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CHOLERA IN INDIA AND KYRGYSZTAN
Tabindah Khursheed, Wani Farheen Mukhtar, M.A. Turdumambetova International Higher School of Medicine, Bishkek, Kyrgyzstan Abstract
Introduction. Cholera is an acute, watery diarrheal disease caused by Vibrio cholera of the O1 or O139 serogroups usually spread through contaminated water and food. The disease causes severe diarrhea and dehydration. Left untreated, cholera can be fatal within hours. In the past two centuries, cholera has emerged and spread from the Ganges Delta six times and from Indonesia once to cause global pandemics. Modern sewage and water treatment have virtually eliminated cholera in industrialized countries. [1]
The aim of the present article is to highlight problems and characterize the morbidity, the spread andprophylaxis ofcholera in India and Kyrgyzstan.
Materials and methods are information about the morbidity and spread of cholera in India and Kyrgyzstan presented by WHO, statistical methods
Results. Statistics about the morbidity and mortality from cholera in India were given. Recommendations for prevention and measures to decrease the morbidity and mortality from the disease relevant to UNICEF's recommendations were given.
Conclusions. Cholera is a typical disease amongst the world's poorest and most disadvantaged communities. Treatment may be effective on an individual basis, but the rapid spread of cholera outbreaks renders communities too susceptible to contain them. Poor hygiene, lack ofproper sanitation and disruption in water supply, result in mixing of drinking water with infectedfeces, which increases the risk of cholera. Good hand-washing practices and adequate sanitation will prevent the spread ofcholera.
Keywords: Cholera; Vibrio cholera; pandemics; cholera vaccine; stockpile; epidemiology; transmission;prophylaxis.
Corresponding author: PhD, Mairamkul A. Turdumambetova, +996 708 428 262,
e-mail: ksma58@mail.ru
ИНДИЯДА ЖАНА КЫРГЫЗСТАНДАГЫХОЛЕРА
Табиндах Хуршид, Вани Фархин Мухтар, М.А. Турдумамбетова Эл аралык Жогорку Медициналык Мектеби, Бишкек, Кыргызстан Аннотация
Актуалдуулугу. Холера - булганган тамак-аш же суу ичкенде Vibrio cholerae бактериясы пайда кылган курч ич втквк инфекциясы. Холера -курч, суулуу ич втквккв алып келиши mym^h болгон втв кооптуу жугуштуу оору. Булганган тамак-ашты же сууну жутуу менен ооруган адамда симптомдордун пайда болушуна чейин 12 сааттан 5 щнгв чейин созулат. Холера балдарга да, чоцдорго да таасир этет, эгерде дарыланбаса, бир нече сааттын ичинде влYмгв алып келишимYмкYн.
Бул макаланын максаты квйгвйлврдY аныктоо жана Индия менен Кыргызстанда холера оорусуна чалдыгуу, таралышы, влYMY боюнча мYнвздвмв берYY жана алдын алуу болуп саналат.
Материалдар жана методдор: Индияда жана Кыргызстанда холера оорусунун таралышы жана таралышы боюнча БДСУнун маалыматтары, статистикалык методдор
Алынган натыйжалар Индиядагы холерадан болгон оору жана влYM боюнча статистикалык маалыматтар. ЮНИСЕФтин сунуштарына ылайык, бул оорудан оорунун жана влYмдYн алдын алуу жана азайтуу боюнча сунуштар берилген.
Корутундулар. Холера менен кYрвшYYдв квп кырдуу мамиле кылуу влYмдY жана ооруну азайтууда чечYYЧY ролду ойнойт. Ал суу менен камсыз кылууну, санитарияны жана гигиенаны жакшыртуу, коомчулукту мобилизациялоо, холерага каршы ооз аркылуу вакциналар менен дарылоо жана колдонуу боюнча чараларды камтыйт. Учурда БДСУнун алдын ала квалификацияланган ооз аркылуу алуучу холера вакциналары бар: Dukoral®, Shanchol™ жана Euvichol-Plus®. Оорудан толук коргоону камсыз кылуу YЧYн Yч эмдвв тец эки жолу берилиши керек.
