The seventh cholera pandemic (also called by some the 1961–1975 cholera pandemic) is the
seventh major outbreak of
cholera
Cholera is an infection of the small intestine by some strains of the bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and ...
and occurred principally from the years 1961 to 1975; but the strain involved persists to the present.
WHO
Who or WHO may refer to:
* Who (pronoun), an interrogative or relative pronoun
* Who?, one of the Five Ws in journalism
* World Health Organization
Arts and entertainment Fictional characters
* Who, a creature in the Dr. Seuss book '' Horton He ...
and some other authorities believe this should be considered as an ongoing pandemic. As stated in its cholera factsheet dated 30 March 2022, the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
(WHO) continues to define this outbreak as a current
pandemic
A pandemic () is an epidemic of an infectious disease that has spread across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals. A widespread endemic (epidemiology), endemic disease wi ...
, and with cholera having become
endemic
Endemism is the state of a species being found in a single defined geographic location, such as an island, state, nation, country or other defined zone; organisms that are indigenous to a place are not endemic to it if they are also found elsew ...
in many countries. In 2017, WHO announced a global strategy aiming to end this pandemic by 2030.
This
pandemic
A pandemic () is an epidemic of an infectious disease that has spread across a large region, for instance multiple continents or worldwide, affecting a substantial number of individuals. A widespread endemic (epidemiology), endemic disease wi ...
is based on the strain called
El Tor
El Tor is a particular strain of the bacterium ''Vibrio cholerae'', the causative agent of cholera. Also known as ''V. cholerae'' biotype eltor, it has been the dominant strain in the seventh global cholera pandemic. It is distinguished from t ...
; it started in
Indonesia
Indonesia, officially the Republic of Indonesia, is a country in Southeast Asia and Oceania between the Indian and Pacific oceans. It consists of over 17,000 islands, including Sumatra, Java, Sulawesi, and parts of Borneo and New Guine ...
in 1961 and spread to
East Pakistan
East Pakistan was a Pakistani province established in 1955 by the One Unit Scheme, One Unit Policy, renaming the province as such from East Bengal, which, in modern times, is split between India and Bangladesh. Its land borders were with India ...
(now
Bangladesh
Bangladesh (}, ), officially the People's Republic of Bangladesh, is a country in South Asia. It is the eighth-most populous country in the world, with a population exceeding 165 million people in an area of . Bangladesh is among the mos ...
), by 1963.
It went to
India
India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
in 1964, and into the
Soviet Union
The Soviet Union,. officially the Union of Soviet Socialist Republics. (USSR),. was a transcontinental country that spanned much of Eurasia from 1922 to 1991. A flagship communist state, it was nominally a federal union of fifteen national ...
by 1966. In July 1970, there was an outbreak in
Odessa
Odesa (also spelled Odessa) is the third most populous city and municipality in Ukraine and a major seaport and transport hub located in the south-west of the country, on the northwestern shore of the Black Sea. The city is also the administrativ ...
(now Ukraine) and in 1972 there were reports of outbreaks in
Baku
Baku (, ; az, Bakı ) is the capital and largest city of Azerbaijan, as well as the largest city on the Caspian Sea and of the Caucasus region. Baku is located below sea level, which makes it the lowest lying national capital in the world a ...
, but the Soviet Union suppressed this information.
Cholera reached
Italy
Italy ( it, Italia ), officially the Italian Republic, ) or the Republic of Italy, is a country in Southern Europe. It is located in the middle of the Mediterranean Sea, and its territory largely coincides with the homonymous geographical re ...
in 1973 from
North Africa
North Africa, or Northern Africa is a region encompassing the northern portion of the African continent. There is no singularly accepted scope for the region, and it is sometimes defined as stretching from the Atlantic shores of Mauritania in ...
.
Japan
Japan ( ja, 日本, or , and formally , ''Nihonkoku'') is an island country in East Asia. It is situated in the northwest Pacific Ocean, and is bordered on the west by the Sea of Japan, while extending from the Sea of Okhotsk in the north ...
and the
South Pacific saw a few outbreaks by the late 1970s.
