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Saturday, 23 June 2018

Yemen is currently facing the largest documented cholera epidemic in modern times. A new report warns it could get worse

Alanna Shaikh
UN Dispatch

From fall 2016 to spring 2018, more than a million suspected cases of cholera were reported in Yemen –  a country of not quite 30 million people. The rate of new infections has finally slowed, but a new study from MSF/Doctors Without Borders, published in The Lancet looks at the patterns of cholera outbreak.

The takeaway: cholera will be back – and worse – when the rainy season returns, unless we take action now.

Cholera is one of those infectious diseases that has been killing people since ancient times. A bacterial infection, it causes severe diarrhea which leads to dehydration and often death. Cholera is a virulent infection; it can kill within hours of onset.

The cholera bacteria, v. cholerae, spreads through contaminated food or water. In places with safe drinking water, uncontaminated food, and effective sanitation systems for human waste, cholera is easily prevented. Cholera ripped through the United States from 1832-1873, for example, and was finally stopped through improving sanitation infrastructure.

In times of war and disaster, infrastructure is often the first to suffer. When sanitation fails, cholera rapidly follows. Cholera spreads easily in refugee camps, crowded cities, and anywhere people cluster together without a good way to dispose of human waste.

There is no cure or specific drug for cholera. It’s a bacterial infection, but antibiotics don’t make any difference to patient outcomes. Cholera is treated through rehydration therapy. In mild cases, that will consist of special rehydration liquids given by mouth. In more severe cases, intravenous liquids are required. With good care, though, cholera has a case fatality rate of only 1%. When untreated, the cholera fatality rate ranges from 25-50%. Cholera does have a vaccine, but it doesn’t take effect fast enough to be useful in an epidemic situation. The vaccine works best in populations who are at risk for cholera but not yet affected by an outbreak.

Cholera isn’t new to Yemen. Like many countries in the Middle East and South Asia, cholera has historically been endemic in Yemen. This kind out outbreak is new, though. Infectious disease modeling techniques estimate that until 2016, Yemen had approximately 17,546 cases of cholera per year and a case fatality rate of 3%. In 2011, the Yemeni revolution began and 30,000 cases of cholera were reported.

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