Introduction
Though cholera is known as a rare disease in the US, it is quite prevalent in the continents of Africa and Asia. According to the World Health Organization (WHO), there are reportedly 1.3 to 4 million people around the world that are infected with cholera every year. With a global estimate of 21,000 to 143,000 deaths per year. This evidence reveals that cholera is a life-threatening disease.
What is cholera? The Centers for Disease Control & Prevention (CDC) calls it an infection caused by Vibrio cholerae, a type of bacterium. It’s described as a comma-like V shape. Cholera thrives in slightly salty and coastal waters, which its most ideal condition is low river flows at warm air temperatures. Although, those aren’t the only places where one can get cholera from.
WHO mentions that there are multiple, different strains of cholera but only two cause outbreaks, as of discovered. The V. cholerae O1 is to blame for the cause of all recent cholera outbreaks. While V. cholerae O139 is mostly affected within Asia. It was first identified in 1992 of Bangladesh and only recently identified in sporadic cases.
US vs. the World
Why is the discussion of cholera only applicable to countries but the US? Well, the high-risk factor areas are typically underdeveloped countries, or places with population proximity. Proximity does not mean direct transmission of the disease because that’s unlikely. Since cholera is transmitted through feces (poop), which usually is contaminated in foods and drinking liquids such as seafood or well water, the chance of exposure to cholera is most common in areas that lack cleanliness. By cleanliness, it means spaces that lack proper water supplies and sewage system. The highest risk of infection is when a place is experiencing poverty, war, or natural disasters. As referenced by New York’s Department of Health’s Cholera Fact Sheet, continents like Africa, Central/South America, and Southeast Asia. However, cholera does not only have to be contained in one part of the world.
Other Risk Factors
As Mayo Clinic lists: poor sanitary conditions, reduced or nonexistent stomach acid, household exposure, type O blood (unclear reasons), and raw or undercooked shellfish are all other ways to acquire cholera. For example, US residents that travel abroad to places of poverty and poor sanitation might be exposed to cholera and bring the disease back with them. If one is infected previously, they can be reinfected if they encounter cholera again. One might ask, how is the US traveler not aware of their infection?
Symptoms
Often, cholera-infected persons can attain the disease without showing symptoms despite the bacteria being present in their feces for 1-10 days after infection. If patients do develop symptoms, a majority have mild or moderate levels of symptoms. Mayo Clinic shares: mild to severe watery diarrhea, vomiting, dehydration, and electrolyte imbalance (cramps). While the Pan American Health Organization (PAHO) adds, the incubation period (how long the bacteria’s growing within the human body) is said to take about 2 hours to 5 days. During this short period of time, the toxins produced by bacteria occur in the small intestine, which secretes enormous amounts of water from its host’s body. This results in excessive dehydration, one of the more major symptoms to look out for.
Real-life Outbreak
Apart from just learning about the disease itself, a couple of professors from the University of Rhode Island wrote an article about cholera and how it affects a certain demographic of people with real life examples. In 2010, Haiti had a cholera outbreak that caused nearly 10,000 deaths. It’s said that a combination of factors caused the outbreak: lack of safe water and sanitation system, elevated air temperatures, and above average rainfall. Looking at Figure 2, once the daily rain increased to almost 100mm/day on November 15, the number of cholera cases immediately followed through the rest of November. This emphasizes that the sudden rainfall caused the spike in cases. That is so because the rainfall would lead to flooding and/or raw sewage contamination of water sources, which ruins supplies for that area’s community.
