Cholerae O1 Causes The Majority of Outbreaks Worldwide

INTRODUCTION
During the 19th century, cholera spread repeatedly from its original reservoir or
source in the Ganges delta in India to the rest of the world, before receding to South Asia. Six
pandemics were recorded that killed millions of people across Europe, Africa and the
Americas. The seventh pandemic, which is still ongoing, started in 1961 in South Asia,
reached Africa in 1971 and the Americas in 1991. The disease is now considered to be
endemic in many countries and the pathogen causing cholera cannot currently be eliminated
from the environment.
CAUSAL AGENT
Vibrio cholerae is a motile, gram negative, non-sporulating rod. Two serogroups

have been identified as causing symptoms in humans which are O1 and O139. These
organisms grow best at a pH of 7.0 but are able to tolerate an alkaline environment. Rather
than invading the intestinal mucosa, they adhere to it. The clinical syndrome is caused by the
action of the cholera toxin.
Both O1 and O139 can cause outbreaks. The main reservoirs are human beings and
aquatic sources such as brackish water and estuaries, often associated with algal blooms
(plankton). Recent studies indicate that global warming might create a favourable
environment for V. cholerae and increase the incidence of the disease in vulnerable areas. V.
cholerae O1 causes the majority of outbreaks worldwide.
The serogroup O139, first identified in Bangladesh in 1992, possesses the same
virulence factors as O1, and creates a similar clinical picture. Currently, the presence of O139
has been detected only in South-East and East Asia, but it is still unclear whether V. cholerae
O139 will extend to other regions. Careful epidemiological monitoring of the situation is
recommended and should be reinforced. Other strains of V. cholerae apart from O1 and O139
can cause mild diarrhoea but do not develop into epidemics.
TRANSMISSION
Cholera is mainly transmitted through contaminated water and food and is closely
linked to inadequate environmental management. The absence or shortage of safe water and
sufficient sanitation combined with a generally poor environmental status are the main causes
of spread of the disease. Typical at-risk areas include peri-urban slums, where basic
infrastructure is not available, as well as camps for internally displaced people or refugees,
where minimum requirements of clean water and sanitation are not met.
However, it is important to stress that the belief that cholera epidemics are caused by
dead bodies after disasters, whether natural or man-made, is false. Nonetheless, rumours and
panic are often rife in the aftermath of a disaster. On the other hand, the consequences of a
disaster such as disruption of water and sanitation systems or massive displacement of
population to inadequate and overcrowded camps which can increase the risk of transmission,
should the pathogen be present or introduced.
Since 2005, the re-emergence of cholera has been noted in parallel with the ever-
increasing size of vulnerable populations living in unsanitary conditions. Cholera remains a
global threat to public health and one of the key indicators of social development. While the
disease is no longer an issue in countries where minimum hygiene standards are met, it
remains a threat in almost every developing country.
The number of cholera cases reported to WHO during 2006 rose dramatically,
reaching the level of the late 1990s. A total of 236 896 cases were notified from 52 countries,
including 6311 deaths, an overall increase of 79% compared with the number of cases
reported in 2005. This increased number of cases is the result of several major outbreaks that
occurred in countries where cases have not been reported for several years. It is estimated that
only a small proportion of cases that less than 10% are reported to WHO. The true burden of
disease is therefore grossly underestimated.
When humans ingest cholera bacteria, they may not become sick themselves, but they
still excrete the bacteria in their stool and can pass cholera disease to others through the fecal-
oral route. This mainly occurs when human feces contaminate food or water supplies, both of
which can serve as ideal breeding grounds for the cholera bacteria. Because more than a
million cholera bacteria is approximately the amount we can find in a glass of contaminated
water are needed to cause illness, cholera usually isn't transmitted through casual person-to-
person contact.
SYMPTOMS
Cholera disease is characterized in its most severe form by a sudden onset of acute
watery diarrhoea that can lead to death by severe dehydration and kidney failure. The
extremely short incubation period which is two hours to five days. This enhances the
potentially explosive pattern of outbreaks, as the number of cases can rise very quickly.
About 75% of people infected with cholera do not develop any symptoms.
However, the pathogens stay in their faeces for 7 to 14 days and are shed back into the
environment, potentially infecting other individuals. Cholera is an extremely virulent disease
that affects both children and adults. Unlike other diarrhoeal diseases, it can kill healthy
adults within hours. Individuals with lower immunity, such as malnourished children or
people living with HIV, are at greater risk of death if infected by cholera.

Cholerae O1 Causes The Majority of Outbreaks Worldwide

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INTRODUCTION

Vibrio cholerae is a motile, gram negative, non-sporulating rod. Two serogroups

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