Transcript New insights on the emergence of Cholera in Latin America during

Cholera and Global Health
Dr Jaime Miranda, M.D.
International Health and Medical Education
Centre University College London
London, March 2004
IHMEC
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International Health and Medical
Education Centre, UCL
IHMEC was established in 2000 to
meet the growing demand from
staff and students for the inclusion
of international health in the
medical curriculum
We have been working to increase
the possibilities for studying global
health and have been publicising
issues relating to the subject
Educating doctors for
world health
…UCL's International Health and
Medical Education Centre is an
important step forward in the effort
to produce doctors who can make a
difference in the world
Lancet 2001;358:1471
Courses offered
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Intercalated BSc in International
Health
Fifth year Special Study Module and
International Health Elective
Special Study Modules for first year
students
Objective
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To understand Cholera as a global
health issue
To Outline environmental,
economical, social and political
issues associated with Cholera
Love in the Time of Cholera
...they no longer felt like newlyweds, and even
less like belated lovers. It was as if they had
leapt over the arduous calvary of conjugal life
and gone straight to the heart of love. They
were together in silence like an old married
couple wary of life, beyond the pitfalls of
passion, beyond the brutal mockery of hope
and the phantoms of disillusion: beyond love.
For they had lived together long enough to
know that love was always love, anytime and
anyplace, but it was more solid the closer it
came to death.
(Gabriel García Marquez)
Overview
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Definitions
Cholera: clinical, epidemiology
History and pandemics
Peru: diary of Cholera’s epidemic
Environmental factors
Cholera today
Conclusion
Overview
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Definitions
Cholera: clinical, epidemiology
History and pandemics
Peru: diary of Cholera’s epidemic
Environmental factors
Cholera today
Conclusion
Definitions
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Nomenclature
Endemic, Epidemic, Pandemic
International Health
Nomenclature
Vibrio: a type of bacteria
 Vibrium cholerae: organism
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Serogroups: O antigen >200 groups
 O1, O139, non-O1 non-O139
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 O1
biotypes: Classical, El Tor
 Serotypes: Ogawa, Inaba, Hikojima
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Cholera: disease
…demic
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Endemic: a disease continually
present in a region
Epidemic: an outbreak of a disease,
introduced from outside a
community, attacks many people
over a short period
Pandemic: an extensive epidemic,
affects populations of several
countries or regions
International Health
Conceptualising health as the end
point of such complex processes
involves looking at economic,
cultural, historical, political,
commercial and environmental
factors on a global scale
Overview
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Definitions
Cholera: clinical, epidemiology
History and pandemics
Peru: diary of Cholera’s epidemic
Environmental factors
Cholera today
Conclusion
Cholera epidemiology
Transmission: food in DC, water in
LDC
 Seasonality
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Bangladesh: 2 peaks, b/a monsoon
rain
 Peru: warm season
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Reservoir: shellfish and plankton
 Case:Infections = 1:3 to 1:100
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Infection
Intestinal immunity
 108 – healthy subjects
 105 – with antacids
 Lower in real:
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No volunteer conditions
 Low gastric ph
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Blood group O – evolution in
Ganges?
Clinical Features
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Incubation: 18h
– 5 days
Watery
diarrhoea,
infectious
Vomiting
10% severe
Up to 0.5-1 L/h
 dehydration
Treatment
Replacement for dehydration
 Signs: 5% bodyweight
 Severe dehydration = 10%
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50kg 5 L saline FAST!!
Antibiotics:
 Illness  diarrhoea
  Use of fluids  hospital stay
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Vaccination?
Cholera outbreak
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… patient older than 5 years
develops severe dehydration or dies
from acute watery diarrhoea, or if
there is a sudden increase in the
daily number of patients with acute
watery diarrhoea, especially patients
who pass “rice water” stools typical
of cholera (WHO definition)
Overview
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Definitions
Cholera: clinical, epidemiology
History and pandemics
Peru: diary of Cholera’s epidemic
Environmental factors
Cholera today
Conclusion
Cholera pandemics
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7.
1817
1826
1839
1863
1881
1899
1961
– 1823
– 1838  UK 1831
– 1853
– 1874
– 1896
– 1923
-…
 America 1991
What happened?
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Cholera extremely linked to social,
economical and political change
Initially: Indian subcontinent
19th century: imperialism, trade,
military conflict, migration
Worldwide disease in 1826