Tag Archives: cholera

India, Orissa: cholera-diarrhoea epidemic claims 140 lives

At least 140 people have died from cholera and diarrhoeal diseases in the Indian state of Orissa. Worst hit is Rayagada district, where 39 deaths have ocurred and 784 affected persons have received medical attention since first week of August 2010. After fierce criticism from opposition parties, accusing the state government for failing to contain the outbreak, Health Minister Prasanna Acharya and the Secretary of the Rural Development Department, which oversees drinking water facilities, rushed to the Rayagada district on 14 September 2010 to take stock of the situation. One opposition leader (Tara Prasad Bahinipati, Congress) claimed that over 600 people had already died in undivided Koraput district.

In Rayagada district, according to official sources, 39 deaths have occurred till date, while unofficial figures put the mark at over 65. Regional Medical Research Centre, Bhubaneswar, has confirmed the prevalence of cholera in the district. [...] To assist the existing medical teams, 70 more personnel, comprising 30 doctors and 40 paramedics, are being sent to the district.

Back in 2007, a cholera and diarrhoea epidemic in Rayagada district had claimed over 100 lives.

Non-availability of clean drinking water, faecal contamination of drinking water sources, lack of awareness about sanitation among tribals living in remote pockets and slow progress of the Total Sanitation Campaign are the reasons behind the recurring cholera and diarrhoea outbreaks in this district during monsoon, said Chief District Medical Officer of Rayagada, B.D. Nayak.

Lack of doctors and communication facilities in remote areas adds to the problem. Fifty-nine posts of doctors are vacant in Rayagada district.

Source: Sib Kuma Das, The Hindu, 15 Sep 2010 ; The Hindu, 14 Sep 2010

Papua New Guinea: cholera patients battle stigma

An ongoing cholera outbreak is killing a growing number of people in Papua New Guinea and making scores more ill. But the disease is also having a severe effect on survivors.

This is the first known outbreak of cholera the country has ever experienced, and the government, the World Health Organization (WHO) and aid workers are struggling to raise awareness about the disease. Few people have ever heard of cholera, leaving infected people shunned and stigmatised.

One is Leah Peter, 25, from the Boundary Road settlement in Lae, the provincial capital of northern Morobe Province, which has experienced most of the cholera cases.

A few weeks ago, she woke up feeling weak and within a few hours was rushed to Angau Hospital in Lae by a friend. “They put two drips into me and told me I had cholera. I didn’t know what it was. My face had sunk in, my body was tiny,” Peter told IRIN.

“When I looked through the tent flaps [of the hospital's cholera treatment centre], I saw people covering their mouths and noses and crossing to the other side of the street. I thought, ‘What’s this disease I have? I must be going to die from something really terrible,’” she said.

Peter survived her battle with cholera but when she returned to the settlement, the villagers ran away in fear. [...] Her boss also told her not to return to her cleaning job. However, after two days of anger and depression, she resolved to fight for her rights.

Peter returned to the cholera centre and spoke to Karin Lind, the Médecins Sans Frontières (MSF) doctor who had treated her. “She told me about the stigma she was experiencing. I called her boss to explain about the disease, and that Leah was not contagious, but it didn’t work. I thought we could find her something to do here at the hospital. But she had another plan,” said Lind.

According to Victor Golpak, coordinator for the national health department, authorities still did not know the origin of the cholera outbreak, first reported in two coastal villages in Morobe Province. They suspect the highly contagious disease was brought in by Southeast Asian workers at a logging operation in the area, or aboard a fishing vessel.

Peter decided to run an awareness programme in her settlement to educate people about cholera.

“Rich people live a luxury life. They can buy good food, drink good water. They have education. They know about cholera and how to protect themselves. They don’t have to be scared of it,” she said.

“In settlements, we are poor and we live with germs. We don’t know anything about cholera, so we get sick. That’s not right.”

Lind helped Peter develop the educational material for her programme, including information sheets about cholera.

Monica Telba is also helping with the education project. “People in the community believe if you argue with someone, you get the cholera germ. But they are wrong,” she said.

While virtually illiterate, between them Peter and Telba speak five of the languages spoken in their settlement, an advantage many outsiders lack. Besides distributing the information sheets, they plan to talk to people individually.

“You can give them a sheet of paper and tell them to read it,” said Telba. “But they won’t understand. And with radio it’s in one ear and out the other. You have to take the time to sit and talk.”

Fighting the stigma

Educating communities is the only way to overcome the stigma associated with cholera, said Sister Gatsia Muwete, senior nurse at Angau Hospital’s cholera treatment centre.

“You can’t blame people like Leah’s boss, really. They’ve never heard about cholera before. We’ve had people who’ve died at the side of the road because no one wanted to take them to hospital.

“Nurses here at the hospital don’t want to have [physical] contact with the nurses working in the cholera centre and avoid us. Of course, we are holding information courses on cholera to educate them,” she said.

