Tag Archives: cholera

U.N. Admits Role In Haiti Cholera Outbreak That Has Killed Thousands

U.N. Admits Role In Haiti Cholera Outbreak That Has Killed Thousands | Source: NPR, Aug 18 2016 |

In the fall of 2010, months after a devastating earthquake struck Haiti, a new disaster began: a cholera outbreak that killed thousands of people and continues to sicken people across the country.

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Cholera patients are treated at the Cholera Treatment Center in the Carrefour area of Port-au-Prince, Haiti, in December 2014. The Caribbean country’s cholera outbreak started in 2010. Hector Retamal/AFP/Getty Images

Experts determined that the source of the disease was a U.N. peacekeeping camp. And now, nearly six years later, the United Nations has admitted it played some role in the deadly outbreak.

At a briefing Thursday, U.N. spokesman Farhan Haq said that over the course of the past year, “the U.N. has become convinced that it needs to do much more regarding its own involvement in the initial outbreak and the suffering of those affected by cholera.”

He said the U.N. would announce new actions to address the issue within the next two months.

“Our legal position on this issue has not changed,” Haq said, adding that the U.N. was not describing any of its actions as “reparations.”

Read the complete article.

 

 

WASHplus – A Surprise Inoculation Against Cholera

A Surprise Inoculation Against Cholera, 2016. WASHplus.

Communities that embraced the WASHplus and Kenya Ministry of Health community-led total sanitation-plus approach appear to have protected themselves against cholera during a recent epidemic.

Using cellphone data to study the spread of cholera

Using cellphone data to study the spread of cholera | Source: Phys.org, May 23 2016 |

While cholera has hardly changed over the past centuries, the tools used to study it have not ceased to evolve. Using mobile phone records of 150,000 users, an EPFL-led study has shown to what extent human mobility patterns contributed to the spread of a cholera epidemic in Senegal in 2005.

vibriocholer

Scanning electron microscope image of V. cholerae. Credit: public domain

The researchers’ findings, published in the Proceedings of the National Academy of Sciences, highlight the critical role a mass gathering of millions of pilgrims played in spreading of the disease, and how measures to improve sanitation at transmission hotspots could decrease the progression of future outbreaks.

“There is a lot of hype around using big data from mobile phones to study epidemiology,” says senior author Enrico Bertuzzo, from the Ecohydrology Laboratory at the Ecole polytechnique fédérale de Lausanne. This is largely due to the fact that can be used to reconstruct, with unprecedented detail, mobility fluxes of an entire population. “But I dare say that this is the first time that such data are exploited to their full potential in an epidemiological model.”

Cholera is an infectious disease that occurs primarily in developing countries with poor sanitation infrastructure. It spreads primarily via water that has been contaminated with the bacterium Vibrio cholerae, present in the feces of infected people. Human mobility and waterways both contribute to spreading the disease among human communities, whereas heavy precipitation events increase the chances of the bacteria to contaminate sources. Researchers at EPFL have developed a mathematical simulation model that accounts for these factors, which they tested on past outbreaks such as the one in Haiti in 2010.

Read the complete article.

The Sanitary Movement – A John Snow Epilogue

Published on Dec 5, 2015

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John Snow’s report on the causes of cholera provided yet more evidence of the dangers of filthy cities. Cities had always been unhealthy places to live, generally with a higher death rate than birth rate, but fixing them just wasn’t the focus of an agricultural world economy. The Industrial Revolution in the 1700s brought more people to the cities, and suddenly, cities had to grow in order to maintain the vastly expanded manufacturing and shipping operations of the new era.

Edwin Chadwick published a report about the sewage in city streets and clearly explaining the need to remove it. His report led to legislation that created local health boards and drove the construction of complex sewer systems. These sewers were massive, expensive undertakings that, even today, remain the foundation of many large modern cities. They reduced diseases across the board and saved countless human lives, part of a legacy that John Snow would be proud of.
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Innovative WASH interventions to prevent cholera

Innovative WASH interventions to prevent cholera. Source: WHO Wkly Epid Rec, Oct 2, 2015

Authors: Daniele Lantagne, Andy Bastable, Jeroen H. J. Ensink, and Eric Mintz.

