overcrowded, rapidly developing cities.
In recent years, storms and political turmoil have interfered with local water supplies and created sanitation crises and cholera outbreaks in countries across the globe.
Global Disease Transmission
A recent cholera outbreak in Haiti claimed tens of thousands of lives, and the country has repeatedly claimed that it had the disease completely under control before visitors from foreign countries brought it back into its borders.
After deliberations dating back to 2010, it was determined that the outbreak began near a United Nations peacekeepers’ camp, where nearly 500 people freshly arrived from Nepal, where an ongoing cholera outbreak was occurring at the time.
The disease has killed over ten thousand people and infected hundreds of thousands more in Haiti since its reintroduction, and since its recent natural disaster woes critically damaged infrastructure, the nation is now struggling to manage cholera once again.
This story is tragically familiar across the globe–developing nations manage to radically reduce the infection rate of cholera and other sanitation-related diseases, only to suffer a setback in the form of natural disaster or war that damages infrastructure and leads to high-risk transmission behaviors like obtaining water from unverified sources.
In a nation like Haiti, where civil progress effectively eradicated the disease, its reintroduction shortly after a devastating earthquake has had sobering consequences. In nations with underdeveloped medical systems that are no longer actively treating cholera, keeping up with the medical load of fast-spreading epidemics can prove daunting if not impossible.
In nations that still struggle with cholera, like Bangladesh, vaccines have been created and programs implemented in an effort to curtail cholera’s devastating effects. Nations which recognize their ineffective infrastructure or climates that make eliminating the disease nearly impossible are combating its spread by immunizing humans to its effects. But in regions where cholera is no longer common, an outbreak can have devastating consequences before medical professionals ever realize what’s happening.
Transmission and Treatment
Part of what makes cholera so devastating is that it kills so quickly and can be transmitted rapidly. Within hours of becoming symptomatic, patients often lose so much fluid through acute gastrointestinal distress that they are critically dehydrated. While specialized blends of fluids and antibiotics can rapidly restore health, missing the treatment window renders patients incapacitated and further increases the risk of transmission.
Many tropical countries with underdeveloped water and sanitation infrastructure harbor massive amounts of cholera bacteria in groundwater and sewage systems, which often manage to contaminate public water supplies. Once an outbreak begins, the contamination worsens through infected individuals’ diarrhea and vomit, which are both constant presences in cholera patients. Those tending to the ill often fall ill, and classic epidemic conditions rapidly occur.
Thanks to the rapid travel and warmer climate of the 21st Century, infected individuals can now bring the disease to areas which have not seen it in over a century, which then creates new epidemics as those regions struggle to treat the infected and contain its spread. Recent civil wars and unrest across the globe have worsened these issues as disruptions to civil utility services and violent threats to hospitals prevent people from accessing clean water or proper treatment.
War and Cholera
In Yemen, a brutal civil war has created even worse epidemic conditions, as the already highly-contagious disease is transmitted faster by resource shortages caused by military blockades. Without guaranteed access to water or food, people are forced to compromise on food and sanitation, which leads to infection. And with war causing crowded hospitals and blocking transport of medical supplies, hospitals cannot keep up with the mounting demand for treatment.
The World Health Organization has identified the situation in Yemen as one of the worst outbreaks of cholera in modern times. Combined with restricted access to basic resources like food and roadways, the rapid deterioration and transmission associated with cholera are proving even more damaging than usual. The correlation between survival rate and rapid access to medical care means that war-torn nations are hit particularly hard.
Tamer Kirolos, Save the Children’s country director for Yemen, said an outbreak of this scale and speed is “what you get when a country is brought to its knees by conflict, when a healthcare system is on the brink of collapse, when its children are starving, and when its people are blocked from getting the medical treatment they need”.
Kirolos said: “There’s no doubt this is a man-made crisis. Cholera only rears its head when there’s a complete and total breakdown in sanitation. All parties to the conflict must take responsibility for the health emergency we find ourselves in.”
Cholera In the 21st Century
Yemen and Haiti are two tragically current case studies in the epidemiology of cholera. Whether reintroduced through international travel or exacerbated by civil war, the disease still has the potential to be as devastating as it was when the first outbreaks swept across the world in the 19th Century.
This is held in tragic contrast with nations which can effectively treat patients who appear to be on the brink of death and release them from the hospital the same day they are admitted.
Modern antibiotics and rehydrating solutions are largely effective treatments, and nations like Vietnam and Bangladesh have decided to preempt rapid strains on vulnerable infrastructure by implementing vaccination programs that prevent humans from acting as transmission vectors in crowded cities.
The dichotomy between modern medicine and the strains of population growth, global travel, and human conflict combine to create situations where cholera outbreaks are still imminently possible and always tragic; but, thanks to our understanding of sanitation, disease transmission, and treatment, most outbreaks are much less catastrophic than those of the past.