However, even educating health workers is a challenge.

“Only three nurses attended the information session today. But we’ll get there,” said Lind.

Source:IRIN, 22 Sep 2009

India: cholera vaccine seen safe, effective – study

An India-made cholera vaccine that meets World Health Organization (WHO) standards has proven to be safe and effective in young children in a part of India where the disease is endemic, a new study says.

The researchers, who published their study results in The Lancet [1], hope the vaccine can soon be rolled out in developing countries where cholera remains endemic.

The trial involved 107,774 participants in Kolkata in eastern India, half of whom were given the vaccine and the other half a placebo. The vaccine was orally administered in two doses, at least 14 days apart [between July and September 2006] , and the researchers tracked the participants for two years.

On average, there were 20 episodes of cholera in the vaccine group and 68 episodes in the placebo group, which meant the vaccine had a protective efficacy rate of 67 percent, the researchers said. There were no adverse events linked to the vaccine.

“This … trial shows that the modified killed-whole-cell oral vaccine is safe and efficacious, providing nearly 70 percent protection against clinically significant cholera for at least 2 years after vaccination,” wrote the researchers, led by John Clemens at the International Vaccine Research Institute (IVI) in Seoul, South Korea. “Protection was seen in children vaccinated at ages under 5 years, as well as in older individuals.”

An earlier version of this vaccine has been used in Viet Nam. Though it is effective, it has never been approved for use elsewhere because the manufacturing process in Viet Nam did not reliably remove cholera toxin from the vaccine, the researchers said. Furthermore, Vietnam’s national regulatory authority is not WHO-approved.

IVI worked with Vietnamese manufacturer VaBiotech to improve the vaccine and production has since been transferred to vaccine maker Shantha Biotechnics in Hyderabad in India, where the national regulatory authority is WHO-approved.

Cholera causes 120,000 deaths every year worldwide, according to the WHO.

The study was funded by the Bill & Melinda Gates Foundation, Swedish International Development Cooperation Agency, Governments of South Korea, Sweden, and Kuwait.

[1] Dipika Sur, M. … [et al.] (2009). Efficacy and safety of a modified killed-whole-cell oral cholera vaccine in India: an interim analysis of a cluster-randomised, double-blind, placebo-controlled trial. The Lancet, Early Online Publication, 9 October 2009. doi:10.1016/S0140-6736(09)61297 [Free registration required].

See also: Sanitation vs. vaccination in cholera control, Sanitation Updates, 15 May 2009

Source: Tan Ee Lyn, Reuters, 08 Oct 2009

Nepal: success of cholera mitigation campaign celebrated

The number of cholera cases in the Kathmandu Valley dropped drastically after various intervention programmes, according to a study carried out by an NGO. The month-long Cholera Mitigation Campaign launched in September 2008, reduced the number cholera cases from 315 to zero. During the campaign 250 volunteers were engaged in awareness raising and chlorine distribution.

A special programme was organised to thank the volunteers involved in the campaign of the Ministry of Physical Planning and Works (MPPW) launched with support from UNICEF, UN-HABITAT Water for Asian Cities programme and some 25 local NGOs.

At the meeting, the Joint Secretary at the Ministry of Physical Planning and Works, Suman Sharma, told that the government is developing a strategy to prevent outbreaks of contagious diseases like diarrhoea and cholera in 2009.

Source: NGO Forum, 16 Dec and 17 Dec 2008

Afghanistan: El-Tor cholera leaves 17 dead

An outbreak of El Tor cholera in northern, eastern and southeastern Afghanistan has killed at least 17 people – mostly women and children – in the past few weeks, the Ministry of Public Health (MoPH) said on 6 October [2008].

Over 1,100 people with diarrhoea and vomiting caused by the outbreak have received treatment at medical facilities in 13 of the country’s 34 provinces.

[...]

“It’s not a classic cholera which quickly turns into an epidemic,” Abdullah Fahim, a spokesman for the MoPH, told IRIN. El Tor (a strain of the bacterium vibrio cholerae) is less fatal, and controllable, Fahim said.

Health workers said the use of contaminated water and poor sanitation had prompted the outbreak.

Less than 24 percent of Afghanistan’s estimated 26.6 million people have access to improved drinking water and only 12 percent have access to improved sanitation, according to the UN Children’s Fund (UNICEF).

A severe drought affecting large swaths of the country has made life very difficult for many communities, forcing people to use unsafe water for drinking, washing and cooking. [The Afghan Ministry of Rural Rehabilitation and Development (MRRD) has been responding to the drinking water shortage by deploying water tankers and constructing rural water supply systems].

[...]

Water chlorination in affected areas is a top priority, as is the boosting of public awareness about personal sanitation and communal hygiene.