Testing for Diagnosis
There is a way to test whether one is diagnosed with cholera. Rapid cholera dipstick tests can be used by doctors – especially best in remote areas – for a quicker confirmation of the diagnosis of the disease. Once finding out about diagnosing cholera, a few types of treatment include rehydration, intravenous fluids, antibiotics, and zinc supplements. Rehydration is a type of oral rehydration salt solution in powdered form, mixed with treated or boiling water to be consumed. Intravenous fluids are fluids containing sodium, potassium, and bicarbonate, and are used for patients with severe diarrhea. Zinc supplements, especially for children, and antibiotics are also used to reduce diarrhea. All these different types of treatments should be quickly received as soon as possible because immediate death is highly possible for cholera-diagnosed patients. Additionally, CDC advises patients not to drink fluids with high sugar content like juice or soda because it’ll worsen the diarrhea problem. Water and broth are recommended to be the better alternatives.
Developed and revised by WHO in 2016, they’ve designed six kits to treat cholera patients. One for investigation, one with supplies for culture confirmation in lab, three for treatment of each community, and one support kit with logistical materials such as solar lamps and water bladders. Each kit’s designed to treat a hundred patients approximately.
Vaccinations
Before needing to go through all this just for cholera, why not attempt to protect people from cholera in the first place? With vaccinations that can boost up the immune system? It’s understood that vaccines are for preventative measures, not to cure diseases – like cholera. On CDC’s website, it has stated that the FDA-approved vaccine for use in the US is Vaxchora. It’s researched to reduce the chance of severe diarrhea between ages 18-45 at 10 days after the vaccination. However, it’s open to all ages between 2-64. Americans usually take the Vaxchora when they’re about to travel to a country exposed to cholera. Meanwhile, WHO had pre-qualified the Dukoral, Shanchol, and Euvichol-Plus vaccines, that aren’t available to the US. All three vaccinations require two doses for full protection. The differences between these three vaccines are the age groups, how long the time it takes for it to be effective, and how it’s administered. For Dukoral, it can be given to anyone over the age of 2, two years of protection for two doses, and it’s administered with a buffer solution for adults, which requires 130mL of clean water. CDC quickly made note, “It’s unknown how long protection lasts beyond 3 months.” Shanchol and Euvichol-Plus share many more commonalities like being given to anyone over the age of 1, two doses equal to three years of protection, and not requiring any buffer solution for administration. The only difference between the two is Shanchol can only be stored in a controlled temperature chain, under traditional two to eight Celsius, while the other doesn’t.
Conclusion
Therefore, the evidence throughout historical events and scientific research proves that cholera is a deadly disease. The rate that it spreads within the community and in the human body is dangerously quick and could even cause immediate death. It’s important to be aware of cholera’s capabilities and make sure to take precautions before encountering this disease.
References
CDC. (2024, May 12). About Cholera. Retrieved from CDC: https://www.cdc.gov/cholera/about/index.html#:~:text=People%20usually%20get%20cholera%20from,slightly%20salty)%20and%20coastal%20waters.
Jutla, A., Whitcombe, E., Hasan, N., Haley, B., & Akanda, A. S. (2013). Environmental Factors Influencing Epidemic Cholera. Retrieved from Digital Commons for University of Rhode Island: https://digitalcommons.uri.edu/cgi/viewcontent.cgi?article=1013&context=cve_facpubs
Mayo Clinic Staff. (2022, December 9). Cholera. Retrieved from Mayo Clinic: https://www.mayoclinic.org/diseases-conditions/cholera/symptoms-causes/syc-20355287
New York State Depart. of Health. (2017, August). Cholera. Retrieved from New York State Depart. of Health: https://www.health.ny.gov/diseases/communicable/cholera/fact_sheet.htm#:~:text=How%20is%20cholera%20spread%3F,water%20supplies%20and%20sewage%20disposal.
PAHO. (n.d.). Cholera. Retrieved from PAHO: https://www.paho.org/en/topics/cholera#:~:text=Cholera%20is%20an%20acute%20diarrheal,two%20hours%20and%20five%20days.
WHO. (2023, December 11). Cholera. Retrieved from WHO: https://www.who.int/news-room/fact-sheets/detail/cholera#:~:text=Researchers%20have%20estimated%20that%20each,treated%20with%20oral%20rehydration%20solution. Assessed and Endorsed by the MedReport Medical Review Board