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Cholera


Cholera [KAHL-er-ah] is a disease caused by the bacterium Vibrio cholerae, which rapidly reproduces in the small intestine, producing a toxin which stimulates the excretion of vast quantities of liquid from the cells of the intestines. The characteristic symptoms are severe diarrhea, usually accompanied by vomiting, resulting in severe dehydration (as well as desalination and depletion of electrolytes). A cholera victim can lose up to 30 liters of liquid in one 24-hour period, producing severe thirst, painful muscle cramps, thickening of the blood, and eventually circulatory and renal collapse. The most obvious treatment involves administering huge amounts of water, most of which, however, is vomited up or passed in diarrhea.

Cholera can be spread from infected people on food or through the air, but is usually transmitted through infected drinking water (although flies may also be transmitters to and from the water). Simply boiling water before its use is one simple and anciently available public health measure that can potentially reduce the impact of an outbreak, although it does nothing for those already infected, making its efficacy less than obvious through most of human history.

The cholera bacterium thrives at a temperature of about 27°C (81°F), but does not survive well in temperatures below 15°C (59°F) or above 42°C (108°F). Outbreaks therefore tend to be confined to tropical regions (or to near-tropical regions during warm periods), especially where there is great population density and contaminated water. A drop in temperature for a time can end an epidemic.

Untreated, cholera has historically been fatal about half of the time, with death coming as soon as a few hours after the first symptoms appear, although death rates are very much lower when antibiotics are applied.

Current thinking is that the disease originated millennia ago in the Ganges and Brahmaputra river basins of northern India, then spread to other warm regions. Since modern-style medical records began early in the XIXth century, at several world-wide pandemics have been described. The first (1817-1823) involved India, eastern Asia, and Africa. The second (1826-1837), although apparently beginning in India, affected Europe and traveled from there to Australia and the Americas. In 1858 an epidemic in India killed about 28,000 people.

Cholera can be effectively treated with antibiotics and the last major pandemic extending to multiple countries was successfully ended in 1926.

Recent Outbreak. In 2010 in the wake of a catastrophic earthquake in Haiti, UN Peacekeepers from Nepal, where a cholera epidemic was under way, assisted in the Haitian rescue and clean-up work. They were headquartered in a makeshift camp near a polluted river, and waste from the camp made the river pollution worse. Included in the pollution was fecal matter from a few Nepali aid workers who had been infected but not yet shown symptoms. This reintroduced cholera to Haiti, producing over 10,000 deaths in the weeks and years that followed. On December 1st, 2016, the United Nations, in its first acknowledgement that the Nepali workers might be the source of the contamination, issued a public apology for the outbreak. The dead people remained dead.

The cholera strain usually found today (Vibrio cholerae El Tor) seems to be less severe, but to be able to survive longer in water, and it may be more antibacterial-resistant. Today worldwide about a quarter million people a year contract cholera, and death rates average from one to four percent, varying greatly by region. By 2018, cholera in Yemen, site of a deadly civil war, was considered by international health authorities to be the most devastating cholera epidemic in modern times.

Sources

This article is based on many sources. The most useful and provocative were:

Francis L.K. HSU
1952 Religion, science, and human crises. London: Routledge & Kegan Paul. Pp. 10, 83.
Vladimir LEMELEV
2010 Antikva, sed ankoraǔ malica gasto. Monato (aǔg-sep):16-17.


 

 

Content Revised: 2018-07-09
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