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The Emergence of Cholera in Latin America: The Peruvian Experience

This article explores the emergence of cholera in Latin America, focusing on the 1991 epidemic in Peru. It discusses the clinical and epidemiological aspects of cholera, environmental factors, and the impact of the epidemic. The study presents new insights into the origins and spread of cholera in the region.

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The Emergence of Cholera in Latin America: The Peruvian Experience

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

  2. New insights on the emergence of Cholera in Latin America during 1991: the Peruvian experience C Seas, J Miranda, AI Gil, et. al. Am J Trop Med & Hyg 2000; 62(4):513-7

  3. Cholera epidemic in Peru, 1991 • Officially started January 23, 1991 in Candelaria, a valley near Chancay • Within a week, cases alongside the 900 km of Peruvian coast • 300,000 cases (peak 45,000/wk) • Low mortality (~1%)

  4. Hypothesis presented • Ships coming from infected areas • Contaminated water eliminated to the sea • V. cholerae non toxigenic acquired virulence through phages • V. cholerae toxigenic was present in low concentrationsorin viable state but not cultivatable

  5. Our hypothesis • V. cholerae, originally from the water environment, was present in multiples coastal places, maybe related with El Niño phenomenon, and increased in concentrations enough to produce human infection • This provoked sporadic and dispersed clinical cases before the start of the epidemic • The epidemic continued because of massive water and food contamination

  6. Material and Methods • Revision of case records and emergency files • Where? 7 coastal cities and ports (Lima, Chancay, Huacho, Chimbote, Trujillo, Chiclayo y Piura) • Period of study: Sep-Jan 1989/90 & 1990/91 • Case definition: patients >5 years, watery diarrhoea and severe dehydration

  7. Results • 3640 records reviewed • 7 people (90/91) fulfill cholera’s clinical definition • First case identified 4 months before the beginning of epidemic • Comparison% diarrhoeal periods 90/91 and 89/90: no difference between Sep-Jan, high Feb-Mar

  8. Cases Compatibles DatePlace Distance (Km) 23 Oct 90 Trujillo (*) 570 11 Dec 90 Chimbote 440 24 Dec 90 Trujillo 26 Dec 91 Chancay 60 29 Dec 90 Trujillo 13 Jan 91 Lima 0 16 Jan 91 Chancay 1050 23 Jan 91 Epidemic’s official beginning (*) Cases identified were from two different hospitals

  9. Discussion (i) • Majority of infections are asymptomatic • V. choleraeis associated with phytoplankton and zooplankton in sea environment • V. cholerae O1 (non-toxigenic) and no-O1 have been cultivated in this region in the last 15 years

  10. Discussion (ii) • Suggest V. Choleraewas present in Peru at least several months before the recognition of the epidemic • Cases alongside the Peruvian north coast explains the large dispersion of Vibrio in the environment

  11. Discussion (iii) • Dissemination of vibrios possibly related to selected plankton populations, increased because of El Niño phenomenon1991 • Limitation: microbiological confirmation

  12. Plankton concentrations during El Niño 82-83 in Bangladesh

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

  14. en

  15. Summary • Rehydration and antibiotics • Clear links with poverty, instability and deprived conditions • Economical and political actors also play a role • Still a problem for some groups

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

  17. Conclusion • “V cholerae cannot be eradicated; it is a part of the normal flora an ecology of the surface water of our planet. Thus, we have to learn to coexist with the vibrios” (Sack DA, et al) • Need to tackle social problems to avoid future outbreaks

  18. Further reading • Sack DA, et al. Cholera. Lancet 2004;363:223-33 • Lee K, Dodgson R. Globalization and Cholera: Implications for Global Governance. Global Governance 2000;6:213-36 • Panisset U. International Health Statecraft: Foreign Policy and Public Health in Peru’s Cholera Epidemic. Lanham: University Press of America, 2000 • WHO, PAHO

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