Cholera is one of the most predominant issues in public health, with high incidence, prevalence, and mortality rates in endemic areas. It is grossly an acute diarrheal illness with the aptitude to kill in a few hours after contraction if urgent and proper medical care is not provided. The rapid dehydration caused by severe diarrhea results in a shock, hence the victim’s abrupt demise. Therefore, local, national, and international health systems need to do extensive research and have the proper understanding of its epidemiology, prevention, and control.
Cholera Epidemiology
The first key aspect in the epidemiology of cholera is its history. The disease has been around since time immemorial and remains one of the most severe illnesses in the history of humanity. In as much as there is a cure, an outbreak can effortlessly get out of hand in the case of an epidemic. There is no account whatsoever of the first person to ail from the disease. However, the first isolated cases of cholera-like illness date back to the fifth century B.C in India, the fourth century B.C, and the first century A.D consecutively in Greece. The first meticulous documentation of cholera was recorded in 1543 in the Ganges Delta in Asia (Deen et al, 2020). The first cholera pandemic occurred in 1817, ensuing from contaminated rice, still in the Ganges Delta. In 1892, an outbreak occurred in Germany stemming from a fault in the waste removal system killing thousands of people. In 1961, there was pestilence in Indonesia, which spread to west Africa in 1970, and by 1991, it had reached the Americas.
The second facet is the modes of transmission, symptoms, and incubation period. Cholera is caused by a bacterial infection of the small intestine. The bacteria scientifically known as Vibrio Cholerae emits a toxin that makes the cellular lining of the intestines lose a significant amount of water rapidly. The ripple effect of this is watery diarrhea and subsequent dehydration (Deen et al, 2020). The bacteria primarily inhabit dirty environments, inclusive of untreated sewage and water. Transmission usually occurs when one eats contaminated food or drinks degraded water. In its initial stages or mild cases, cholera is relatively asymptomatic (Deen et al, 2020). However, in severe contractions, one is bound to experience acute diarrhea, vomiting, and leg cramps. On most occasions, one experiences these symptoms in 2-3 days from the point of contraction. In other incidents, depending on the degree of contamination, the incubation period ranges from a few hours to five days.
The third epidemiologic factor is population affected, place of infection, and time of contraction. Generally, cholera affects both males and females in equal proportions and rates. However, children under the age of five years are the most vulnerable compared to adults. Nonetheless, the range does not incorporate infants who are breastfed by mothers who have initially had cholera. Individuals with blood group O are also more susceptible to cholera infection than individuals with different blood groups (Deen et al, 2020). The rate of cholera infection is usually high during the warmest months of the year. As such, cases of cholera infection are more often in tropical regions. Slums, refugee camps, famine-stricken areas, and war zones with inadequate or a total lack of sewage and water treatment also have many outbreaks. On a worldwide level, cholera is endemic in India, parts of the middle east, Asia, South America, and Africa.
Another critical element is the incidence and prevalence rates of cholera. For the endemic countries or locations, an outbreak can be seasonal because of climate change or adoption and abandonment of containment schemes. An estimated 2.8 million cases are recorded annually in these endemic regions (Deen et al, 2020). Globally, there is an annual incidence rate of 2.0 cases per 1,000 vulnerable people and 1.15 cases per 1,000 people who are not susceptible. A significant percentage of these cases come from Africa and Southern Asia. Among these cases, half of them are of children under the age of five years.
Furthermore, sources of data are also an essential factor in the epidemiology of cholera. Public health alliances need to have up-to-date and valid data relating to the incidence and prevalence rates of the disease. They also need to have data on the counter-attack measures that were and have been put in place. This is key in applying the strategies that have worked in endemic areas to developing epidemic regions. One source of such data is surveillance programs that incorporate case-control studies in the predominant areas (Deen et al, 2020). Disease monitoring systems such as the Program for Morning Emergency Diseases are reliable sources for media reports on locales with an outbreak. Literature research can also be used as a primary source of data in providing accurate statistics of an infection in a given area.
The last fundamental aspect is the known risk factors for infection. Several elements make one susceptible to the contraction of the disease. The most common is poor sanitary conditions at the household community levels. This is why there are many incidence rates in slums, refugee camps, famine, and war-stricken areas. Another factor that elevates the chances of infection is house exposure (Deen et al, 2020). An individual living with an infected person can easily contract the disease. Undercooked seafood such as shellfish is also a risk factor. Most households, especially those in developing regions, usually release waste to water bodies; hence the cholera-causing bacteria might find their way to shellfish habitat. Lastly, individuals with low stomach acid levels are also more susceptible to a cholera infection than those with normal acid levels.
Risk Factor Hypothesis Testing
The rate of cholera infection will reduce if sanitary conditions are improved. A case-control study at a refugee camp with poor hygiene would be efficient in gathering data for a prophylactic measure. The integral population for the case-control study would be individuals who fall between 5-70 years. Before the actual testing, data on the number of people living in that particular refugee camp would be recorded (Deen et al, 2020). In addition, the incidence and prevalence rates of cholera within the refugee camp would also be registered. A brief questionnaire on sanitary behaviors of the population would be conducted and support structure identified.
Prevention and Control Measures
If the study reveals a positive relationship between sanitary conditions and infection rate, a change of hygienic behaviors would be indispensable. Firstly, clean water for cooking and drinking should be provided to the locals. Secondly, hand washing water points should be installed at strategic locations within the refugee camp. In addition, sufficient pit latrines need to be constructed and proper waste management streams installed (Deen et al, 2020). Lastly, policies should be formulated to ensure that the locals follow the laid-down strategies. An examination of the steps would be done in 2 or 3 months after taking effect. Data on the subsequent incidence and prevalence rates would be cross-examined with the initial data gathered to determine the effectiveness of the models.
In conclusion, cholera is a highly infectious disease that can result in an epidemic if essential measures are not taken. Therefore, there is a need for health systems and the public to understand the epidemiology, risk factors, prevention, and control measures for cholera to ensure progressive disease containment. In addition, there is a need to create public awareness on the risk factors and also formulate adherence policies since prevention is better than cure.
Reference
Deen, J., Mengel, M. A., & Clemens, J. D. (2020). Epidemiology of cholera.Vaccine, 38(1), A31-A40. Web.