Source: IRIN, 07 Oct 2008

Bangladesh: factors determining vulnerability to diarrhoea during and after severe floods

Hashizume, M. … [t al.] (2008). Factors determining vulnerability to diarrhoea during and after severe floods in Bangladesh. Journal of water and health ; vol. 6, no. 3 ; p. 323-332. doi:10.2166/wh.2008.062

Abstract

This paper identifies groups vulnerable to the effect of flooding on hospital visits due to diarrhoea during and after a flood event in 1998 in Dhaka, Bangladesh. The number of observed cases of cholera and non-cholera diarrhoea per week was compared to expected normal numbers during the flood and post-flood periods, obtained as the season-specific average over the two preceding and subsequent years using Poisson generalised linear models. The expected number of diarrhoea cases was estimated in separate models for each category of potential modifying factors: sex, age, socio-economic status and hygiene and sanitation practices. During the flood, the number of cholera and non-cholera diarrhoea cases was almost six and two times higher than expected, respectively. In the post-flood period, the risk of non-cholera diarrhoea was significantly higher for those with lower educational level, living in a household with a non-concrete roof, drinking tube-well water (vs. tap water), using a distant water source and unsanitary toilets. The risk for cholera was significantly higher for those drinking tube-well water and those using unsanitary toilets. This study confirms that low socio-economic groups and poor hygiene and sanitation groups were most vulnerable to flood-related diarrhoea.

Contact: Masahiro Hashizume, Research Center for Tropical Infectious Diseases, Institute of Tropical Medicine, Nagasaki University, Japan, hashizum [at ] nagasaki-u.ac.jp

Nepal: cholera mitigation campaign launched

Kathmandu: Guthi, a non-governmental organisation, launched a cholera mitigation campaign with a slogan of ‘Build Good Habit, Drink Pure Water’ with the assistance of the Nepal government, UNICEF and UN-HABITAT. [The launch was held at the] Ganabahal unit of Nepal Red Cross Society.

According the figures from Valley-based hospitals, 4,000 people suffered from diarrhoea [in 2007]. Among them, 250 people suffered from cholera and five of them died. Most of the victims were children. In the current year, according to records of Teku Hospital, 200 people were found to have caught cholera.

[...]

The [campaign] organizers said they were going to set up mitigation camps at 75 places of Kathmandu Valley mobilizing their volunteers to distribute chlorine and raise awareness among the people about use of purified water at hotels, restaurants, schools and houses. At the programme, the organizers had exhibited the techniques of water purification, sanitation and management of household garbage.

Director of Guthi Anil Sthapit said, “We will go from door to door to make people aware about cholera and water purification technology.”

Source: NGO Forum, 05 Sep 2008

Chlorine solution has been distributed free of cost to around 1,000 families to control cholera that has been raging in the Kathmandu Valley. The solution for water disinfection is being distributed at 75 different locations from temporary booths of the Kathmandu Valley.

[...]

“We have already educated more than 2,000 people about personal hygiene and the process of making drinking water safe,” said Dipesh Raj Sharma, coordinator of the campaign, adding.

[...]

More than 100 volunteers of the campaign are visiting door-to-door, grocery stores and small and big restaurants to make them aware of safe drinking water and sanitation. Additional 100 volunteers will be mobilized in the month-long campaign.

Source: Annapurna Post / NGO Forum, 15 Sep 2008

Pakistan: IDPs face cholera, difficult camp conditions – ICRC warns

After prayer time at mosques in Peshawar, the provincial capital of Pakistan’s North West Frontier Province (NWFP), donations are collected for charity during Ramadan. [...] Among those for whom funds are being allocated this year are internally displaced persons (IDPs) from conflict-affected Bajaur Agency, on Pakistan’s border with Afghanistan. While a ceasefire between the army and the militant groups they have fought over the past month has been called over the Ramadan period, some 300,000 people remain displaced, according to the International Committee of the Red Cross (ICRC).

[...]

Conditions in many camps remain grim. The ICRC reported that cholera had broken out among the IDPs and as such its top priority was providing clean water and sanitation.

[...]

Outbreaks of cholera, an acute gastro-intestinal infection spread through contaminated food and water, have been reported in the past in northern areas and elsewhere.

“I don’t know what illness they are suffering, but the situation is very bad,” said Muhammad Jamshed, 45, a mechanic who had been based until a week ago at a camp in Lower Dir but has now moved to Peshawar to look for a job and place to stay. “Many people, especially children, are falling sick with severe stomach problems. The food being served is substandard. These people need help. The hygiene conditions are appalling because there are no toilets.”

Source: IRIN , 07 Sep 2008

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Lao PDR suffers first cholera outbreak in nearly eight years

VIENTIANE, Lao PDR, 30 January 2008 – The first outbreak of cholera in southern Lao People’s Democratic Republic in nearly eight years has prompted a vigorous response from UNICEF and its partners.

Securing safe water and adequate sanitation is essential in tackling cholera, a water-borne disease. As such, immediate support has included chlorinating water sources, repairing damaged bore holes and educating villagers on hygiene.

Read more: Tom Greenwood, UNICEF, 30 Jan 2008