In 1971, the number of cases reported worldwide was 155,000. But in 1991, it reached 570,000.
The spread of the disease was helped by modern transportation and mass migrations. Mortality rates, however, dropped markedly as governments began modern curative and preventive measures. The usual mortality rate of 50% dropped to 10% by the 1980s and less than 3% by the 1990s.
In 1991, the strain made a comeback in
Latin America
Latin America or
* french: Amérique Latine, link=no
* ht, Amerik Latin, link=no
* pt, América Latina, link=no, name=a, sometimes referred to as LatAm is a large cultural region in the Americas where Romance languages — languages derived f ...
. It began in Peru, where it killed roughly 10,000 people.
Research has traced the origin of the strain to the seventh cholera pandemic.
Researchers initially suspected the strain came to Latin America through Asia from contaminated water, but samples from Latin America and samples from Africa were found to be identical.
![Bay of Bengal map](https://upload.wikimedia.org/wikipedia/commons/0/0e/Bay_of_Bengal_map.png)
This rapid transmission of the pathogen around the globe in the 20th century can be attributed chiefly to the major hub, the
Bay of Bengal
The Bay of Bengal is the northeastern part of the Indian Ocean, bounded on the west and northwest by India, on the north by Bangladesh, and on the east by Myanmar and the Andaman and Nicobar Islands of India. Its southern limit is a line between ...
, from where the disease spread.
This pandemic can be categorized into two main periods. During Period 1 (1961–1969), 24 Asian countries reported 419,968 cholera cases. In Period 2 (1970–1975), 73 countries from
Asia
Asia (, ) is one of the world's most notable geographical regions, which is either considered a continent in its own right or a subcontinent of Eurasia, which shares the continental landmass of Afro-Eurasia with Africa. Asia covers an area ...
,
Africa
Africa is the world's second-largest and second-most populous continent, after Asia in both cases. At about 30.3 million km2 (11.7 million square miles) including adjacent islands, it covers 6% of Earth's total surface area ...
,
Europe
Europe is a large peninsula conventionally considered a continent in its own right because of its great physical size and the weight of its history and traditions. Europe is also considered a Continent#Subcontinents, subcontinent of Eurasia ...
and the
Americas
The Americas, which are sometimes collectively called America, are a landmass comprising the totality of North and South America. The Americas make up most of the land in Earth's Western Hemisphere and comprise the New World.
Along with th ...
reported 706,261 cases. Cholera is caused by eating food or drinking water that is contaminated with the bacteria ''
V. cholerae''. It affects both children and adults, causing severe watery
diarrhea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...
with
dehydration
In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
. But, as noted, the El Tor strain has persisted for decades to the present, causing repeated epidemics in varied locations, with 570,000 cases in 1991 alone.
WHO
Who or WHO may refer to:
* Who (pronoun), an interrogative or relative pronoun
* Who?, one of the Five Ws in journalism
* World Health Organization
Arts and entertainment Fictional characters
* Who, a creature in the Dr. Seuss book '' Horton He ...
and other authorities believe that the seventh pandemic continues.
Introduction
Cholera
Cholera is an infection of the small intestine by some strains of the bacterium ''Vibrio cholerae''. Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea that lasts a few days. Vomiting and ...
is an acute diarrhoeal infection caused by the ingestion of food or water contaminated with the bacterium ''
Vibrio cholerae
''Vibrio cholerae'' is a species of Gram-negative, facultative anaerobe and comma-shaped bacteria. The bacteria naturally live in brackish or saltwater where they attach themselves easily to the chitin-containing shells of crabs, shrimps, and oth ...
''. Most commonly the contamination of food or water occurs via
faecal matter, and the infection is spread through the
faecal-oral route. Cholera has also been found to be caused by eating raw
shellfish
Shellfish is a colloquial and fisheries term for exoskeleton-bearing aquatic invertebrates used as food, including various species of molluscs, crustaceans, and echinoderms. Although most kinds of shellfish are harvested from saltwater envir ...
