Cholera disease is making an unwelcome comeback

In the fight against cholera "climate change is a new key factor to consider", said the director of the World Health Organization (WHO) team dedicated to this disease, Philippe Barboza, regarding the recent increase in cases of cholera in countries such as Syria or Haiti, among others.

The "unwelcome" return of cholera has been one of the challenges highlighted by the WHO in a press conference dedicated to the global challenges that threaten human health, among which specialists have also addressed Covid-19, smallpox monkey, Ebola -with regard to the latest outbreak in Uganda- and the effects of climate change.

"After years of declining cases around the world, in the last year we have seen a rebound in cholera outbreaks around the planet," said WHO Director-General Tedros Adhanom Ghebreyesus, who has asserted that it is a “deadly” disease, but one that can be prevented with vaccines and access to clean water and sanitation.

Key points

• Most of those infected have no or mild symptoms and can be successfully treated with oral rehydration salts.

• In 2017, a global strategy for cholera control was launched, called “Ending Cholera: a global roadmap to 2030”, which aims to reduce deaths from the disease by 90%.

• Researchers estimate that each year there are between 1.3 and 4 million cases of cholera in the world and between 21,000 and 143,000 deaths from this cause.

• Cholera is an acute diarrheal disease that can cause death within hours if left untreated.

• Safe water supply and sanitation are essential to prevent and control the transmission of cholera and other waterborne diseases.

• Severe cases need to be treated quickly with intravenous fluids and antibiotics.

• Oral cholera vaccines should be used in conjunction with improvements in water and sanitation to control cholera outbreaks and to prevent the disease in high-risk areas.

Rebound in cholera outbreaks

In the last year we have witnessed a rebound in cholera outbreaks across the planet, says the WHO

Although cholera is "easily treatable" with oral rehydration or antibiotics for the most serious cases, "the reality is that many people do not have access to these simple interventions," Adhanom lamented, citing the recent words of the UN director, António Guterres. "This is not about generosity, but about justice."

The climate crisis has occupied a large part of the declarations of the experts, for whom this challenge represents a "new key factor" to take into account in the increase in the incidence of diseases such as cholera.

"Cholera thrives on poverty and conflict, but it is now being fueled by climate change," Adhanom said, explaining that "extreme weather events such as floods, cyclones and droughts further reduce access to clean water." and they create the ideal environment for the spread of cholera.”

New cases and higher mortality

• Only in the first nine months of this year, 27 countries have reported outbreaks of this disease, recalled the specialist, who pointed out that an increase in mortality has also been observed, whose average rate so far this year is "almost three times higher than in the last five years.

• In Syria, more than 10,000 suspected cases of cholera have been registered in the last six weeks, while in Haiti, after more than three years without cholera cases, two cases have been officially reported this week in the capital, Port-au-Prince though "the actual number of cases is likely to be significantly higher," he explained.

• The director of the WHO has valued this outbreak as "a particular setback" in Haiti, which was just preparing to be certified as a "cholera-free" country at the end of this year.

• Cholera can kill within hours if left untreated, and while most will have no or mild symptoms, around 1 in 10 people will develop severe symptoms, including severe watery diarrhoea, vomiting and muscle cramps.

• Although cholera can be prevented with vaccines and easily treated with oral rehydration solution (or intravenous fluids and antibiotics in very severe cases), "the reality is that many people don't have access to these simple interventions," Tedros said.

27 countries alerted about cholera outbreaks

“So far in 2022, there are 27 countries that have alerted about cholera outbreaks in their territory”

While the other factors that usually explain cholera cases remain stable, something that "has changed drastically" in recent years is the impact of climate change, Barboza stressed, in relation to the severe droughts or monsoons that have affected many countries.

“This has really pushed the outbreak beyond what is normally seen during its presence, and the concern is that it will continue to increase in the coming years,” he added, warning that greater investment in water and sanitation is required to prevent cases.

