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  • Cholera. You've probably heard about this disease that's plagued the world for centuries,

  • spreading around sickening and killing millions. But what you probably didn't know is that

  • the disease has created one of the world's longest pandemics ... ever. So what exactly

  • does cholera do to the body? How can we prevent it? And why has this ancient disease lasted

  • throughout the ages?

  • It's actually a good time to be talking about cholera because of the COVID pandemic right

  • now because cholera causes pandemics and we've had seven pandemics of cholera in the last

  • 200 years.

  • I am Anita Zaidi and I'm the director for the Bill and Melinda Gates Foundation

  • in enteric and diarrheal diseases.

  • First discovered in the Ganges delta in India, Cholera is caused by the bacteria vibrio cholerae.

  • And it's been around since ancient times, with multiple pandemics starting in 1817.

  • During that first outbreak was when the world really got to know about this disease. Out

  • of the more than 200 serogroups of V. cholerae, only two are known to actually cause Cholera:

  • O1 which is responsible for most of the recent outbreaks, and O139 which is linked to more isolated

  • casesSo how exactly does the bacteria spread?

  • Well, that mystery was solved thanks to a pump back in 1854.

  • John Snow is like one of those legendary epidemiology figures that everybody learns about when they

  • learn about cholera. John Snow noticed, that there was a lot of cholera happening in London

  • and he started looking at the patterns of how cholera was spreading and he noticed that

  • the areas which had high incidence of cholera, all had a similar drinking source, a water pump.

  • And so he removed that water pump and it showed that cholera rates in those areas went down

  • and it's a famous epidemiology story about one smart person paying attention to patterns

  • of disease and figuring out how to stop it. And two centuries later, we're still trying

  • to figure it out.

  • What we know is that when a person contracts cholera, it's usually through a contaminated

  • source like drinking water that's come into contact with infected feces. Now, after that

  • first sip, it takes the bacteria anywhere from a few hours to a couple of days to begin

  • wreaking havoc on the body.

  • When you ingest the bacteria, it goes from your mouth, into your esophagus, into your stomach, and then

  • pass the stomach and where it causes disease is in the small intestine.

  • Once there, the bacteria swims towards the intestinal wall, pushing through the thick

  • mucous layer of the intestines' epithelial cells where it then attaches itself and begins

  • to multiply, releasing toxins that stimulate the cells to secrete water. And that's where

  • the chaos begins.

  • What it does to the body is it will cause vomiting. It causes stomach pains. It causes

  • bad watery diarrhea. All of a sudden, all of the water in your body starts being secreted

  • through your intestinal cells. The secretion of fluids is so massive that you basically

  • pour out liters of fluid from your body. That's how cholera kills, right, because it just

  • dehydrates then all of the organs shut down. Like if you've seen a cholera dehydration in

  • your life once, you never forget it.

  • Oh and if that weren't scary enough, that rapid loss of fluid can all happen within

  • a matter of hours of showing symptomsThankfully, only a minority of cases experience

  • this. While the rest have mild to moderate symptoms, developing bouts of nausea, vomiting,

  • and loose stools. But milder cases still present a threat because patients can excrete V. cholerae

  • for up to two weeks after the infection has passed.

  • Luckily though, we know how to treat it. For patients suffering, the most important thing

  • to do is to replace the rapid loss of minerals, so a solution of oral rehydration salts is

  • usually given and in the more extreme cases, IV fluids can be used to get the job done

  • faster. And to stem future spread, antibiotics can help reduce the amount of the bacteria

  • present in the stool.

  • As for prevention, there are two main methods: One is of course making sure that people have

  • access to clean water and sanitation and now we know much more about the types of areas

  • where cholera spreads, they're called hotspots, where there is a lot of people living in close

  • proximity, so high population density slums, inner city areas in developing countries and

  • typically they are close to a body of water.

  • While the other is vaccines. Currently, there's the oral cholera vaccine, which is taken in

  • two doses one to two weeks apart. It's the main one used in mass vaccination efforts

  • and it's produced by two manufacturers: Euvichol and Shanchol. And the best part is,

  • is that it's really cheap, at less than two dollars a dose.

  • This vaccine has now saved thousands and thousands of lives. 30 to 40 million doses are being

  • used every year in the cholera hotspotsThis is for the first time that so many doses

  • of vaccines are being used that we are now seeing a number of deaths from cholera decreasing

  • in the world for the last two years and so that's really good news on cholera.

  • So if we know how to treat the disease and have a way to prevent it, then why is this

  • ancient disease still an issue today?

  • The reason that Cholera has persisted is that we have not addressed poverty to the level

  • that we should and with time we know how Cholera happens and where it happens and we should

  • be able to focus on those cholera hotspots as first priority for areas which need improved

  • sanitation and hygiene. And that's countries working together prioritizing health over

  • other things and improving their own infrastructure.

  • So when we can do that, cholera will disappear.

  • To help get there, the World Health Assembly,

  • which is the WHO's decision making body, pledged to eradicate cholera by 2030, hoping

  • to reduce deaths worldwide by 90%. And if we can achieve that goal, we may soon see the

  • end of one of the world's longest pandemics.

  • We have an opportunity to get rid of cholera from the world forever and also an opportunity

  • for the world to understand how we have worked together as a multinational effort, coming

  • together to control cholera as an infectious disease pandemic and what are the lessons

  • learned for controlling COVID in the same way.

Cholera. You've probably heard about this disease that's plagued the world for centuries,

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The Pandemic the World Has Forgotten

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    Summer posted on 2020/09/08
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