. Symptoms of the disease appear between 12 hours and 5 days of infection; however, only 10% of infected people show severe symptoms of watery diarrhoea, vomiting and leg cramps. Cholera is diagnosed through a stool test or rectal swab, and today treatment takes the form of an
oral rehydration solution
Oral rehydration therapy (ORT) is a type of fluid replacement used to prevent and treat dehydration, especially due to diarrhea. It involves drinking water with modest amounts of sugar and salts, specifically sodium and potassium. Oral rehydrat ...
(ORS). The ORS uses equimolar concentrations of
sodium
Sodium is a chemical element with the symbol Na (from Latin ''natrium'') and atomic number 11. It is a soft, silvery-white, highly reactive metal. Sodium is an alkali metal, being in group 1 of the periodic table. Its only stable iso ...
and
glucose
Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, using ...
to maximise sodium uptake in the
small intestine
The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...
, and carefully replaces fluid losses. In severe cases, the rapid loss of bodily fluids leads to dehydration and patients are at risk of
shock
Shock may refer to:
Common uses Collective noun
*Shock, a historic commercial term for a group of 60, see English numerals#Special names
* Stook, or shock of grain, stacked sheaves
Healthcare
* Shock (circulatory), circulatory medical emergen ...
. This requires administration of
intravenous
Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
fluids and
antibiotic
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of ...
s.
The transmission of cholera is closely linked to inadequate access to clean water and sanitation facilities and hence, people at risk largely live in
slum
A slum is a highly populated urban residential area consisting of densely packed housing units of weak build quality and often associated with poverty. The infrastructure in slums is often deteriorated or incomplete, and they are primarily inh ...
s and poor communities. In the spread of cholera from 1961 to 1975, other factors were identified that played a role in the cholera pandemic.
Terrorism
Terrorism, in its broadest sense, is the use of criminal violence to provoke a state of terror or fear, mostly with the intention to achieve political or religious aims. The term is used in this regard primarily to refer to intentional violen ...
and disruption of social institutions,
flood
A flood is an overflow of water ( or rarely other fluids) that submerges land that is usually dry. In the sense of "flowing water", the word may also be applied to the inflow of the tide. Floods are an area of study of the discipline hydrol ...
s, improper
sewage
Sewage (or domestic sewage, domestic wastewater, municipal wastewater) is a type of wastewater that is produced by a community of people. It is typically transported through a sewer system. Sewage consists of wastewater discharged from residenc ...
disposal, and a lack of environmental
hygiene
Hygiene is a series of practices performed to preserve health.
According to the World Health Organization (WHO), "Hygiene refers to conditions and practices that help to maintain health and prevent the spread of diseases." Personal hygiene refer ...
were the main causes of the spread.
Sources
The 7th pandemic is traced to early 1961. The evolution of the classical cholera strain known from the first six pandemics was revealed through
genetic analysis
Genetic analysis is the overall process of studying and researching in fields of science that involve genetics and molecular biology. There are a number of applications that are developed from this research, and these are also considered parts of ...
. The first observation of the new lineage came from a laboratory in El Tor,
Egypt
Egypt ( ar, مصر , ), officially the Arab Republic of Egypt, is a transcontinental country spanning the northeast corner of Africa and southwest corner of Asia via a land bridge formed by the Sinai Peninsula. It is bordered by the Mediter ...
, in 1897. By this time, the ‘El Tor’ strain differed from its relatives by 30%.
It originated in
South-Asia
South Asia is the southern subregion of Asia, which is defined in both geographical and ethno-cultural terms. The region consists of the countries of Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka.;;;;;;;; ...
, then transitioned to its
non-pathogenic form in the
Middle East
The Middle East ( ar, الشرق الأوسط, ISO 233: ) is a geopolitical region commonly encompassing Arabian Peninsula, Arabia (including the Arabian Peninsula and Bahrain), Anatolia, Asia Minor (Asian part of Turkey except Hatay Pro ...
in 1900. Sometime between 1903 and 1908, the El Tor strain picked up
DNA that triggered its ability to cause disease in humans.
