Cholera: epidemiology, transmission, and public health response

Cholera was not recognized as such until the late nineteenth century, it has been afflicting its victims for centuries. "In 1832, in the days before germ theory, it was an affliction without cause or logic" (Jortner, 2007, p. 234). At that time, the cholera virus would seemingly pick its victims randomly, oftentimes the first affects would be felt in the morning, and the victim would be dead by evening. "Symptoms were multiform and terrifying: muscular cramps, spasmodic vomiting, fever, a constant stream of rice-water diarrhea. It was known, alternately, as Asiatic cholera, pestilential cholera, spasmodic cholera, and the blue pest" (Jortner, p. 234).

Writings from the ancient Sanskrit era mention the diarrheal disease, providing evidence that it has been afflicting mankind for centuries, and even with all the modern medical technology now available, Cholera continues to affect mankind today. It was not, however, until the mid-1800's that society first began to understand cholera, how it was spread, and its effects. A man by the name of John Snow was the first to actually carry out a published epidemiological study in 1849. Snow accomplished this by charting cases of cholera in London. At the time there was a cholera epidemic in London, and a new germ theory of disease was being vociferously debated in the medical community. Snow "concluded that the cholera cases clustered around a well in central London when cholera was at its peak during the summer months" (Colwell, 2006, p. 754).

Cholera causes severe diarrhea and can be diagnosed with a simple bacterial evaluation.

This evaluation will determine whether the bacteria that causes cholera is present in the patient's body. The examining doctor will ask the patient a number of family medical history questions as well as taking a stool sample, which can be examined under a microscope. The examination is to determine whether the bacteria is evident.

Where cholera is endemic, "outbreaks often coincide with the rainy seasons" (Antibacterial, 2005, p. 38). It has not been discovered why this fact holds true, but there are a plethora of studies that show the prevalence of cholera during wetter periods of time. Oftentimes water will help to spread the bacteria as well. The above article states "when poor sanitation permits feces from a cholera patient to enter a water supply, the bacteria spread to other people" (Antibacterial, 2005, p. 38).

Normally, a person's stomach acid is potent enough to kill most microbes, including the one that is present in cholera. "However, some baceteria -- including the one that causes cholera -- regularly pass through this gauntlet (stomach acid) to wreak havoc in the intestines" (Seppa, 2002, p. 357). Seppa's study continues by asserting that, "the result is severe diarrhea that can lead to fatal dehydration" (Seppa, p. 358).

Treating cholera can be done with a variety of antibiotics and medical supplies, but the simplest and most effective way to both minimize the effects of cholera as well as to keep the patient alive is by re-hydrating the individual.

Hydration of the individual takes place by drinking large quantities of water, or water mixed with salts and sugars to replace the chemicals being lost through the severe diarrhea. This method of treating cholera is used throughout the world and is the most effective method of doing so. Most experts believe that re-hydration of the patient is much more important than attempting to cure the disease (at least for that individual).

Efforts to eradicate the virus after it has presented is usually predicated on wiping out the pathogen and isolating those afflicted individuals in order to stop the transference of the disease to other healthy individuals, even though casual contact with the affected individual will not (normally) transfer the disease. Cholera is normally not found in developed countries and when it is can usually be traced to a bacteria found in shellfish or water. There are only 1-5 cases per year (average) reported in the United States.