The map on the left shows that the areas that Cholera is discovered in are situated below the Brandt line. This is because these areas are surrounded by warm oceans where the growth of algae will be high. Therefore the Cholera bacteria will occur in higher frequency in these areas. This is proven by the map of the world below, which shows the temperatures of the world’s oceans. Many people now fear that Cholera could emerge in regions, such as the southern coasts of the United States, as the sea temperature rise. If this was the case then Cholera could in this way be linked to human factors, as it is said that sea temperature rise is due to global warming, which is partly due to human activities.
Case study 1- Zimbabwe
A large cholera outbreak is affecting most regions of Zimbabwe, with more than 11 700 cases and 473 deaths recorded between August 2008 and November 2008. Cholera outbreaks in Zimbabwe have occurred annually since 1998, but previous epidemics have never reached these proportions. The last large outbreak was in 1992 with 3000 cases recorded.
The main cause of the outbreak was the lack of access to safe water in urban areas. This was due to the collapse of the urban water supply, sanitation and rubbish collection systems. Also the rainy season leads to faeces with cholera bacteria being washed into water sources, in particular public drains, providing readily available but contaminated water.
The areas affected have been demonstrating weaknesses in case management and/or infection control practices. Potential causes of the high fatality rate that must be addressed are:
- delays in people seeking treatment:
- poor accessibility to health facilities:
- gaps in case management: and
- Inadequate infection control.
Cholera cases have also been reported either side of Zimbabwe’s border with South Africa, Botswana and Mozambique, which demonstrates the sub regional extent of the outbreak. In South Africa, the Ministry of Health has confirmed more than 160 cholera cases, including three deaths. Cases have also been reported in Johannesburg and Durban.
This cholera outbreak has strained Zimbabwe’s already overloaded health care system and resulted in a nationwide shortage of medicines and other materials for treatment, increasing the shortage of health care providers and the poor access to overall care. The outbreak can and has spread quickly throughout Zimbabwe, as shown by the map below. Fatality rates may rapidly rise in populations that do not have immediate access to simple treatments.
In order to control the current outbreak of cholera the World Health Organisation and its Health Cluster partners are finalizing a "Cholera Response Operational Plan". The objectives of the response are to:
1. Reduce the epidemic spread by:
- Ensuring access to safe water and sanitation conditions, particularly in health facilities;
- Reinforcing community mobilization;
- Ensuring safe isolation and infection control practices in health structures (including funerals);
- Strengthening Health Cluster coordination.
2. Decrease mortality by:
- Ensuring early case detection;
- Improving access to health care;
- Ensuring adequate care, including feeding support.
This approach will involve close partnership with public health authorities in Zimbabwe and neighbouring countries, as well as nongovernmental organizations and United Nations agencies including UNICEF. An Inter-Agency Rapid Assessment Team is going to be established to investigate and confirm outbreaks.
The emphasis is going to be on rapidly addressing the known risk factors for cholera transmission. The immediate priorities include:
- Standardized case reporting to understand the distribution of Cholera and guide treatment priorities
- Ensuring access to safe water and sanitation;
- Standardized case management to reduce mortality;
- Producing treatment and prevention materials, as well as prevention messaging campaigns to lessen the risk to populations.
The total cost of health response activities for three months is 2 million dollars, which includes the supply of:
- Cholera and diarrhoeal disease kits;
- Emergency health kits;
- Water purification equipment;
- 10 portable laboratory kits for diagnosis;
- Personnel (including for epidemiological control and Health Cluster coordination);
- Cholera treatment training.