Cholera and Global Health

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Cholera and Global Health

• Dr Jaime Miranda, M.D.
• International Health and Medical Education
  Centre University College London
• London, March 2004

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IHMEC

• International Health and Medical Education
  Centre, UCL
• IHMEC was established in 2000 to meet the growing
  demand from staff and students for the inclusion
  of international health in the medical curriculum
• We have been working to increase the
  possibilities for studying global health and have
  been publicising issues relating to the subject

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Educating doctors for world health

• UCL's International Health and Medical
  Education Centre is an important step forward in
  the effort to produce doctors who can make a
  difference in the world
• Lancet 20013581471

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Courses offered

• Intercalated BSc in International Health
• Fifth year Special Study Module and International
  Health Elective
• Special Study Modules for first year students

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Objective

• To understand Cholera as a global health issue
• To Outline environmental, economical, social and
  political issues associated with Cholera

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Love in the Time of Cholera

• ...they no longer felt like newlyweds, and even
  less like belated lovers. It was as if they had
  leapt over the arduous calvary of conjugal life
  and gone straight to the heart of love. They were
  together in silence like an old married couple
  wary of life, beyond the pitfalls of passion,
  beyond the brutal mockery of hope and the
  phantoms of disillusion beyond love. For they
  had lived together long enough to know that love
  was always love, anytime and anyplace, but it was
  more solid the closer it came to death.
  (Gabriel García Marquez)

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Overview

• Definitions
• Cholera clinical, epidemiology
• History and pandemics
• Peru diary of Choleras epidemic
• Environmental factors
• Cholera today
• Conclusion

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Overview

• Definitions
• Cholera clinical, epidemiology
• History and pandemics
• Peru diary of Choleras epidemic
• Environmental factors
• Cholera today
• Conclusion

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Definitions

• Nomenclature
• Endemic, Epidemic, Pandemic
• International Health

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Nomenclature

• Vibrio a type of bacteria
• Vibrium cholerae organism
• Serogroups O antigen gt200 groups
• O1, O139, non-O1 non-O139
• O1 biotypes Classical, El Tor
• Serotypes Ogawa, Inaba, Hikojima
• Cholera disease

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demic

• Endemic a disease continually present in a
  region
• Epidemic an outbreak of a disease, introduced
  from outside a community, attacks many people
  over a short period
• Pandemic an extensive epidemic, affects
  populations of several countries or regions

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International Health

• Conceptualising health as the end point of such
  complex processes involves looking at economic,
  cultural, historical, political, commercial and
  environmental factors on a global scale

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Overview

• Definitions
• Cholera clinical, epidemiology
• History and pandemics
• Peru diary of Choleras epidemic
• Environmental factors
• Cholera today
• Conclusion

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Cholera epidemiology

• Transmission food in DC, water in LDC
• Seasonality
• Bangladesh 2 peaks, b/a monsoon rain
• Peru warm season
• Reservoir shellfish and plankton
• CaseInfections 13 to 1100

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Infection

• Intestinal immunity
• 108 healthy subjects
• 105 with antacids
• Lower in real
• No volunteer conditions
• Low gastric ph
• Blood group O evolution in Ganges?

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Clinical Features

• Incubation 18h 5 days
• Watery diarrhoea, infectious
• Vomiting
• 10 severe
• Up to 0.5-1 L/h ? dehydration

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Treatment

• Replacement for dehydration
• Signs 5 bodyweight
• Severe dehydration 10
• 50kg ?5 L saline FAST!!
• Antibiotics
• ? Illness ? diarrhoea
• ? Use of fluids ? hospital stay
• Vaccination?

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Cholera outbreak

• patient older than 5 years develops severe
  dehydration or dies from acute watery diarrhoea,
  or if there is a sudden increase in the daily
  number of patients with acute watery diarrhoea,
  especially patients who pass rice water stools
  typical of cholera (WHO definition)

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Overview

• Definitions
• Cholera clinical, epidemiology
• History and pandemics
• Peru diary of Choleras epidemic
• Environmental factors
• Cholera today
• Conclusion

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Cholera pandemics

1. 1817 1823
2. 1826 1838 ? UK 1831
3. 1839 1853
4. 1863 1874
5. 1881 1896
6. 1899 1923
7. 1961 - ? America 1991

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What happened?

• Cholera extremely linked to social, economical
  and political change
• Initially Indian subcontinent
• 19th century imperialism, trade, military
  conflict, migration
• Worldwide disease in 1826

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