In the late 19th and early 20th centuries, epidemic cholera was virtually eliminated in industrialized countries through municipal water supply with treatment and sanitation infrastructure.1 A century later, in 2014, only 58% of the global population had access to piped-on premises water,2 and an estimated 1.8 billion people (28% of the global population) drank microbiologically contaminated water.3 Within this inadequate water and sanitation context, cholera transmission continues. wer

In 2014, 32 countries – many of which are struggling with poverty, rapid population growth, and instability – reported cholera transmission.4

A recent model found that national improved water access of 71%, and improved sanitation access of 39%, predicted whether a country would have endemic cholera with 62%–65% sensitivity and specificity.5

As progress is made towards universal access to reliable piped-on-premises water, reducing the remaining cholera burden requires a comprehensive strategy. Community- and household level water, sanitation, and hygiene (WASH) interventions are one part of that strategy.

Common cholera-prevention WASH interventions include: water supply, water treatment (well, pot, or bucket chlorination and household treatment); sanitation options (latrines); and, promotion of hand washing and environmental hygiene.6

The effectiveness of these interventions varies7 : water supply and chlorine-based, filtration, and solar disinfection household options have been shown to reduce cholera transmission among users;8, 9, 10, 11, 12 well/pot chlorination effectively treats water only for a few hours,13, 14, 15 unless chlorine is regularly added;16 there is little research on bucket chlorination, sanitation, and hygiene interventions.

Recent innovations in chlorine-prevention WASH include identification of factors leading to programmatic success, and new product design (such as sourcebased water treatment and personal use sanitation options).

An investigation of 14 household treatment programmes implemented in 4 emergencies (including 3 cholera emergencies) found that reported use ranged from 1% to 93% and effective use (the percentage of recipients who improved their drinking water microbiological quality to international standards) ranged from 0 to 68%.17

The most successful programme provided an effective method (chlorine tablets), with the necessary supplies to use it (bucket and tap), and ongoing training by local community health workers to people using contaminated water who were familiar with chlorination before the emergency. Conversely, the least successful programme distributed only chlorine tablets in a relief kit labeled in English to populations without previous chlorination experience.

Similar results were found in an evaluation of dispensers, an innovative source-based intervention that includes a chlorine dispenser and dosing valve installed at water sources, community education, and chlorine refills. Across seven evaluations in four emergencies (including 3 cholera emergencies), reported dispenser use ranged from 9-97% and effective use from 0 to 81%.18

More effective programmes installed dispensers at point-sources, maintained a high-quality chlorine solution manufacturing and distribution chain, maintained hardware, integrated dispenser projects within larger water programmes, compensated promoters, had experienced staff, worked with local partners to implement the project, conducted ongoing monitoring, and had a sustainability plan.

The Peepoo is a personal, single-use, biodegradable selfsanitizing double-plastic bag toilet. Peepoos contain sufficient powdered urea to inactivate harmful pathogens in urine and feces after 4 weeks, at which time the waste can be used as fertilizer. Peepoos have been used where latrines are not feasible due to population density, and to bridge the gap between emergency onset and latrine construction.19

One emergency programme concluded that products should be pre-positioned before the emergency, all products necessary for use (including a sitting/squatting stool) should be provided to recipients, training for community health workers should occur before distribution, compensation for collection activities should be provided, and that the disposal mechanism and exit strategy should be predefined before distribution.

As can be seen, lessons learned from the programmes described above are similar: WASH interventions can successfully improve water quality, isolate feces from the environment, and reduce the potential for cholera transmission if they are wisely implemented and distributed with appropriate supplies and training to at-risk populations.

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Aug 10 – Weekly Update of Selected WASH Studies

Effectiveness of emergency water treatment practices in refugee camps in South Sudan. WHO Bulletin, Aug 2015. Authors: Syed Imran Ali, Syed Saad Ali & Jean-Francois Fesselet.
Link: http://goo.gl/BtnQVh

Current guidelines for free residual chlorine in emergency water supplies are not based on field evidence and offer inadequate protection after distribution in refugee camps in South Sudan. We recommend that the free residual chlorine guideline be increased to 1.0 mg/L in all situations, irrespective of disease outbreak, pH, or turbidity conditions. This is a tentative recommendation because the degree to which these findings can be generalized to other camps in different settings is unknown.

Nutrition in Ethiopia: An emerging success story? Author: Headey, Derek D.
Link: https://goo.gl/tmMCqX

Research does not always provide the results that we expect. At the recent conference on improving nutrition in Ethiopia, Together for Nutrition 2015, we learnt about the rapid progress in Ethiopia in child nutritional outcomes that are linked to improved birth size and, hence, improved maternal health. However, most of the improvement in maternal health seems related to better sanitation, rather than to diet, care, or health factors.