Hence, it had mutated into the El Tor pandemic strain.
Makassar, South Sulawesi was the source of a 1960 outbreak of the El Tor strain, where it gained new
gene
In biology, the word gene (from , ; "...Wilhelm Johannsen coined the word gene to describe the Mendelian units of heredity..." meaning ''generation'' or ''birth'' or ''gender'') can have several different meanings. The Mendelian gene is a ba ...
s that likely increased transmissibility.
Cholera spread overseas in 1961, indicating a pandemic strain.
Many studies point to Indonesia as the source of the seventh cholera pandemic; however, research has indicated that outbreaks in
China
China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's most populous country, with a population exceeding 1.4 billion, slightly ahead of India. China spans the equivalent of five time zones and ...
between 1960 and 1990 were associated with the same sub-lineages. These strains spread globally from the
Bay of Bengal
The Bay of Bengal is the northeastern part of the Indian Ocean, bounded on the west and northwest by India, on the north by Bangladesh, and on the east by Myanmar and the Andaman and Nicobar Islands of India. Its southern limit is a line between ...
on multiple occasions.
China has been classified as both a sink and source during the pandemic spread of cholera throughout the 1960s and 1970s. The suggestion that the pandemic spread of cholera may have been augmented by Chinese cases, in addition to China being identified as an origin for bordering countries, contrasts with the view that the pandemic began in Indonesia.
Spread and mortality
The El Tor cholera outbreak was first reported in
Java
Java (; id, Jawa, ; jv, ꦗꦮ; su, ) is one of the Greater Sunda Islands in Indonesia. It is bordered by the Indian Ocean to the south and the Java Sea to the north. With a population of 151.6 million people, Java is the world's List ...
, a seaside community near Kendal which was visited by travellers from Makassar in May 1961. Shortly after,
Semarang
Semarang ( jv, ꦏꦸꦛꦯꦼꦩꦫꦁ , Pegon: سماراڠ) is the capital and largest city of Central Java province in Indonesia. It was a major port during the Dutch colonial era, and is still an important regional center and port today. ...
and
Djakarta
Jakarta (; , bew, Jakarte), officially the Special Capital Region of Jakarta ( id, Daerah Khusus Ibukota Jakarta) is the capital city, capital and list of Indonesian cities by population, largest city of Indonesia. Lying on the northwest coa ...
became infected in June.
The disease was carried into
Kuching
Kuching (), officially the City of Kuching, is the capital and the most populous city in the States and federal territories of Malaysia, state of Sarawak in Malaysia. It is also the capital of Kuching Division. The city is on the Sarawak River ...
, Sarawak when boats from Celebes participated in a
regatta
Boat racing is a sport in which boats, or other types of watercraft, race on water. Boat racing powered by oars is recorded as having occurred in ancient Egypt, and it is likely that people have engaged in races involving boats and other wate ...
in Kuching; the first cholera cases appeared on 1 July. This outbreak lasted two weeks, infecting 582 persons with 79 deaths (17% mortality). By August, the outbreak had reached
Kalimantan
Kalimantan () is the Indonesian portion of the island of Borneo. It constitutes 73% of the island's area. The non-Indonesian parts of Borneo are Brunei and East Malaysia. In Indonesia, "Kalimantan" refers to the whole island of Borneo.
In 2019, ...
and
Macau
Macau or Macao (; ; ; ), officially the Macao Special Administrative Region of the People's Republic of China (MSAR), is a city and special administrative region of China in the western Pearl River Delta by the South China Sea. With a pop ...
(13 patients and six deaths). The first case in
Hong Kong
Hong Kong ( (US) or (UK); , ), officially the Hong Kong Special Administrative Region of the People's Republic of China ( abbr. Hong Kong SAR or HKSAR), is a city and special administrative region of China on the eastern Pearl River Delt ...
appeared on 15 August in a community near Kwangtung, a fishing area. The second case was from a boat-dwelling population located between Kwangtung and Hong Kong. Hong Kong had 72 cases with 15 deaths (20.8% mortality).
