2023-05-24 15:33:14
In 24 countries we are witnessing an unprecedented surge of this easily treatable intestinal infection if caught early. Here are the symptoms and treatments
Cholera has never stopped being scary. Especially in Africa. But now the situation is becoming dramatic in different parts of the world. The latest report of an epidemic concerns South Africa, where the infectious disease has killed at least 10 people in Gauteng province, the most populous province. This was reported by the health authorities quoted by the local media, according to which At least 95 people have been hospitalized with symptoms of cholera since last Monday in Hammanskraal, an area north of the capital Pretoria, as reported by Agenzia Nova.
The first alarm in March
The first alarm was launched in March by the World Health Organization, during World Water Day and the historic United Nations Conference on Water in New York. The world is facing a wave of cholera, also affecting countries where it hasn’t been seen for decades. Years of progress against this century-old disease are gone. While the situation is unprecedentedthe lesson to be learned is not new: safe drinking water, sanitation and hygiene are the only long-term and sustainable solutions to end this cholera emergency and prevent future ones, wrote the experts of the Global Task Force for Cholera Control (GTFCC) by appealing to countries and the international community to transform this concern into concrete actions.
Just two months later, that cry of alarm was forcefully taken up by Jrme Pfaffmann Zambruni, head of theUnicef Public Health Emergency Unit: The current global cholera situation is unprecedented due to the alarming size of the outbreaks, geographical spread and extraordinarily high rate of deaths. We need to increase intervention capacities.
What is cholera and how is it transmitted?
Cholera an acute diarrheal infection caused by the bacterium Vibrio cholerae. Its transmission takes place by oral contact, direct or indirect, with faeces or contaminated food and in the most serious cases it can lead to dangerous phenomena of dehydration. In the 19th century, cholera spread several times from its original area around the Ganges delta to the rest of the world, giving origin of six pandemics (by pandemic we mean an epidemic manifestation of a disease on a very large scale, even planetary) which have killed millions of people all over the world.
Researchers have estimated that each year there are 1.3 to 4 million cases of cholera and 21,000 to 143,000 deaths worldwide. due to cholera. The seventh pandemic still ongoing: started in 1961 in South Asia, then reaching Africa in 1971 and America in 1991. Today the disease is considered endemic in many countries and the bacterium that causes it has not yet been eliminated from the environment. Cholera is a fecal-oral transmitted disease: it can be contracted following the ingestion of water or food contaminated with faecal material from infected individuals (sick or healthy carriers or convalescents). The foods most at risk for the transmission of the disease are raw or undercooked foods and, in particular, seafood. However, other foods can also serve as a vehicle.
The pandemic of the poor
As Unicef points out, cholera has long been a pandemic of the poor. It disproportionately affects poor and vulnerable communities that lack access to basic services and where health systems are weakest. The disease is increasingly present in fragile and emergency contexts. Since 2019, cholera outbreaks have occurred in more than half of the countries experiencing humanitarian emergencies. The low investment in water and sanitation systems an accurate risk indicator for cholera: 97% of cholera cases from 2010 to 2021 occurred in countries with the lowest water and sanitation levels in the world. Without access to safe water and sanitation, preventing and controlling the transmission of cholera and other waterborne diseases is virtually impossible.
Emergency numbers
Unicef numbers explain the new emergency better than many words: 25 countries have already declared outbreaks since the beginning of 2023. According to a new analysis, 22 more countries around the world are at risk of declaring cholera outbreaks. Over the past 10 years, the world has experienced a steady decline in cholera. But the trend reversed: in 2021 there was a surge in cases which continued in 2023. As of May, 24 countries are reporting cholera outbreaks, up from 15 last year. If the trend continues, especially as West Africa is entering the wet season, we could exceed the annual total number of countries battling outbreaks in 2022 and 2021.
And, as the Global Task Force for Cholera Control has already pointed out, the average mortality rate of current cases is twice the target threshold of less than 1%. And they usually tell us about problems with the quality, access and speed of care. As outbreaks arise in many more countries, we are also seeing more deaths from cholera than ever before. For example, 3 out of 100 people infected with the disease have died in Malawi (since the outbreak began in March 2022) and Nigeria (and Nigeria in 2023).
In Malawi, where a serious humanitarian crisis is underway, a cholera epidemic has already claimed 1,759 lives. The children of Malawi are at the center of a global polycrisis. Food insecurity, exacerbated by a growing climate crisis, disease outbreaks and a global economic downturn, threatens to wreak havoc and disrupt the lives of millions of children, said the country’s UNICEF representative Gianfranco Rotigliano. The prospect of having over half a million children suffering from unacceptable malnutrition. Without an immediate response, the impact on these vulnerable children will be deadly, he adds
A treatable disease
Yet it is an easily treatable disease. Most people can be treated successfully with the prompt administration of an oral rehydration solution. Providing clean water and treating wastewater properly protects people from infection. There is also an oral vaccine.
In an article published on The Conversation
, microbiologist Sam Kariuki, director of Kenya’s Medical Research Institute, tries to explain why cholera is so difficult to control in Africa. In my opinion, governments in endemic areas do not recognize cholera as a serious problem until there is a major epidemic, when it is out of control – he writes among other things -. Some countries still deny the outbreaks. This is partly due to fears of repercussions on trade and tourism. But in an interconnected world this attitude is useless. What is missing is a concerted effort for all endemic countries – which I consider to be all sub-Saharan African countries – to have joint measures in place to address the transboundary transmission and persistence of cholera epidemics.
Little support for prevention campaigns
What to do? In November 2022, Unicef appeals to donors for $150 million to respond to cholera outbreaks. But support has been scant. Since then, in just six months, the appeal for funding has grown by 220%, while the situation has become more and more serious. Inaction costs lives, and money.
The situation is set to worsen. We know it’s not a matter of if, but when. We are seeing climate change as a multiplier of vulnerability. As climate shocks increase in number and intensity and temperatures rise, damage to water and sanitation services will increase, contamination of safe water sources and an increase in the displacement of people. Think, for example, of cyclones like Freddy in Mozambique and Malawi, the floods in Pakistan and Nigeria last year or the drought in the Horn of Africa, which have created favorable conditions for waterborne diseases.
In the aftermath of Cyclone Mocha in Myanmar and Bangladesh, Unicef fears that the risk of waterborne diseases could increase in the coming days, points out Pfaffmann Zambruni who returns to urgently ask for 480 million dollars for immediate preventive interventions and response to cholera in the areas of health, water and sanitation and risk communication and community engagement for social and behavioral change.
In 2017, WHO launched a suggestively named global cholera control strategy: Ending Cholera: a global roadmap to 2030, with the goal of reducing cholera deaths by 90%. At this rate, however, more than a goal risks becoming a mirage.
May 24, 2023 (change May 24, 2023 | 3:46 pm)
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