How cholera in Haiti began after earthquake

Two years after an earthquake shook Haiti, the small country grappled with the death, the destruction and the debris.

After the earthquake on January 12, another health crisis struck about 10 months later: cholera.

The bacterial disease brings about a painful death, as quickly as within two to three hours, because of the amount of fluid and electrolytes that are lost.  Symptoms are watery diarrhea, dehydration, nausea and vomiting.  

Cholera spreads through contaminated water.  While it has largely been eradicated in the West, it has been known to come back during war or natural disasters when people are forced to live in crowded places without proper sanitation and clean water.

So far, cholera has killed 7,000 people and infected 520,000 people, according to the Pan American Health Organization.

Medical workers continue to encounter about 200 new cases everyday, said Dr. Jon Andrus, deputy director of PAHO, which is part of the World Health Organization.

In an article published in the American Journal of Tropical Medicine Monday, the authors identified who they believe to be the first to get cholera in Haiti after the earthquake.  An 28-year-old man with mental illness from the town of Mirebalais was suffering from hallucinations, disorganized thoughts and paranoia, according to the article written by Dr. Louise Ivers and Dr. David Walton from Harvard Medical School and Partners in Health.

The man was known to wander through town naked, and drank from and bathed in the in the Latem River. He fell ill with watery diarrhea and within a day of showing symptoms, the man died.  The two people who prepared the body for his funeral also developed watery diarrhea.

There is no lab method to confirm that this was the first patient to start the epidemic, wrote the authors. “This patient’s case is the first in the community’s collective memory to have had symptoms that are recognizable, in retrospect, to be those of cholera,” according to the study released Monday.

The patient had an underlying mental health condition that led him to drink from the river and this contributed to his illness, the authors concluded.

The cholera epidemic has continued to spread even until today. The infection spread to the neighboring Dominican Republic, and individual cases were exported to the United States, such as Boston and Miami.

By sequencing the genome of the cholera strain, researchers found that it was nearly identical to strains circulating in South Asia, according to a study published online in the New England Journal of Medicine last year.

An independent report later linked the outbreak to peacekeepers from Nepal.  According to the report, fecal matter from the U.N. camp where the Nepalese were based was improperly routed by a contractor and "this contamination initiated an explosive cholera outbreak downstream in the Artibonite River Delta and eventually throughout Haiti.”

The best way to prevent cholera is to get clean water and better sanitation.  Treatment for the disease is immediately necessary through rehydration, intravenous fluids, antibiotics and zinc supplements.

The authors wrote, “Such discussion is not intended as an attempt to attribute blame.  Rather, the case should cause reflection for global health practitioners on the importance of the increasing interconnectedness of globalization for public health.”

Cholera

Is an infection in the small intestine caused by the bacterium vibrio cholorae.

The main symptoms are profuse, watery diarrhea and vomiting. Transmission occurs primarily by drinking water or eating food that has been contaminated by the feces of an infected person, including one with no apparent symptoms. The severity of the diarrhea and vomiting can lead to rapid dehydration andelectrolyte imbalance, and death in some cases.


The primary treatment is oral rehydration therapy, typically with oral rehydration solution (ORS), to replace water and electrolytes. If this is not tolerated or does not provide improvement fast enough, intravenous fluids can also be used.


Antibacterial drugs are beneficial in those with severe disease to shorten its duration and severity. Worldwide, it affects 3–5 million people and causes 100,000–130,000 deaths a year as of 2010. Cholera was one of the earliest infections to be studied by epidemiological methods.


Taken from:http://en.wikipedia.org/wiki/Cholera

A short animated film produced by the Global Health Media Project

History of Cholera in an African country, which are symptoms and other things about cholera.

Signs and symptoms

The primary symptoms of cholera are profuse, painless diarrhea and vomiting of clear fluid. These symptoms usually start suddenly, one to five days after ingestion of the bacteria. The diarrhea is frequently described as "rice water" in nature and may have a fishy odor. An untreated person with cholera may produce 10–20 litres of diarrhea a day with fatal results. For every symptomatic person, 3 to 100 people get the infection but remain asymptomatic. Cholera has been nicknamed the "blue death" due to a patient's skin turning a bluish-gray hue from extreme loss of fluids.

If the severe diarrheoea is not treated with intravenous rehydration, it can result in life-threatening dehydration and electrolyte imbalances. The typical symptoms of dehydration include low blood pressure, poor skin turgor (wrinkled hands), sunken eyes, and a rapid pulse.

