Africa's ongoing cholera epidemic "unconscionable"

Mar 24 2009

Although illness rates and mortality from cholera have been drastically reduced in a vast majority of the world, Africa remains plagued by soaring cases and deaths from the waterborne intestinal disease.

"It is time to sound the alarm," say two global health experts, who are calling Africa's ongoing cholera epidemic "unconscionable" on both regional and global levels.

In a Perspective published in the March 12, 2009 edition of the New England Journal of Medicine, Richard L. Guerrant, M.D., director of the Center for Global Health at the University of Virginia School of Medicine, and Eric D. Mintz, M.D., head of the Diarrheal Diseases Epidemiology Team at the Centers for Disease Control, emphasize that cholera is easy to prevent and simple to treat, yet in Zimbabwe alone there have been an estimated 73,000 cases and 3,500 deaths since November 2008. And the cholera epidemic continues to spread to surrounding countries.

"These preventable cases and deaths result from a lack of essential infrastructure, inadequate health care delivery, and the failure of the global community to muster the political will necessary to extend the benefits of the sanitary and treatment revolutions to all people," states Guerrant, an internationally renowned expert on bacterial infections of the intestines who was awarded the 2008 Walter Reed Medal from the American Society of Tropical Medicine and Hygiene (ASTMH).

In the United States and other developed countries, cholera all but vanished nearly 150 years ago after scientists discovered its mode of transmission and developed extremely effective prevention measures - a period referred to as the "sanitary revolution." Cholera remained endemic in South Asia until the 1960s when the development of oral rehydration therapy (ORT) reduced the fatality rate from more than 30 percent to less than 1 percent.

Co-authors Guerrant and Mintz point to the case of epidemic cholera in Latin America in the 1990s in which these prevention and treatment measures proved to be highly effective, given swift investments in health care, drinking water and sanitation by United Nations agencies, governments and the private sector.

However, the co-authors argue, such collective efforts are not being mobilized in Africa, where cholera rates and mortality continue to soar for lack of clean water and sanitation and basic ORT ingredients of salt and sugar.

"Improving access to safe drinking water, adequate sanitation and basic health services," they write, "are among the core Millennium Development Goals agreed to by all United Nations member states."

Read the full Perspective, "A Lion in Our Village - The Unconscionable Tragedy of Cholera in Africa," in the New England Journal of Medicine online at http://content.nejm.org.