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Today’s World Health Organization’s WER (Weekly Epidemiological Record) has an extensive overview of the global spread of cholera between the years 2000 and 2010.
Last year, the WHO listed 317,534 cases worldwide, including 7,543 deaths, an increase of 43% over 2009 and up 130% compared to 2000.
A good deal of this increase is due to the epidemic which began last October in Haiti.
Globally, these numbers are widely assumed to be an undercount, and specifically do not include the 500,000-700,000 cases of ‘acute watery diarrhea’ in southeastern and central Asia.
In truth, many countries do not report cholera due to a lack of surveillance and testing capacity or out of fears of negative economic impact.
Under the International Health Regulations adopted in 2005, mandatory notification of all cases of cholera is no longer required.
So the true burden of cholera around the world can only be estimated.
Last May, the World Health Organization recognized the re-emergence of cholera as a significant global public health problem during their World Health Assembly, and adopted resolution WHA 64.15 (Cholera: mechanism for control and prevention), calling for an integrated and comprehensive global approach to cholera control.
A few excerpts from the report follow, but the entire 15-page article is highly informative and very much worth worth reviewing.
Cholera control
Current responses to cholera outbreaks tend to be
reactive, taking the form of ad hoc emergency responses. This approach may prevent deaths but it
fails to prevent cases of cholera.
Controlling cholera requires more than the prompt medical treatment of cases. The interplay of prevention, preparedness and response activities
within an efficient surveillance system is
paramount to preventing occurrence, mitigating
outbreaks and decreasing case-fatality rates.
Sustained development is critical to effectively
containing cholera. However, simple and efficient
measures can curb the incidence of the disease, pro-
vided that there is a concerted multidisciplinary
approach and strong community involvement aimed
at improving access to safe water, and providing
hygiene education and proper sanitation.
National and subregional action plans that include
cross-border collaboration should be developed to
enhance multidisciplinary prevention, and preparedness and response activities.
Travel sanctions and trade sanctions serve only to
increase the burden of cholera in countries affected by the disease.
Future challenges
Greater financial support and commitment are needed to strengthen and encourage environmental management in developing countries, in particular to improve water supplies, access to hygiene and sanitation, and to support research on new strategies for prevention and control.
Cholera and other epidemic-prone diarrhoeal diseases are major public health problems, which should be recognized and addressed. It is critical that commitments be made and financial support provided for recognition of the burden of cholera and for efforts to implement efficient control measures, in view of the emergence of new strains and the ongoing trends in increasing incidence of the disease.
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