By February 1, 1962, 4,107 people were infected with cholera, with 897 deaths (21.8% mortality). By September, despite a massive vaccination campaign, cholera had rapidly moved through the
Philippines
The Philippines (; fil, Pilipinas, links=no), officially the Republic of the Philippines ( fil, Republika ng Pilipinas, links=no),
* bik, Republika kan Filipinas
* ceb, Republika sa Pilipinas
* cbk, República de Filipinas
* hil, Republ ...
, where the number of infected people reached 15,000 by March 1962, with 2,005 deaths. In the Philippines alone, mortality reached 1,682 in 1962.
It was reintroduced into
British Borneo
British Borneo comprised the four northern parts of the island of Borneo, which are now the country of Brunei, two Malaysian states of Sabah and Sarawak, and the Malaysian federal territory of Labuan. During the British colonial rule before Worl ...
, supposedly by an
asymptomatic
In medicine, any disease is classified asymptomatic if a patient tests as carrier for a disease or infection but experiences no symptoms. Whenever a medical condition fails to show noticeable symptoms after a diagnosis it might be considered asy ...
traveller from
Jolo Island
Jolo ( tsg, Sūg) is a volcanic island in the southwest Philippines and the primary island of the province of Sulu, on which the capital of the same name is situated. It is located in the Sulu Archipelago, between Borneo and Mindanao, and has ...
. Outbreaks subsequently occurred in
Cambodia
Cambodia (; also Kampuchea ; km, កម្ពុជា, UNGEGN: ), officially the Kingdom of Cambodia, is a country located in the southern portion of the Indochinese Peninsula in Southeast Asia, spanning an area of , bordered by Thailand t ...
,
Thailand
Thailand ( ), historically known as Siam () and officially the Kingdom of Thailand, is a country in Southeast Asia, located at the centre of the Indochinese Peninsula, spanning , with a population of almost 70 million. The country is bo ...
,
Singapore
Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, borde ...
and
India
India, officially the Republic of India (Hindi: ), is a country in South Asia. It is the seventh-largest country by area, the second-most populous country, and the most populous democracy in the world. Bounded by the Indian Ocean on the so ...
.
In 1963,
WHO
Who or WHO may refer to:
* Who (pronoun), an interrogative or relative pronoun
* Who?, one of the Five Ws in journalism
* World Health Organization
Arts and entertainment Fictional characters
* Who, a creature in the Dr. Seuss book '' Horton He ...
declared that cholera remained the number-one killer in diseases subject to international
quarantine
A quarantine is a restriction on the movement of people, animals and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been ...
, having been reported in
Taiwan
Taiwan, officially the Republic of China (ROC), is a country in East Asia, at the junction of the East and South China Seas in the northwestern Pacific Ocean, with the People's Republic of China (PRC) to the northwest, Japan to the nort ...
,
Pakistan
Pakistan ( ur, ), officially the Islamic Republic of Pakistan ( ur, , label=none), is a country in South Asia. It is the world's List of countries and dependencies by population, fifth-most populous country, with a population of almost 24 ...
,
Afghanistan
Afghanistan, officially the Islamic Emirate of Afghanistan,; prs, امارت اسلامی افغانستان is a landlocked country located at the crossroads of Central Asia and South Asia. Referred to as the Heart of Asia, it is bordere ...
,
Iran
Iran, officially the Islamic Republic of Iran, and also called Persia, is a country located in Western Asia. It is bordered by Iraq and Turkey to the west, by Azerbaijan and Armenia to the northwest, by the Caspian Sea and Turkmeni ...
,
Southern Russia
Southern Russia or the South of Russia (russian: Юг России, ''Yug Rossii'') is a colloquial term for the southernmost geographic portion of European Russia generally covering the Southern Federal District and the North Caucasian Federal ...
