Cholera (Vibrio cholerae) was originally found only in India, according to the textbook (Power of Plagues by Irwin Sherman, copyright 2017). Its initial spread beyond the subcontinent to Sri Lanka, Burma, Thailand, and Singapore was due to colonization efforts by the British. After that, trade routes brought it to China and areas of the Middle East and Russia. At times the sickness appeared to stop and disappear, only to reemerge later and then pass into a new area, creating a new pandemic. Seven pandemics of cholera have occurred to date, though trade and sometimes fighting troops, such as Russian soldiers in Turkey in the early 19th century. Urbanization facilitated the spread of cholera as well, since many people could be infected by a single source. One example is the Broad Street pump during the 1854 breakout, as shown in the film in class. John Snow studied the distribution of cases and determined that contaminated water was the source of the breakout, assisted by the Reverend Henry Whitehead in gaining the trust of the locals and convincing them to remove the handle of the contaminated pump. Filippo Pacini was the first one to identify the cholera bacterium in 1854, though Robert Koch was the first to publicly identify and name it in 1882. The most recent pandemic of cholera is characterized by the El Tor strain, which is characterized by its increased ability to survive in aquatic environments and mild symptoms in some people (allowing further unnoticed spread) compared to previous strains of the bacteria.

Improvements in hygiene, sanitation, and infrastructure have greatly reduced instances of cholera in the modern world, though it continues to be an issue in places with poor infrastructure, especially in the wake of natural disasters such as the 2010 earthquake in Haiti. Following the earthquake, Nepalese UN workers arrived at the site and were housed in an area upriver from the local living site. Latrines were not properly-made and wastewater contaminated the drinking source, leading to widespread outbreak among the locals. According to the PowerPoint shown in class, as of 2016 the epidemic in Haiti had killed 10,000 and sickened more than 800,000 people in Haiti. In 2012 an oral vaccine began being distributed in Haiti, then in Iraq in 2015 and Yemen in 2017. The outbreak in Yemen followed airstrikes which destroyed local infrastructure, and according to the article “Vaccines Blocked As Deadly Cholera Raged Across Yemen” by Maggie Michael, UN workers struggle to transport and administer vaccines in areas heavily affected by conflict. Areas suffering the most destruction due to conflict are also the most likely to suffer outbreaks, and despite a brief lull near the end of 2018, 150,000 cases have been reported in the first half of 2019 alone. If the vaccine is widespread enough, scientists hope that “herd immunity” may keep others from getting sick. Vaccines and oral rehydration salts (ORS) for treatment, along with education on cholera and its prevention, are the key resources that UN health workers continue to distribute among the locals in affected areas.

HR: References as listed in text, class discussion, Microsoft Word for spelling/grammar check