Episode #143 – The race to stop cholera before it’s too late

VGS This disease has been killing humans for centuries. In fact, there are references to it in literature, in history, religious text. There's even a goddess in India that protects you against it. We are talking about cholera today with Doctor Kate Alberti.

Many people think cholera is a disease of the past, but it really isn't. In fact, in the recent years, as many as 30 countries from across the globe have been reporting outbreaks every year. What do you need to know about cholera and how can you prevent it? Welcome, Kate. So, what is cholera and why is it still on the rise?

KA Vismita, thanks very much. And you're right that cholera should be a thing of the past. But it's not. So, cholera is an infection of the gut. And people get it when they eat or drink something that has been contaminated with the bacteria called Vibrio cholerae. And that means that somehow human waste or poop got into what it is that they're eating or drinking.

So, when cholera strikes, most people will get mild diarrhea. In some instances, they'll get severe diarrhea and vomiting. That leads to life threatening dehydration. And in fact, someone can have my diarrhea in the morning. And by the evening, they've died of cholera. The good news is that in most cases, people can be treated and survive. So why is cholera on the rise?

Well, poverty, lack of element and conflict have always created the conditions for cholera. And now, in addition to those, we also have climate change. And you see that cyclones, floods and drought can disrupt water systems. And that is also increasing the risk of cholera. And in fact, what we've been seeing is countries who hadn't seen cholera for many years are now seeing outbreaks.

VGS A recent WHO-UNICEF report said that 1 in 4 people around the world do not have access to safe water. If cholera can spread so fast, how can we stop it?

KA Well, you're right, that report is really the key to preventing cholera. If people have access to safe water and sanitation, then you can prevent cholera. And other key elements include hygiene measures. So, washing your hands after going to the toilet and before preparing or eating food, cooking food thoroughly and eating it when it's hot and keeping human waste out of what we're eating and drinking. We also have an oral cholera vaccine. It's safe, effective, and can help protect people during outbreaks or even before they occur. The challenge is that the demand for the vaccine is much higher than the production of the vaccine. You know, that's increasing. And so, we're having to prioritize high risk areas for vaccination. Communities themselves are really at the heart of preventing cholera.

VGS So, I learned something new during, while we were researching this episode that auris was actually developed for cholera.

KA You're right. The oral rehydration solution. Or as most people associate it with a quick and easy treatment for childhood diarrhea. But in fact, it was developed for cholera. And for adults, it was seen that it was so effective for cholera that it started to be used for all these other diarrheal diseases. So during big outbreaks, in addition to color treatment centers, which are like small hospitals specifically for cholera, we also set up something called oral rehydration points. And those can be in primary health care centers or independent in affected communities. And people with mild disease can come and get oral rehydration solution there. It's a really important part of the community response to outbreaks. Early access to ORS is critical to saving lives.

VGS So what's the impact of cholera?

KA Well, the obvious thing is health. People get ill and many people die. But the impact is in much broader than that as well. If there's no free access to treatment, then people eight are losing their livelihood because they're not able to work. The families are also paying for health care and even transport to get to that health care. So the ripple effect is much bigger. I remember vividly, during the first scholar outbreak that I was working on, there was a woman came in. She was lifeless and we had multiple members of staff were trying to get an IV into her so that we could rehydrate her. And one of my colleagues luckily succeeded. When I came back to the ward a couple of hours later, she was sitting up in bed and she waved at me. And that's an example. This woman was the breadwinner for the family. So if she had died, they not only would have lost their mother, but they would have lost their income as well. So the effects are much broader than we initially think.

VGS So what can people do to keep themselves and their loved ones safe from cholera?

There are essentially five things. One is to make sure that they are drinking and cooking the safe water. The second is implementing hygiene measures. So that means, as I mentioned earlier, washing hands after going to the toilet, before preparing food and before eating. A third thing is cooking food thoroughly and making sure you eat it while it's still hot. Seeking treatment quickly is also very important because the disease develops so rapidly. And the final thing is vaccination. If there is a vaccination campaign in your community. Make sure that you and your whole family get vaccinated it. And remember, individuals can be part of the solution. By sharing accurate information, you can share accurate information on how cholera spreads and how it can be prevented. That information can help save lives. And even if your community isn't directly affected, you can advocate to your government or authorities to ensure that everyone has access to safe water and toilets. No one should die because they don't have access to safe water.

VGS Thank you Kate. That was science and five today. Until next time. Then stay safe. Stay healthy and stick with science.