Ачкыч свздвр: холера; холера вибриону; пандемия; холерага каршы вакцина; эпидемиология; берYYжолдору; алдын алуу.
ХОЛЕРА В ИНДИИ И КЫРГЫЗСТАНЕ
Табиндах Хуршид, Вани Фархин Мухтар, М.А. Турдумамбетова Международная высшая школа медицины, Бишкек, Кыргызстан Аннотация
Актуальность. Холера - острая диарейная инфекция, вызываемая бактерией Vibrio cholerae при попадании в организм зараженных пищевых продуктов или воды. Холера - чрезвычайно заразная болезнь, которая может вызывать тяжелую острую водянистую диарею. Между попаданием в организм зараженных пищевых продуктов или воды и появлением симптомов у заболевшего проходит от 12 часов до 5 дней. Холера поражает как детей, так и взрослых и при отсутствии лечения может за несколько часов привести к смерти.
Цель данной статьи - выявить проблемы и дать характеристику заболеваемости, распространённости, смертности и профилактики холеры в Индии и Кыргызстане.
Материалы и методы: данные ВОЗ о заболеваемости и распространённости холеры в Индии и Кыргызстане, статистические методы
Полученные результаты - приведены статистические данные заболеваемости и смертности от холеры в Индии. Даны рекомендации по профилактике и снижению заболеваемости и смертности от данного заболевания в соответствии с рекомендациями ЮНИСЕФ.
Выводы. Решающую роль в борьбе с холерой и сокращении заболеваемости и смертности из-за этой болезни играет многосторонний подход. Он предусматривает мероприятия по улучшению водоснабжения, санитарии и гигиены, мобилизацию общественности, лечение и применение оральных вакцин против холеры. В настоящее время существуют три оральные вакцины против холеры, прошедшие преквалификацию ВОЗ: Dukoral®, Shanchol™ и Euvichol-Plus®. Для обеспечения полной защиты от болезни все три вакцины должны быть введены двухкратно.
Ключевые слова: Холера; холерный вибрион; пандемия; вакцина против холеры; эпидемиология; пути передачи; профилактика
Introduction
Cholera is an acute disease of the gastrointestinal tract caused by Vibrio cholera. The disease was localized in Asia until 1817, when a first pandemic spread from India to several other regions of the world. After this appearance, six additional major pandemics occurred during the 19th and 20th centuries, the latest of which originated in Indonesia in the 1960s and is still ongoing. In 1854, a cholera outbreak in Soho, London, was investigated by the English physician John Snow. He described the time course of the outbreak, managed to understand its routes of transmission, and suggested effective measures to stop its spread, giving rise to modern infectious disease epidemiology [1, 3, 6].
1.FIRST PANDEMIC (1817-1823): duration - 7 years, started in Bengal, entered Russia (Astrakhan) from Iran
2. SECOND PANDEMIC (18261837): duration - 12 years, began in India, penetrated into Russia (Orenburg) from Afghanistan by caravan route. Introduced to Europe, America, Australia.3. THIRD PANDEMIC (1846-1862): duration - 17 years, began in India, cholera was brought to Russia along the Volga route from Iran and through Western Europe. Local outbreak of cholera in London in 1855. - Snow. The Crimean War (1854-1856) contributed to the spread of cholera.
4.FOURTH PANDEMIC (18641875): duration 12 years, cholera entered
Russia from Turkey and across the western borders. The peculiarity is the speed of the spread of infection, which was facilitated by mo dern means o f transpo rtation -steamships and new canals (Suez). During this pandemic in Russia, 884,754 fell ill and 326,968 people died. Quarantine issues.5. FIFTH PANDEMIC (1883-1896): duration - 14 years, cholera was brought to Russia from Iran. Then to Germany and other countries. In 1883, R. Koch singled out a pure culture of Vibrio cholerae. An intensive study of cholera began.6. SIXTH PANDEMIC (1902-1925): duration - 25 years, began in India, penetrated into Russia along the coast of the Caspian Sea and further along the Volga inland. Water flash in 1908. In eastern Russia, cholera spread from China. The cholera situation in Russia was exacerbated by wars and economic
7.SEVENTH PANDEMIC (1961 -present): began on about. Sulawesi and by the mid-1960s. covered Indonesia, Philippines, Pakistan, Afghanistan, Iran. Cholera first appeared on the territory of the Soviet Union in 1965 (Uzbek SSR). In 1970, cholera entered the territory of present-day Russia in the common way through the city of Astrakhan and further along the Volga. A new wave of diseases is caused by Vibrio cholerae of El Tor biovar. This biovar was first isolated by the German bacteriologist Gottschlich in 1905. at the El Tor quarantine point in the Sinai Peninsula [4].
