Why does cholera cause problems in the aftermath of disasters such as the earthquake in Haiti?
Cholera is an extremely severe form of gastroenteritis. It’s caused by an organism called Vibrio cholerae, which triggers a watery diarrhea. The passage of frequent, voluminous diarrhea can very rapidly dehydrate a person and result in death. Children are most susceptible because of their smaller size, and are more often among the fatalities.
Vibrio cholerae survives well in water—the most common agent in transmission—and once a case occurs in a family, other household residents will very likely become infected. Food may become contaminated, and cholera is spread where sanitation is poor.
The outbreak of cholera in Haiti in 2010* was not fully anticipated because there had been no cases of cholera for a long time. How the organism reached Haiti has not yet been determined.
The disruption to water supplies and the lack of sewage treatment and disposal result in ideal conditions for a cholera epidemic.
The severity and speed of a cholera epidemic can be gauged from the fact that, in Haiti, the first cases were reported on October 21, 2010; by November 19, every part of the country had experienced cases. By December 17, some 121, 500 cases had been reported. The burden of diarrhea on a reeling country was enormous: 63,711 people had to be hospitalized, and 2,591 deaths had been reported. Many more cases will have occurred since then, with transmission by travelers to the adjacent country of the Dominican Republic and to the U.S. state of Florida.
Fluid replacement is the key to managing any kind of diarrhea, but it’s lifesaving in cholera. Not all cases are quite the same, and treatment with antibiotics may not always be required. Both doxycycline and ciprofloxacin have been shown to shorten the illness and result in more rapid clearing of the illness.
It’s important to note that anyone who visits a country in which cholera is present and comes down with abdominal cramping, diarrhea and vomiting, lethargy, or weakness needs to see a healthcare professional.
The risk of cholera and other diarrheal diseases can be much reduced by the drinking of safe water. The boiling of water or its proper treatment with chlorine will sterilize it. Canned or bottled water is usually safe if supplied by a reputable company.
Vigorous attention to eating only food that has been cooked and served hot reduces risk. Hand washing with soap and clean water, as well as the frequent use of hand sterilizers, is another important factor. Swimming or bathing in rivers or canals is very unwise, because they may be contaminated with sewage.
Until all countries are free of cholera, all other countries need to remain on alert. With travel as frequent and global as it is today, disease acquired halfway around the world can appear in your home the next day.
Experience with the cholera vaccine has been disappointing. It’s no longer recommended for U.S. travelers, and the World Health Organization (WHO) does not recommend it. The taking of antibiotics as a preventative for cholera is also not recommended, as there is little evidence of its efficacy.
Although cholera is in the news and much to be feared, most cases of acute diarrhea are not caused by cholera. The viral causes of gastroenteritis are still very prevalent, and pathogenic E. coli are still frequent causes of diarrhea. Bloody diarrhea, associated with fever, is more serious and may reflect infection with bacterial pathogens in the shigella, salmonella, or yersinia families. Oral rehydration is a mainstay, and specially formulated packages of rehydration salts to be added to clean water may be readily purchased.
While one trusts God to protect us, He expects us to do our part in safeguarding our health.