,
Iraq
Iraq,; ku, عێراق, translit=Êraq officially the Republic of Iraq, '; ku, کۆماری عێراق, translit=Komarî Êraq is a country in Western Asia. It is bordered by Turkey to Iraq–Turkey border, the north, Iran to Iran–Iraq ...
,
Korea
Korea ( ko, 한국, or , ) is a peninsular region in East Asia. Since 1945, it has been divided at or near the 38th parallel, with North Korea (Democratic People's Republic of Korea) comprising its northern half and South Korea (Republic o ...
, Burma,
Cambodia
Cambodia (; also Kampuchea ; km, កម្ពុជា, UNGEGN: ), officially the Kingdom of Cambodia, is a country located in the southern portion of the Indochinese Peninsula in Southeast Asia, spanning an area of , bordered by Thailand t ...
,
South Vietnam
South Vietnam, officially the Republic of Vietnam ( vi, Việt Nam Cộng hòa), was a state in Southeast Asia that existed from 1955 to 1975, the period when the southern portion of Vietnam was a member of the Western Bloc during part of th ...
,
Malaysia
Malaysia ( ; ) is a country in Southeast Asia. The federation, federal constitutional monarchy consists of States and federal territories of Malaysia, thirteen states and three federal territories, separated by the South China Sea into two r ...
,
Singapore
Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, borde ...
,
Nepal
Nepal (; ne, नेपाल ), formerly the Federal Democratic Republic of Nepal ( ne,
सङ्घीय लोकतान्त्रिक गणतन्त्र नेपाल ), is a landlocked country in South Asia. It is mai ...
,
Thailand
Thailand ( ), historically known as Siam () and officially the Kingdom of Thailand, is a country in Southeast Asia, located at the centre of the Indochinese Peninsula, spanning , with a population of almost 70 million. The country is bo ...
,
Uzbekistan
Uzbekistan (, ; uz, Ozbekiston, italic=yes / , ; russian: Узбекистан), officially the Republic of Uzbekistan ( uz, Ozbekiston Respublikasi, italic=yes / ; russian: Республика Узбекистан), is a doubly landlocked cou ...
and
Hong Kong
Hong Kong ( (US) or (UK); , ), officially the Hong Kong Special Administrative Region of the People's Republic of China ( abbr. Hong Kong SAR or HKSAR), is a city and special administrative region of China on the eastern Pearl River Delt ...
.
The mid-60s saw cholera infiltrate Southeast Asia, with outbreaks in
Chittagong
Chittagong ( /ˈtʃɪt əˌɡɒŋ/ ''chit-uh-gong''; ctg, চিটাং; bn, চিটাগং), officially Chattogram ( bn, চট্টগ্রাম), is the second-largest city in Bangladesh after Dhaka and third largest city in B ...
, Bangladesh, Cambodia, Thailand and Malaysia, and India in 1964. The El Tor strain moved further westward, invading South Asia in 1965, including
Pakistan
Pakistan ( ur, ), officially the Islamic Republic of Pakistan ( ur, , label=none), is a country in South Asia. It is the world's List of countries and dependencies by population, fifth-most populous country, with a population of almost 24 ...
,
Nepal
Nepal (; ne, नेपाल ), formerly the Federal Democratic Republic of Nepal ( ne,
सङ्घीय लोकतान्त्रिक गणतन्त्र नेपाल ), is a landlocked country in South Asia. It is mai ...
,
Afghanistan
Afghanistan, officially the Islamic Emirate of Afghanistan,; prs, امارت اسلامی افغانستان is a landlocked country located at the crossroads of Central Asia and South Asia. Referred to as the Heart of Asia, it is bordere ...
,
Iran
Iran, officially the Islamic Republic of Iran, and also called Persia, is a country located in Western Asia. It is bordered by Iraq and Turkey to the west, by Azerbaijan and Armenia to the northwest, by the Caspian Sea and Turkmeni ...
and part of
Uzbekistan SSR
Uzbekistan (, ) is the common English name for the Uzbek Soviet Socialist Republic (Uzbek SSR; uz, Ўзбекистон Совет Социалистик Республикаси, Oʻzbekiston Sovet Sotsialistik Respublikasi, in Russian: Уз ...
