Cholera cases are on the rise in India too but it’s seasonal, say experts

• According to WHO, around 27 countries have reported cholera outbreaks in the first nine months of this year.
  
• The prevalence rates of cholera in India are 6.7% and 1.4% in rural and urban areas respectively.
  
• “If untreated, delay in diagnosis can lead to mortality of 50-70%. If diagnosed early and treated, mortality can reduce to less than 0.5%,” said Dr Balaji at Fortis Healthcare.

As Covid-19 seems to be ebbing, another disease is emerging globally. According to the World Health Organization (WHO), around 27 countries have reported cholera outbreaks in the first nine months of this year.

“Not only are we seeing more outbreaks but more deadly outbreaks. The data we have, which are limited, show the average case fatality rate so far this year is almost three times the rate of the past five years,” said Dr Tedros Adhanom Ghebreyesus, director-general of WHO in a media briefing on October 6.

In Syria, more than 10,000 suspected cases of cholera have been reported just in the past six weeks. Haiti has also reported two cases earlier this month in the capital city Port-au-Prince, with 20 suspected cases and seven deaths under investigation in other areas.

What is Cholera?

Cholera is an acute diarrhoeal disease caused by an infection of the intestine by toxigenic bacteria called Vibrio cholerae. It causes severe diarrhoea and if left untreated, can lead to dehydration and death.

It takes between 12 hours to 5 days for a person to show symptoms after ingesting contaminated food or water and affects both children and adults, and can kill within hours if untreated.

In July this year, 8 people succumbed to a cholera outbreak in Odisha's Rayagada district while 120 were hospitalised.

Cholera is said to be endemic in India. However, the reported cases in India tend to be much lesser than the actual numbers, say doctors and experts. The country reports nearly 20,000 to 30,000 cases of cholera every year, usually during the monsoon season of July to September.

Currently, amid the monsoon season, cholera cases have spurted again in the country.

“Yes, we are witnessing a surge in an episodic manner as our country is endemic to this particular infection. So, before and after the rainy season, outbreaks happen in clusters which are distributed throughout the country,” said Dr Balaji G, consultant - gastroenterology, Fortis Hospital in Bangalore.

According to Dr Balaji, the prevalence rates of cholera in India are 6.7% and 1.4% in rural and urban areas respectively.

“The severity of cholera varies from mild to severe disease. If untreated, delay in diagnosis can lead to mortality of 50 to 70% . Whereas if diagnosed early and treated, the mortality can reduce to less than 0.5%. Hence, early medical attention is very important,” Dr Balaji added.

Persons who have inadequate access to clean water and sanitation facilities are prone to cholera.

“The number of cases are rising in India because we still lack the basic sanitation, hygiene and access to clean water in many communities,” Dr Haripriya Jagadish, consultant physician, Apollo Clinic, Chennai told Business Insider India.

Climate change adds up another layer to the cholera outbreak, said Philippe Barboza, WHO team lead for Cholera and Epidemic Diarrheal Diseases. Barboza further added that climate-induced floods in Pakistan and Bangladesh have resulted in a larger outbreak of cholera.

How can we tackle this infection?

The only way to prevent this disease is to provide access to safe water and sanitation. Cholera can be treated easily with oral rehydration or with antibiotics in more severe cases.

Vaccines are also available in the market to treat Cholera. Dukoral, Shanchol and Euvichol are the three WHO pre-qualified oral cholera vaccines.

WHO recommends that people living in endemic regions and travellers who travel to these endemic regions take 2 doses of the cholera vaccine, with a 2 week gap between each dose, as a safety measure.

Increasing outbreak of cholera is leading to increased demand for vaccines.

“In 2013, WHO and our partners created an international stockpile of cholera vaccines which last year shipped 27 million doses but, with an increasing number of outbreaks, supply cannot keep up with demand. We urge the world’s leading vaccine manufacturers to talk to us about how we can increase production,” WHO’s Ghebreyesus said.

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