At the press conference, the WHO spokesmen also referred to the floods in Pakistan, which have already claimed more than 1,500 lives in the country where "although the waters have stopped rising, the dangers only grow", Adhanom has alarmed.

Nearly 10% of Pakistan's health facilities have been damaged, "leaving millions of people without access to health care," he said, while stocks of essential drugs and medical supplies "are limited or washed away by the water, and damaged roads and bridges. prevent access to services and supplies.

"These are the communities that suffer the injustice of the climate crisis or the mixture of the two conflicts of the climate crisis and water and food insecurity," lamented Barboza.

Key background

Cholera was one of the most feared diseases in human history and remains a leading cause of death in some parts of the world. It has caused seven pandemics in the last 200 years since it emerged from India, killing millions. It is a serious disease and, in severe cases, is one of the fastest-known fatal human infections if left untreated.

It was once nicknamed the "blue death" due to the skin colour of dehydrated victims. Cholera can quickly tear affected communities apart and often emerges after natural disasters and war, where people live in crowded conditions and water sources may have been compromised.

War-torn Syria is facing a massive outbreak, and gang violence in Haiti is causing a spike in cases. In war-torn Ukraine and Pakistan, where floods have engulfed much of the country, health officials fear conditions allow the disease to spread easily.

According to the European Center for Disease Prevention and Control, significant cholera outbreaks are ongoing in Afghanistan, Bangladesh, the Democratic Republic of the Congo, Ethiopia, and Nigeria.

Impact of Climate Change on Cholera

Increasingly severe heat waves and more frequent and intense flooding due to climate change will spur the spread of cholera in vulnerable regions of the world, new research suggests.

In an effort to better understand the environmental conditions that cause deadly cholera outbreaks and to be able to predict them in the future, University of Maryland researchers compiled more than 40 years of cholera studies to compare climatic and groundwater conditions with the patterns of the shoots.

Researchers who study the diseases already agree that as temperatures rise and the weather becomes more unpredictable, populations around the world are likely to see more and more cholera outbreaks. Now, using climate models, satellite data and known patterns in disease spread, scientists have begun to estimate when and where outbreaks may occur.

With both extreme heat and more intense storms expected to increase due to climate change, the researchers anticipate that cholera outbreaks could become more frequent in the future, Colwell said. Even in the last decade, regions of Africa have seen a resurgence of the disease due to extreme weather, the team reported.

Researchers are now analyzing data from NASA's Gravity Recovery and Climate Experiment (GRACE) satellites to identify elements of climatic and hydrological cycles, including temperature, precipitation, and groundwater levels, that correlate with outbreaks of cholera, and use the information to predict future outbreaks. months in advance.

These predictions are possible because weather patterns that occur up to six months before a given dry or monsoon season affect groundwater conditions six months later, said study co-author Ali Akanda, a researcher at the University of Rhode Island.

End cholera: a global roadmap to 2030

In October 2017, GTFCC partners launched a cholera control strategy called “ Ending Cholera: A global roadmap to 2030”. This country-led strategy aims to reduce cholera deaths by 90% and eliminate cholera in up to 20 countries by 2030.

The global roadmap focuses on three strategic axes:

• 1. Early detection and rapid response to contain outbreaks: The strategy focuses on containing outbreaks—wherever they occur—through early detection and rapid multisectoral response, and includes community engagement, strengthening surveillance and laboratory capacity, operational readiness in terms of health systems and supply, and support for rapid response teams.

• 2. A targeted multisectoral approach to prevent the recurrence of cholera: The strategy calls on countries and partners to focus on cholera “hot spots”, i.e. the relatively small areas most affected by cholera. anger. Cholera transmission can be stopped in these areas with measures such as improved water, sanitation and hygiene and the use of oral cholera vaccine.

• 3. An effective coordination mechanism for technical support, advocacy, resource mobilization, and collaboration at the local and global levels: The GTFCC provides a strong framework to help countries scale up efforts to control cholera, building on country-led intersectoral cholera control programs and supporting them with human, technical, and financial resources.

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