Responsible for seven pandemics in the past two centuries and the death of millions, cholera, also known as “King Cholera,” is water- or food-borne illness (Cholera PPT slides 3, 9). Caused by Vibrio cholerae, cholera can be transmitted by drinking water or by food that is irrigated, washed, or cooked with contaminated water (slides 10, 14). By inhabiting water, this disease kills ‘perfectly healthy people’ at profoundly alarming rates (slide 2). Symptoms of cholera include muscle cramps, diarrhea, and vomiting which results in radical dehydration. Often times, symptoms were exacerbated, leaving individuals drained of water and electrolytes within 24 hours (slide 7). Many victims lost their lives within one day, commonly appearing discolored and shriveled (slide 5).

In the 19th and 20th centuries, various societal/cultural factors such as trade and colonization enhanced the spread of cholera. For example, the Hindu pilgrimages and holy festivals in the Ganges river in India, as well as, the trade routes to China, Japan, Philippines, Persian Gulf, Africa, and central Asia aided in the transmission of this pandemic (slides 19, 24). The first pandemic/outbreak was in Calcutta from 1816 to 1823 (slide 24) Not long thereafter, the second pandemic held in Russia, rapidly spread throughout Europe, impinging Paris, London, and Ireland from 1829 to 1851 (slide 26).

Immigration and urbanization further developed the infection. Irish immigrants carrying the infection crossed to Canada and New York, then to the west coast of the U.S., and southwards into Mexico and Latin America. Cholera outbreaks then occurred with regularity in port cities such as New Orleans with high death rates and panic (slide 26). From 1852 to 1863, the third pandemic affected Africa, the U.S., Middle East, Europe, and India (slide 30). Immigration had created denser populations, expanding cesspools and garbage.

During the London epidemic of 1854, John Snow studied the transmission of cholera with the assistance of Henry Whitehead, a priest of the Church of England (slides 33, 67). Though there were many ideas regarding the diseases’ transmission, Snow found that the epidemic was centered in the Soho district close to his residence and believed that cholera was related to water contamination (slide 33). He observed various associations between cholera cases and contaminated water supplies (slide 49). Within his observations, he had noticed several anomalies. He discovered that paupers north of Broad Street used their own well and suffered very few cholera deaths and that none of the brewery workers east of Broad Street contracted cholera, possibly due to the fermentation of their beer (slide 54).

Accompanied by Reverend Henry Whitehead’s extensive knowledge of the local community and John Snow’s sources on the resident’s lives, he was able to identify the epidemic’s starting point. Thus, convincing the local authorities to handle the issues regarding the Broad Street pump (slide 68). Whitehead and Snow’s epidemiological findings demonstrated the importance of public health’s role and in knowledge of the community and its organizations (slide 75). Snow, however, did not determine the specific causative agent. In fact, Filippo Pacini, an Italian researcher, identified the cholera bacterium and published his work of the Vibrio cholerae within the same time frame Snow had discovered it, though he was unrecognized until his death (slide 76).

In 1883, unaware of Pacini’s work, Dr. Robert Koch along with Pasteur discovered the causative agent of cholera in the outbreaks in Egypt and Calcutta (slides 80-81). Although they had reached similar conclusions, Koch was more universally known due to the press and had received the Nobel Prize for Physiology/Medicine for his discovery (slide 81). Overall, with the scientific observations of all parties (Snow, Pacini, and Koch), they debunked the miasma theory of cholera and has helped limit the lethality of future cholera outbreaks (slide 86).

The fourth and fifth pandemic beginning in 1863 and 1881 were spread worldwide. Outbreaks in Naples, Spain, and Russia killed 200,000 between 1893-94, almost 1.5% of the population perished in Hamburg, and had widespread mortality in China, Japan, and South America (slide 88). In accordance to improved public health sanitation and water systems, the pandemic failed to reach the Americas and the last outbreak in Europe was in 1892 (slides 93, 96). However, in regions such as India, Arabia, Russia, Italy, Greece, Turkey, and the Balkans, where they did not progress in sanitation, it was severely affected by cholera (slides 94, 96).

In to the 21st century, poor water quality and sanitation in relation to public health infrastructure and health care access, has ensured the prevalence of cholera (slide 98). By February 2009, there were 128,548 cases of cholera in sub-Saharan Africa along with 4,053 fatalities (slide 99). In 2008-2009, the outbreak in Zimbabwe had reached mortality levels of 5.7%, surpassing the 1% typically associated with large-scale cholera epidemics (slide 102). Additionally, the 2010-2011 outbreak in Haiti recorded 473,649 cases and 6,631 deaths (107).

The cholera outbreak in Haiti intensified during the rainy season with increased flooding (slides 125-126). With the UN taking responsibility for the epidemic in 2016, the biggest priority has been on sanitation and clean water access (slide 124, 126). Distribution of cholera vaccinations such as Shanchol has also been acted upon (slide 127). Additionally, the recent cholera attacks in 2017 displayed that war has devastated the infrastructure and economy of Yemen leading to little or no access to clean water and malnourishment (slides 133, 136, 140).

Studies regarding the treatment of cholera is ongoing. Today, we have made progress in developing rehydration fluid that can be administered orally (slide 143). ORS or oral rehydration salts is currently the mainstay of treatment for cholera and all diarrheal illnesses (slide 144). Despite this, cholera is a constant, ongoing threat to millions of people who lack clean water in many third world countries.

Help Received: Cholera PPT, Artifact 8 handout, Cadet Jones (structure and organization of information), Dictionary/Thesaurus