. Iran, which had been free from cholera since 1939, reported 2,704 cases by mid-October.
When these outbreaks occurred in Iran, the
Pasteur Institute of Iran
Pasteur Institute of Iran is a medical research center located in Tehran, Iran. The institute is one of the oldest leading research and public health centers in Iran and the Middle East, established in 1920 following an agreement between the Inst ...
produced 9.5 million cholera vaccines to protect the population of the eastern regions of Iran. In 1966 Iraq reported its first case.
The cholera strain reached the Middle East and Africa in 1970 and spread rapidly. It is thought that a traveler returning from Asia or the Middle East introduced the disease into Africa.
The Arabian Peninsula, Syria and Jordan became infected, followed by Guinea in August 1970. Cholera was first thought to have spread along
waterway
A waterway is any navigable body of water. Broad distinctions are useful to avoid ambiguity, and disambiguation will be of varying importance depending on the nuance of the equivalent word in other languages. A first distinction is necessary b ...
s along the coast and into the interior along the
river
A river is a natural flowing watercourse, usually freshwater, flowing towards an ocean, sea, lake or another river. In some cases, a river flows into the ground and becomes dry at the end of its course without reaching another body of wate ...
s.
In November 1970 infected individuals seemed to travel by modernised rapid transport. This allowed cholera to extend 1,000 km, when it appeared in
Mopti, Mali. Subsequently, customary large gatherings of people facilitated the outward radiation of cholera.
From 1970 to 1971, Sierra Leone, Liberia, Côte d'Ivoire, Ghana, Togo, Benin, Nigeria and southern Cameroon, experienced outbreaks. The west-African outbreak of cholera during 1970–1971 infected more than 400,000 persons. Africa had a high cholera
fatality rate
In epidemiology, case fatality rate (CFR) – or sometimes more accurately case-fatality risk – is the proportion of people diagnosed with a certain disease, who end up dying of it. Unlike a disease's mortality rate, the CFR does not take int ...
of 16% by 1962. 25 countries were infected by the end of 1971 and, between 1972 and 1991, cholera spread throughout much of the remainder of Africa.
Research
An international campaign began in 1970, including the research laboratory in
Dhaka
Dhaka ( or ; bn, ঢাকা, Ḍhākā, ), formerly known as Dacca, is the capital and largest city of Bangladesh, as well as the world's largest Bengali-speaking city. It is the eighth largest and sixth most densely populated city ...
, Bangladesh; the
Southeast Asia Treaty Organisation
The Southeast Asia Treaty Organization (SEATO) was an international organization for collective defense in Southeast Asia created by the Southeast Asia Collective Defense Treaty, or Manila Pact, signed in September 1954 in Manila, the Philipp ...
(SEATO), the United Kingdom, Australia, and various American agencies. Human volunteers took part in an
NIH
The National Institutes of Health, commonly referred to as NIH (with each letter pronounced individually), is the primary agency of the United States government responsible for biomedical and public health research. It was founded in the late ...
-sponsored series of tests to develop an effective cholera vaccine. At this time, new outbreaks of cholera were occurring in Egypt, South Korea, and the Soviet Union.
The 1964 invention of use of oral rehydration salts (ORS) to treat cholera was endorsed by
WHO
Who or WHO may refer to:
* Who (pronoun), an interrogative or relative pronoun
* Who?, one of the Five Ws in journalism
* World Health Organization
Arts and entertainment Fictional characters
* Who, a creature in the Dr. Seuss book '' Horton He ...
in the 1980s. This practice of replacing fluids and electrolytes is estimated to have saved the lives of 40 million individuals infected with cholera. As a result of the success of ORS treatment, the past 30 years have seen changes to cholera response that centred on treating affected individuals in the short term, and attempting to provide safe water and improved hygiene in the long term.