Taken from: http://en.wikipedia.org/wiki/Cholera

Figure 1: Rice-water stool from a patient with cholera; note the flecks of mucus precipitated at the bottom of the cup that resemble rice grains. SOURCE: CDC













Figure 2: Washer woman hands (loss of skin elasticity) are a sign of the dehydration seen in cholera. SOURCE: CDC

What causes cholera, and how is cholera transmitted?

Cholera is caused by the bacterium V. cholerae. This bacterium is Gram stain-negative and has a flagellum (a long, tapering, projecting part) for motility and pili (hairlike structures) used to attach to tissue. Although there are many V. choleraeserotypes that can produce cholera symptoms, the O groups O1 and O139, which also produce a toxin, cause the most severe symptoms of cholera. O groups consist of different lipopolysaccharides-protein structures on the surface of bacteria that are distinguished by immunological techniques. The toxin produced by these V. cholerae serotypes is an enterotoxin composed of two subunits, A and B; the genetic information for the synthesis of these subunits is encoded on plasmids (genetic elements separate from the bacterial chromosome). In addition, another plasmid type encodes for a pilus (a hollow hairlike structure that can augment bacterial attachment to human cells and facilitate the movement of toxin from V. cholerae into human cells). The enterotoxin causes human cells to extract water and electrolytes from the body (mainly the upper gastrointestinal tract) and pump it into the intestinal lumen where the fluid and electrolytes are excreted as diarrheal fluid. The enterotoxin is similar to toxin formed by bacteria that cause diphtheria in that both bacterial types secret the toxins into their surrounding environment where the toxin then enters the human cells. The bacteria are usually transmitted by drinking contaminated water, but the bacteria can also be ingested in contaminated food, especially seafood such as raw oysters.

Taken of: http://www.medicinenet.com/cholera/page3.htm

What is the history of cholera?

Cholera has likely been with humans for many centuries. Reports of cholera-like disease have been found in India as early as 1000 AD. Cholerais a term derived from Greek khole (illness from bile) and later in the 14th century to colere (French) and choler (English). In the 17th century, cholerawas a term used to describe a severe gastrointestinal disorder involving diarrhea and vomiting. There were many outbreaks of cholera, and by the 16th century, some were being noted in history. England had several in the 18th century, most notable being in 1854, when Dr. John Snow did a classic study in London that showed a main source of the disease (resulting in about 500 deaths in 10 days) came from at least one of the major water sources for London residents termed the "Broad Street pump." The pump handle was removed, and the cholera deaths slowed and stopped. The pump is still present as a landmark in London. Although Dr. Snow did not discover the cause of cholera, he did show how the disease could be spread and how to stop a local outbreak. This was the beginning of modern epidemiologic studies. The last reference shows the map Dr. Snow used to identify the pump site.

V. cholerae was first isolated as the cause of cholera by Filippo Pacini in 1854, but his discovery was not widely known until Robert Koch (who also discovered the cause of tuberculosis), working independently 30 years later, publicized the knowledge and the means of fighting the disease. The history of cholera repeats itself. The U.S. National Library of Medicine houses original documents about multiple cholera outbreaks in the U.S. from the 1820s to the 1900s, with the last large outbreak in 1910-1911. Since the 1800s, there have been seven cholera pandemics (worldwide outbreaks).

Cholera riots occurred in Russia and England (1831) and in Germany (1893) when the people rebelled against strict government isolation (quarantines) and burial rules. In 2008, cholera riots broke out in Zimbabwe as police tried to disperse people who tried to withdraw funds from banks and were protesting because of the collapse of the health system that began with a cholera outbreak. Similar but less violent public protests have occurred when yellow fever, typhoid fever, and tuberculosis quarantines have been enforced by health authorities.

Multiple outbreaks worldwide continue into the 21st century with outbreaks in India, Iran, Vietnam, and several African countries occurring over the last 10 years (most recent outbreaks occurred in Haiti and Nigeria in 2010-2011). Why is cholera history repeating itself? The answer can be traced back to Dr. Snow's studies that show a source (water or occasionally food) contaminated with V. cholerae can easily and rapidly transmit the cholera-causing bacteria to many people. Until safe water and food is available to all humans, it is likely that cholera outbreaks will continue to happen.

Taken from: http://www.medicinenet.com/cholera/page3.htm