Chapter 1: Understanding Cholera

Cholera is a disease that has afflicted humanity for centuries, causing widespread sickness and claiming millions of lives. What many may not realize is that cholera has contributed to one of history's longest-running pandemics. So, what precisely occurs in the body when cholera strikes? How can it be prevented? Moreover, why has this ancient ailment endured over time? The current discourse surrounding cholera is particularly relevant given the ongoing COVID-19 pandemic, as cholera has triggered seven pandemics in the past two centuries.

Initially identified in the Ganges delta of India, cholera is caused by the bacterium Vibrio Cholerae. This disease has been documented since ancient times, with its first pandemic beginning in 1817. It was during this initial outbreak that the world became aware of cholera's severity. Among the more than 200 subtypes of V. Cholerae, only two—O1, which is linked to most contemporary outbreaks, and O139, associated with isolated cases—are known to cause the disease.

How does the bacterium spread? The mystery was unraveled by John Snow in 1854, a pivotal figure in epidemiology. He observed a surge of cholera cases in London and investigated the patterns of infection. Snow discovered that neighborhoods with high cholera rates shared a common water source—a pump. By removing this pump, he demonstrated a marked decline in cholera cases, showcasing the importance of tracking disease patterns. Even today, understanding cholera transmission remains critical. Typically, individuals contract cholera through contaminated water that has been tainted with infected fecal matter. After ingestion, it can take anywhere from a few hours to several days for the bacteria to manifest symptoms.

Once ingested, the bacteria travel from the mouth to the esophagus, then to the stomach, and ultimately to the small intestine, where they inflict damage. The bacteria navigate through the intestinal mucosa to attach and multiply, releasing toxins that cause the intestinal cells to secrete excess water.

This results in severe symptoms, including vomiting, abdominal pain, and profuse watery diarrhea. The excessive fluid loss can lead to rapid dehydration, causing organ failure. This rapid loss of fluids can occur within hours of symptom onset, making cholera particularly dangerous. Fortunately, only a small percentage of cases result in severe dehydration; most individuals experience milder symptoms like nausea, vomiting, and diarrhea. However, even those with less severe cases can still spread V. Cholerae for up to two weeks post-infection.

Treatment for cholera primarily focuses on replenishing lost fluids and electrolytes. Oral rehydration salts are commonly administered, and in more severe cases, intravenous fluids may be necessary. Antibiotics can also help reduce bacterial load in the stool, aiding in the control of outbreaks. Preventative measures include ensuring access to clean water and sanitation, particularly in high-density urban areas known as cholera hotspots.

Additionally, vaccination plays a crucial role in cholera prevention. The oral cholera vaccine is administered in two doses, spaced one to two weeks apart. It is the primary vaccine used in mass immunization campaigns and is produced by two manufacturers, Euvichol and Shanchol. Remarkably affordable at under two dollars per dose, this vaccine has saved countless lives, with 30 to 40 million doses distributed annually in cholera-prone areas. Recent years have seen a decline in cholera-related deaths, a positive sign for public health.

Despite the knowledge and tools available to treat and prevent cholera, the disease persists, largely due to unresolved poverty issues. With advancements in understanding cholera transmission and hotspots, prioritizing sanitation and hygiene in these areas is essential. Collaborative efforts among countries to enhance health infrastructure could lead to significant improvements.

The World Health Assembly, the decision-making body of the World Health Organization, has committed to eradicating cholera by 2030, aiming for a 90% reduction in worldwide deaths. Achieving this goal could signify the end of one of history's longest pandemics.

As we strive to eliminate cholera, we also have an opportunity to learn from this experience. The global effort to control cholera can inform our approaches to managing infectious diseases like COVID-19.

The first video titled "The Pandemic the World Has Forgotten" examines cholera's historical significance and its impact on contemporary public health.

The second video, "The Alliance Explains: Cholera - the forgotten pandemic," delves into the details of cholera and its ongoing challenges in global health.