Diet and specific microbial exposure trigger features of environmental enteropathy in a novel murine model. Nature Communications, Aug 2015. Authors: Eric M. Brown, et al.
Link: http://goo.gl/Sgx6XP

Here we demonstrate that early-life consumption of a moderately malnourished diet, in combination with iterative oral exposure to commensal Bacteroidales species and Escherichia coli, remodels the murine small intestine to resemble features of EE observed in humans. We further report the profound changes that malnutrition imparts on the small intestinal microbiota, metabolite and intraepithelial lymphocyte composition, along with the susceptibility to enteric infection. Our findings provide evidence indicating that both diet and microbes combine to contribute to the aetiology of EE, and describe a novel murine model that can be used to elucidate the mechanisms behind this understudied disease.

An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial. The Lancet, Aug 2015. Authors: Paul Little, Beth Stuart, et al.
Link: http://goo.gl/hHLnLI

Handwashing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic. However, the role of handwashing is debated, and no good randomised evidence exists among adults in non-deprived settings. We aimed to assess whether an internet-delivered intervention to modify handwashing would reduce the number of RTIs among adults and their household members.

Associations between school- and household-level water, sanitation and hygiene conditions and soil-transmitted helminth infection among Kenyan school children. Parasit Vectors. 2015 Aug. Authors: Freeman MC, Chard AN, et al.
Link: http://goo.gl/HkdIyS

Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection. WASH risk factors differed across individual worm species, which is expected given the different mechanisms of infection. No trend of the relative importance of school versus household-level WASH emerged, though some factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting other school practices, such as hand-washing and keeping school toilets clean.

Modelling Optimal Control of Cholera in Communities Linked by Migration. Comput Math MethodsMed. 2015. Authors: Njagarah JB, Nyabadza F
Link: http://goo.gl/VU6I5G

A mathematical model for the dynamics of cholera transmission with permissible controls between two connected communities is developed and analysed. The dynamics of the disease in the adjacent communities are assumed to be similar, with the main differences only reflected in the transmission and disease related parameters. This assumption is based on the fact that adjacent communities often have different living conditions and movement is inclined toward the community with better living conditions. Our results indicate that implementation of controls such as proper hygiene, sanitation, and vaccination across both affected communities is likely to annihilate the infection within half the time it would take through self-limitation. In addition, although an infection may still break out in the presence of controls, it may be up to 8 times less devastating when compared with the case when no controls are in place.

WASHplus Weekly: Focus on Cholera and Ebola Outbreaks

Issue 157 | August 8, 2014 | Focus on Disease Outbreaks

This issue highlights recent alerts, news and publications on cholera and Ebola outbreaks. On August 1, 2014, WHO published its latest statistics on the number of cholera cases and cholera-related deaths in 2013. In 2013, there was a 47% decrease in the number of cases reported compared to 2012 and this is the second consecutive year in which reported cholera era cases declined. Resources on the Ebola outbreaks include WHO alerts, a WHO fact sheet, recent newspaper articles and reports on the One Health approach, which investigates human, animal, and environmental interconnectedness and its impact on health.

CHOLERA NEWS/OUTBREAK ALERTS

Recent Newspaper Articles on Outbreaks – Cameroon – Aug 6, 2014 | Ghana – Aug 4, 2014 | South Sudan – July 30, 2014 | Vietnam – Aug 6 2014 |

CHOLERA STATISTICS/FACT SHEETS

Cholera Fact Sheet, 2014. World Health Organization. (Link)
Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Every year, there are an estimated 3–5 million cholera cases and 100,000–120,000 deaths due to cholera. The short incubation period of two hours to five days enhances the potentially explosive pattern of outbreaks.

USAID-IWASH Ebola Preparedness Response

USAID-IWASH Ebola Preparedness Response

Cholera in 2013. Weekly Epidem Rec, Aug 2014. WHO. (Link)
In 2013, 47 countries reported a total of 129,064 cases of cholera including 2102 deaths, giving a case-fatality rate of 1.63%. This represents a decrease of 47% in the number of cases reported compared to 2012 and this is the second consecutive year in which reported cholera era cases declined.

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