Cholera is a water- and food-borne disease caused by Vibro cholerae.1 Within the past two centuries, there have been seven cholera epidemics throughout the world, causing millions of deaths.2 Most of the pandemics from the 19th into the 20th centuries have been the result of the classical biotype of cholera. The current pandemic (seventh), is resultant of the El Tor biotype.3 El Tor causes mild or no symptoms in its victims, meaning that the infected have the capability to spread the disease far and wide since they would be more likely to travel than those suffering from severe symptoms, the disease could easily spread quickly from one continent to another.4 Cholera caused by the classical biotype is devastating in its own right. The disease causes severe muscle cramps, diarrhea, vomiting, and water loss, which can result in a death within just one day.5
Cholera was originally mostly confined to India, however, in 1816, British ships and troops would spread the disease, causing the first cholera epidemic.6 Like many other diseases, cholera would continue to make its rounds as it was transmitted along trade routes throughout the world.6,7 In the next epidemic, Irish immigrants would bring the disease to Canada and into the United States at New York where it would then spread across the continent.8 English troops sent to supress the slave trade in Muscat brought cholera with them, which then made its way down the East coast of Africa following the slave trade.6 Port cities, such as New Orleans, New York, and Philidelphia, were regularly hit with outbreaks from the 1830s onwards as trade ships continued to bring in disease.9 Urbanization has also contributed to the spread of cholera. As the human population grew in relation to the Industrial Revolution, factories needed workers and many people moved from their villages to cities where they were crammed on top of one another with little privacy or space between neighbors. In villages, excrements, or night soil, were utilized as fertilizer. In cities, where space was already limited, there were fewer and fewer places to spread the night soil, because of this, it was not uncommon for the excrements to be dumped in rivers or streams. In cases where privies were used, dozens would share one privy and they would hardly ever be cleaned out. Instead, their contents would empty into cesspools or cellars which would overflow out into the alleyways and streets.10,11
During the 1854 epidemic, John Snow determined that cholera was water-borne and not caused by miasmas, as was the popular belief at the time.12 Reverend Henry Whitehead, a supporter of Snow’s work on cholera, helped Snow pinpoint the epidemic’s origin through his knowledge of the community, and used his influence to convince authorities to remove the handle of the Broad Street pump responsible for distributing contaminated water to locals. The two set a precedent for epidemiology, the importance of public heath, adn the changes that public policy can facilitate.13 Although Snow did identify the bacterium that caused cholera, unbeknownst to him, Filippo Pacini also identified the bacteria at the same time, but he published his findings in a paper that was ignored for decades. Pacini also correctly described the disease and recommended intravenous injections of fluids that proved to be quite effective.14 In 1883, Dr. Robert Koch, also unaware of Pacini’s work, identified and named the bacterium and he was able to successfully isolate V. cholera in pure culture.15 As a result of his findings, he produced Koch’s Postulates, which explain how to determine the cause of an infectious disease.16
In 2010, a massive earthquake devestated Haiti, the reprucussions of such an event, although tragic, were what was expected. What was not foreseen however, was the emergence of cholera in Haiti since it had never before been present. The United Nations had sent Nepalese peacekeepers to assist in aid relief efforts. They set up camp with poor plumbing that leaked into the Artibonite River, and because of the contaminating the Haitian water supply for the first time with cholera. Due to the breakdown in sanitation and the health infrastructure from the earthquake, a huge epidemic insued.17 Additionally, Haiti is severely impoverished, and as such, lacks sewer systems. Its capital, Port-au-Prince is one of the largest cities in the world without a sewer system.18,19 Citizens use outhouses, but excrements find their way into ditches or impromptu dumping grounds which easily contaminate water sources.19 To make ends-meat, may find themselves working for measley wages removing the waste by hand.18 Although measures are being taken to combat the disease, new cases of cholera continue to emerge throughout Haiti.20 In May of 2018, there were 708 suspected cases of cholera and 8 deaths reported, down by 47% and 11% respectively from what was reported in May 2017.21 From January to June 2018, 58,923 households recieved at least one water treatmentproduct, 4,408 cases were responded to by response teams, 86% of suspected cholera cases were responded to, 94% were responded to within 48 hours, and 598,584 individuals were sensitized during rapid response.21 There are currently two safe and effective oral cholera vaccines (OCV) that are available for about $1.70-$1.85 per dose.22 Studies have shown that persons who recieved OCV and household vaccination did not produce a single case of culture produced cholera.22 While different measures have been implemented to prevent cholera, to truly have a chance at ridding Haiti of the disease, proper sewage disposal and treatment facilities must be implemented and citizens must have easy access to fresh, clean water.
As war rages in Yemen, disease spreads and wrecks havoc. The country is unable to recieve shipments of vaccines to fight off cholera due to the war.23 Bombings and blockades have rendered hospitals and health care facilities ineffective and useless, which has only contributed to the more than one million cases of infections and over 2000 deaths caused by cholera.24 In Mozambique, cyclone Idai hit, especially effecting the port city of Beira. The cyclone left a path of destruction in which there was stagnant, standing water that had decomposing bodies in it. This combined with poor sanitation and hygiene practices put the people of Mozambique at risk of contracting cholera and other diseases.25 In each case discussed, there has been a common theme of health and sanitation practices. When these practices slip, people are at higher risk. It does not matter what part of the world you live in, if safe practices are not adhered to, anyone could fall victim to this disease.
https://www.youtube.com/watch?v=_lUCjqvsNqM