Table 1. Seven pandemics of cholera in the world
Date Duration Where Number of Deaths
1st pandemic 1817-1823 7 years India (Bengal) 100000
2nd pandemic 1826-1837 12 years India 22000
3rd pandemic 1846-1862 17 years India 23000
4th pandemic 1864-1875 12 years India to Spain and naples 90000
5th pandemic 1883-1896 14 years India and spread to Asia, Europe and South America 290000
6th pandemic 1902-1925 25 years India and spread to North Africa, Eastern Europe and Russia 800000
7th pandemic 1961 to present Presently going on Indonesia
PERIOD BETWEEN PANDEMICS
Since 1926 there has been a relatively quiet period for 34 years. Epidemic outbreaks of cholera periodically occurred on the territory of states in Southeast Asia. The last Asiatic cholera epidemic in Russia took place in 1941-1942. In August 1941, an outbreak of cholera was registered in Kharkov among prisoners who arrived from Azerbaijan. In the summer of 1942, cholera was brought to Stalingrad, then to Astrakhan, Guryev. The largest number of patients (978 out of 1338 cases) was noted in the Volga region and in the territories adjacent to the Caspian Sea.
Cholera in India
Total population of India is 1.38 billion. The first cholera pandemic (1817-1824), also known as the first Asiatic cholera pandemic or Asiatic cholera, had started near the city of Calcutta and spread throughout South and Southeast Asia to the
Middle East, eastern Africa and the Mediterranean coast. While cholera had spread across India many times previously, this outbreak went further; it reached as far as China and the Mediterranean Sea before subsiding. Millions of people died as a result of this pandemic, including many British soldiers, which attracted European attention. This was the first of several cholera pandemics to sweep through Asia and Europe during the 19th and 20th centuries. This first pandemic spread over an unprecedented range of territory, affecting almost every country in Asia. The Indian subcontinent is vulnerable to this disease due its vast coastlines with areas of poor sanitation, unsafe drinking water, and overcrowding [5]. Mortality Rate of cholera in India
As for India, the initially reported mortality rate was estimated to be 1.25 million per year, placing the death toll at
around 8,750,000. However, this report was certainly an overestimation as David Arnold writes: "The death toll in 1817-21 was undoubtedly great, but there is no evidence to suggest that it was as uniformly high as Moreau de Jonnes presumed. Statistics collected by James Jameson for the Bengal Medical Board showed mortality in excess of 10,000 in several districts.
Although reporting was sketchy, for the Madras districts as a whole the mortality during the height of the epidemic appears to have been around 11 to 12 per 1,000. If this figure were applied to the whole of India, with a population of some 120-150 million, the total number of deaths would have been no more than one or two million" [5].
Reasons for spread of Cholera in
India
UNICEF reports that the sanitation goals in the Millennium Development Program have not been met. For millions of people, clean drinking water, basic sanitation facilities, and sewage treatment systems are not present. The majority of such communities are found in rural areas that are devoid of the means to obtain and sustain better sanitation. Approximately 700 children pass away every day due to diarrhea. Cholera is frequently spread by the
fecal-oral route. Untreated human excreta are a major cause of cholera. UNICEF estimates that half of the world's human excreta remains untreated by sewage systems. Open defecation is still practiced globally by nearly 673 million people. Among school-age children, approximately 373 million do not have appropriate sanitation facilities at home or in schools. The peak incidence of cholera in some provinces is, no doubt, partly explained by the holding of large-scale pilgrim festivals, as, for example, the Kumbh Fairs taking place every six years at Hardwar, situated in north-west India in Uttar Pradesh (formerly United Provinces), and similar fairs 'held at different six-yearly intervals at Allahabad in the east of that State. Hardwar and Allahabad are the two most important pilgrim centers, attracting devotees from all over the country. However, apart from these occasions, Hardwar is visited by a stream of pilgrims from different parts of India almost throughout the year. The close association between the Kumbh fairs and cholera incidence is amply shown by the history of cholera in the United Provinces and the adjoining province of the Punjab, which lies farther west [7].