The cholera pandemic beginning in 1962 is identified through the ‘El Tor’ biotype, and considerable research has been undertaken into this specific strain of cholera. The El Tor biotype has been demonstrated to have increased resistance to the environment.
This has heightened the risk of unknowing transmission from asymptomatic carriage in humans, as opposed to the classical biotype that caused the first six cholera pandemics.
Previously, health workers who were against the administration of the
cholera vaccine
Cholera vaccines are vaccines that are effective at preventing cholera. For the first six months after vaccination they provide about 85percent protection, which decreases to 50percent or 62percent during the first year. After two years the level ...
based their opinion on the view that always limited resources should be directed at immediate rehydration and improved practices, and longer term investment to provide safe water and improved sanitation. Such practices as appropriately cooking food before consumption, using sterilised water, following general personal hygiene, and sanitising environments, decrease the spread of cholera. In the 21st century, cholera control activities have typically still been focused on emergency responses to outbreaks, with limited attention to the underlying causes that can prevent recurrence.
But, the development of new and improved
cholera vaccine
Cholera vaccines are vaccines that are effective at preventing cholera. For the first six months after vaccination they provide about 85percent protection, which decreases to 50percent or 62percent during the first year. After two years the level ...
s has allowed this practice of emergency responses to be revised.
In addition, recent research has advanced understanding of cholera, its transmission and the
immune response
An immune response is a reaction which occurs within an organism for the purpose of defending against foreign invaders. These invaders include a wide variety of different microorganisms including viruses, bacteria, parasites, and fungi which could ...
. Subsequently, these advances have resulted in the development of experimental cholera vaccines derived from non-living and
attenuated live strains. By 2017 the
FDA
The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...
had approved a single-dose, live, oral cholera vaccine called
Vaxchora
Cholera vaccines are vaccines that are effective at preventing cholera. For the first six months after vaccination they provide about 85percent protection, which decreases to 50percent or 62percent during the first year. After two years the leve ...
for adults aged 18–64 who are travelling to an area of active cholera transmission. A study in
Haiti
Haiti (; ht, Ayiti ; French: ), officially the Republic of Haiti (); ) and formerly known as Hayti, is a country located on the island of Hispaniola in the Greater Antilles archipelago of the Caribbean Sea, east of Cuba and Jamaica, and ...
has shown lasting protection from a two-dose cholera vaccine. During the
2010–2017 cholera outbreak in Haiti, those who received the two doses of the vaccine were 76% less likely to become sick. This protection lasted 4 years.
The clinical severity of the El Tor biotype causing pandemic cholera in 1962, also resulted in modern research assessing administration of
antimicrobial
An antimicrobial is an agent that kills microorganisms or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibiotics are used against bacteria, and antifungals ar ...
s in the initial phase of an outbreak. This was tested in the 1970s with tetracycline but was found not to be useful due to
resistance against this antibiotic.
Questions have been raised alluding to newer drugs, and whether the administration of these will be more useful than such previous attempts.
The ongoing seventh pandemic has affirmed that cholera is still prevalent in society and can cause high mortality. In 1992 the Global Task Force on Cholera Control (GTFCC) was organized to coordinate activities and support countries after a severe cholera outbreak in Peru. Today it consists of more than 30 collaborating institutions, including NGOs, academic institutions, and UN agencies supporting affected countries.
In 2017 they convened a high-level meeting with officials from cholera-affected countries, donors, and technical partners to announce their strategy “The Global Roadmap to 2030”, an initiative to end cholera as a threat to public health by 2030. The three components of the strategy are: “early detection and quick response to contain the outbreaks; a multi-sectorial approach to prevent cholera recurrence, and, coordination of technical support and advocacy, resource mobilisation and partnership at the global level.
References
External links
Epidemics and Pandemics"> Epidemics and Pandemics
{{DEFAULTSORT:Cholera Pandemic, 7
Cholera pandemics
20th-century health disasters
1960s disease outbreaks
1970s disease outbreaks
Disease outbreaks in Italy