Gregory Parham
BI-245X
07/17/19
Dr. Hinks
Cholera
Throughout history diseases have come through and gone, but there is one in particular that didn’t play with anybody. That disease is called Cholera and it was greatly feared by everybody! Cholera is a bacterial disease usually spread through contaminated water. Cholera is a water or food borne disease caused by Vibrio cholerae, a gram-negative comma-shaped bacillus and lives in salt-tolerant water. It spread with speed and strong consequences and earned the nickname “King Cholera”. Symptoms of cholera included muscle cramps, diarrhea, vomiting, loss of water and electrolytes, and a person can die in one day due to dehydration.
In the past two years, there has been seven pandemics of cholera and is responsible for the deaths of millions, societal disruption, and enormous economic losses. The first to sixth pandemics are classified as classical biotype. The seventh pandemic is called the El Tor biotype and is significant due to it being a much hardier organism than the classical biotype and it can survive for long periods of time in aquatic environments. If you infected with El Tor biotype, you only have mild to no symptoms at all. The first pandemic in 1816 to 1823 was transmitted along trade routes to China, Japan and the Philippines; Persian Gulf; Africa; central Asia to the borders of Russia. It started with an outbreak in Calcutta and cholera became a global disease. The second pandemic happened from 1829 to 1851 and it took place in Russia and spread through Europe. Irish immigrants carried the infection across the Atlantic Ocean to Canada and New York, with outbreaks happening in New Orleans, NY, and Philadelphia adding high death rates and panic. Third pandemic was considered the deadliest because there was an outbreak in London from 1853 to 1854 with killed 31,000 people. The dates for the third pandemic was from 1852 to 1863 and founded in Africa, Middle East, U.S., as well as India and Europe. During this time John Snow published his landmark epidemiological studies on cholera. Dr. Snow studied the transmission of cholera and found out the symptoms for cholera. There was a lot of effects of urbanization from the spreading of cholera. Some effects were privies emptied into cesspools or cellars more often than directly into sewer pipes, pervasive stench of animal and human feces combined with rotting garbage made the miasma theory of disease seem very plausible and diseases was more prevalent in lower-class neighborhoods due to the moral depravity of poor people weakened their constitutions so they was more vulnerable to disease.
John Snow hypothesized that the contaminated water caused cholera and then the mortality would be lower in people getting their water from the Lambeth Company in London. He used the “shoe leather” epidemiology to find cases in the community. He saw something on Broad Street where workers at the brewery drank and the fermentation killed the cholera and the water tasted better. Henry Whitehead was a priest in Soho during the 1854 cholera outbreak and was a firm believer of miasma model of disease but ended up supporting Snow’s conclusions regarding waste-contaminated water as a source of cholera. With Whitehead knowing the details of the resident’s lives well enough to identify the epidemic’s starting point and it helped remove the handle of the Broad Street pump. Filippo Pacini identified the cholera bacterium of Vibrio cholerae but didn’t gain prominence until 82 years after his death. He first discovered a comma-shaped bacillus and was a supporter of the germ theory which insisted cholera was contagious. Robert Koch was noted as one of the founding fathers of the science of bacteriology. He observed and the named the bacteria causing cholera (Vibrio cholerae) unaware of Pacini’s work. Koch went to Egypt in 1883 and found a bacillus in the intestinal mucosa in persons who died of cholera, but not of other diseases and saw that they were extensively present in the characteristic “rice water stools” of advanced cholera patients. He knew that cholera produced a toxin and was transmitted by water-contaminated food. The fourth and fifth cholera pandemics happened in 1863 and 1881 and less severe than the previous ones. Koch put in work during the fifth pandemic and spread to Naples, Spain, Russia, China, Japan, and South America in early 1890s. The 1992 outbreak of Hamburg killed 8,600 people but this was the last serious European cholera outbreak as cities improved their sanitation and water systems. The sixth pandemic was lethal in India, in Arabia and alongside the North African coast and failed to reach the Americans due to public health sanitation achievements. The last and seventh pandemic began in Indonesia in 1961, Bangladesh in 1963, then India and Russia. It hit Africa due to poor water quality and poor sanitation. The conflict of cholera is a part of the public health infrastructure, health care access in Africa. The treatment of cholera came down to oral rehydration salts.
Haiti had an outbreak in 2010 to 2011 due to an earthquake, where fecal matter had contaminated the Artibonite River, a major source of drinking water. The disease had spread across all Haiti’s provinces and reached the Dominican Republic. It was a total of 473,649 cases and 6,631 deaths. The current status of cholera in Haiti is still ongoing and the preventive measures for Haiti has been oral vaccines, clean water access and building of household toilets. More sanitation systems and more ways to clean water is still needed to be done. Cholera in Yemen has war enabling them to occur due to damaged infrastructure and poverty. There has been 815,000 cases and 2,156 deaths and 15 million people in Yemen don’t have access to clean water and 1.8 million children was malnourished.