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Cholera and Global Health

Cholera and Global Health. Dr Jaime Miranda, M.D. International Health and Medical Education Centre University College London London, March 2004. IHMEC. International Health and Medical Education Centre, UCL

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Cholera and Global Health

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  1. Cholera and Global Health Dr Jaime Miranda, M.D. International Health and Medical Education Centre University College London London, March 2004

  2. IHMEC • International Health and Medical Education Centre, UCL • IHMEC was established in 2000 to meet the growing demand from staff and students for the inclusion of international health in the medical curriculum • We have been working to increase the possibilities for studying global health and have been publicising issues relating to the subject

  3. Educating doctors for world health …UCL's International Health and Medical Education Centre is an important step forward in the effort to produce doctors who can make a difference in the world Lancet 2001;358:1471

  4. Courses offered • Intercalated BSc in International Health • Fifth year Special Study Module and International Health Elective • Special Study Modules for first year students

  5. Objective • To understand Cholera as a global health issue • To Outline environmental, economical, social and political issues associated with Cholera

  6. Love in the Time of Cholera ...they no longer felt like newlyweds, and even less like belated lovers. It was as if they had leapt over the arduous calvary of conjugal life and gone straight to the heart of love. They were together in silence like an old married couple wary of life, beyond the pitfalls of passion, beyond the brutal mockery of hope and the phantoms of disillusion: beyond love. For they had lived together long enough to know that love was always love, anytime and anyplace, but it was more solid the closer it came to death. (Gabriel García Marquez)

  7. Overview • Definitions • Cholera: clinical, epidemiology • History and pandemics • Peru: diary of Cholera’s epidemic • Environmental factors • Cholera today • Conclusion

  8. Overview • Definitions • Cholera: clinical, epidemiology • History and pandemics • Peru: diary of Cholera’s epidemic • Environmental factors • Cholera today • Conclusion

  9. Definitions • Nomenclature • Endemic, Epidemic, Pandemic • International Health

  10. Nomenclature • Vibrio: a type of bacteria • Vibrium cholerae: organism • Serogroups: O antigen >200 groups • O1, O139, non-O1 non-O139 • O1 biotypes: Classical, El Tor • Serotypes: Ogawa, Inaba, Hikojima • Cholera: disease

  11. …demic • Endemic: a disease continually present in a region • Epidemic: an outbreak of a disease, introduced from outside a community, attacks many people over a short period • Pandemic: an extensive epidemic, affects populations of several countries or regions

  12. International Health Conceptualising health as the end point of such complex processes involves looking at economic, cultural, historical, political, commercial and environmental factorson a global scale

  13. Overview • Definitions • Cholera: clinical, epidemiology • History and pandemics • Peru: diary of Cholera’s epidemic • Environmental factors • Cholera today • Conclusion

  14. Cholera epidemiology • Transmission: food in DC, water in LDC • Seasonality • Bangladesh: 2 peaks, b/a monsoon rain • Peru: warm season • Reservoir: shellfish and plankton • Case:Infections = 1:3 to 1:100

  15. Infection • Intestinal immunity • 108 – healthy subjects • 105 – with antacids • Lower in real: • No volunteer conditions • Low gastric ph • Blood group O – evolution in Ganges?

  16. Clinical Features • Incubation: 18h – 5 days • Watery diarrhoea, infectious • Vomiting • 10% severe • Up to 0.5-1 L/h  dehydration

  17. Replacement for dehydration Signs: 5% bodyweight Severe dehydration = 10% 50kg 5 L saline FAST!! Antibiotics:  Illness  diarrhoea  Use of fluids  hospital stay Vaccination? Treatment

  18. Cholera outbreak • … patient older than 5 years develops severe dehydration or dies from acute watery diarrhoea, or if there is a sudden increase in the daily number of patients with acute watery diarrhoea, especially patients who pass “rice water” stools typical of cholera (WHO definition)

  19. Overview • Definitions • Cholera: clinical, epidemiology • History and pandemics • Peru: diary of Cholera’s epidemic • Environmental factors • Cholera today • Conclusion

  20. Cholera pandemics • 1817 – 1823 • 1826 – 1838  UK 1831 • 1839 – 1853 • 1863 – 1874 • 1881 – 1896 • 1899 – 1923 • 1961 - …  America 1991

  21. What happened? • Cholera extremely linked to social, economical and political change • Initially: Indian subcontinent • 19th century: imperialism, trade, military conflict, migration • Worldwide disease in 1826

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