PICTURE 1: shows how cholera spread in India by contaminated water.
Prophylactic measures of Cholera in Kyrgyzstan
Total population in Kyrgyzstan is 6.8 million
Kyrgyzstan cholera deaths was 0 in 1994 - the single year for which the data is available at the moment.
1. S e tti ng up c ho l e ra treatment units and oral rehydration points.
2. ensuring early detection and transfer of severe cases, training health professionals, and applying standard case-management protocols.
3. s t r e n g t h e n i n g epidemiological and laboratory capacity for surveillance.
4. ensuring access to water in quantity and quality; promoting hygiene conditions and practices (i.e. hand-washing, safe preparation of food, safe burials, etc.); and improving sanitation and excreta disposal. with access to soap for hand washing, households practicing water treatment, improving sources of safe water.
5. Prophylactic vaccination to the persons visiting endemic areas.
Prophylactic measures of Cholera in
India
In 2014, the government of India began the Swachh Bharat Mission to provide rural and urban poor communities with subsidies for the construction of toilets. However, not all communities have benefited from the scheme. Meanwhile, almost half of the population in India defecated in the open. In 2014, WHO/UNICEF estimated that India accounted for 60% of the global population engaging in open defecation. UNICEF
reported that universal sanitation programs have not reached all populations. Cholera vaccine immunization for populations in endemic areas might be the best and most equitable method of prevention. Drink safe and clean water, wash hands frequently with soap and clean water, proper hygiene and sanitation, cook food well and cover it properly [8].
Vaccines currently available in India
WHO recommendations on oral cholera vaccines. The WHO published a position paper on cholera in 2010, which had recommended two doses of a killed oral bivalent cholera vaccine two weeks apart in those aged over one years, with booster doses after two years , is now updated with the 2017 recommendations of the Strategic Advisory Group of Experts (SAGE):
1.Dukoral (WC-rBS): a monovalent oral vaccine based on whole-cell (WC) heat-killed V. cholera O1 and recombinant cholera toxin B subunit.
2. Shanchol (shancol) and mORCVAX (m-or-si-vaks): bivalent oral vaccines created on the basis of serogroups O1 and O139 without the B-subunit of cholera toxin; these vaccines are similar but are produced by different manufacturers.
3.Euvichol-Plus/Euvichol: oral inactivated, or non-live cholera vaccines.
Specific prophylaxis of Cholera
No country in the world currently re quire s cho lera vacc inatio n. The international certificate does not contain the "cholera vaccination" column. According to WHO recommendations, in countries where the implementation of preventive measures in full is difficult, it is necessary to plan and carry out vaccination of the population against cholera [9].
Epidemiological Surveillance
The epidemiological surveillance of
cholera provides a system of measures aimed at the timely detection of foreign and local cases of cholera, the detection of vibrio cholera O1 and O139 serogroups in environmental objects, information support, the development of sound recommendations for planning and implementing preventive and anti-epidemic
measures in order to localize and elimination of the arisen centers of cholera. The goal of surveillance is to obtain objective epidemiological information sufficient to ensure rational planning, implementation and adjustment of cholera prevention and control measures.
PICTURE 2: shows Indian vaccination programs
Conclusion
Cholera is a typical disease amongst the world's poorest and most disadvantaged communities. Treatment may be effective on an individual basis, but the rapid spread of cholera outbreaks renders communities too susceptible to contain them. Poor hygiene, lack of proper sanitation and disruption in water supply, result in mixing of drinking water with infected feces, which increases the risk of cholera. Good hand-washing practices and adequate sanitation will prevent the spread of cholera.
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