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Disease Focus: Cholera

Cholera in Afghanistan 

By Nora Rideg 

Cholera remains a critical public health issue in Afghanistan due to the socio-economic and environmental conditions. The ongoing conflict has severely impacted infrastructure, including water and sanitation systems, leaving many communities vulnerable to waterborne diseases. According to the World Health Organization (WHO), between 30 March 2024 and 27 April 2024, Afghanistan recorded 8,754 new cholera cases and 3 additional deaths. From the beginning of 2024 to 27 April 2024, a total of 33,307 cases and 16 deaths have been reported, marking an increase compared to the same period in 2023 when 22,848 cases and 7 deaths were documented.  

The provinces most affected include Kabul, Helmand, and Kandahar, where conflict and crumbling infrastructure contribute significantly to water contamination and rapid spread of Vibrio cholerae. Cholera spreads through contaminated water sources, exacerbated by the lack of access to clean drinking water and proper sanitation facilities. Poor hygiene, overcrowded living conditions and inadequate waste disposal further increase the risk of disease transmission.

Cholera is a severe health threat that affects people of all ages, but young children are especially vulnerable due to their weaker immune systems and higher risk of rapid dehydration. While most children infected with cholera experience mild symptoms and can be treated with oral rehydration solutions, untreated cases can be fatal within hours. Severe cases require rapid treatment with intravenous fluids and antibiotics. Contaminated food or water can cause symptoms within 12 hours to 5 days, with bacteria remaining in the feces for up to 10 days, potentially infecting others. The impact of cholera on human health is significant where the disease spreads rapidly through contaminated resources, causing acute diarrhea, fever, and dehydration. The situation is exacerbated by natural disasters like floods, which force communities to rely on muddy, contaminated water, leading to widespread illness. The crisis is worsened by limited access to healthcare, shortages of essential medicines, and the closure of health facilities. The reduction in international aid since the Taliban takeover in 2021 has further strained Afghanistan's healthcare system, making it difficult to manage cholera outbreaks effectively. 

Climate change is a major factor in the rise of cholera outbreaks in Afghanistan. Extreme weather events like floods, cyclones, and droughts disrupt water and sanitation infrastructure, leading to contaminated water sources. In Afghanistan, severe or catastrophic drought conditions affect 25 out of 34 provinces, impacting more than half of the 40 million population. These water shortages not only worsen poverty but also lead to poor hygiene practices, creating a breeding ground for cholera. The WHO has raised the global cholera risk to a very high level and is working to reduce deaths and contain outbreaks. 

Organizations like the WHO and UNICEF are actively combating cholera in Afghanistan. The WHO has provided healthcare facilities with cholera kits, conducted mass casualty management training for healthcare workers, and emphasized rapid access to treatment, such as oral rehydration solutions and intravenous fluids. They also support disease surveillance and response measures, aiming to improve water sanitation and hygiene (WASH) infrastructure. UNICEF also contributes by providing treatment kits and vaccines by running awareness campaigns to educate the population about cholera symptoms and prevention. 

 

References:  

 

European Centre for Disease Prevention and Control. (2024, May 27). Cholera worldwide overview. https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly 

KabulNow. (2023, December 8). Afghanistan struggles with highest cholera cases in 2023, who reports. https://kabulnow.com/2023/12/afghanistan-struggles-with-highest-cholera-cases-in-2023-who-reports/ 

Kakar, S., & Siddique, A. (2024, June 25). Cholera outbreak hits Afghanistan amid natural disasters, crumbling health care. RadioFreeEurope/RadioLiberty. https://www.rferl.org/a/afghanistan-natural-disasters-disease-cholera/33008517.html 

 MBBS, H., Hafsa , A., Khulud , Q., Nilofer, Z., Zoaib, T., & Abdullah, M. (2023, July 17). Cholera spike amidst a deteriorating humanitarian crisis in Afghanistan: a correspondence.

https://journals.lww.com/ijsgh/fulltext/2023/07010/cholera_spike_amidst_a_deteriorating_humanitarian.58.aspx 

Reid, K. (2023, July 5). Cholera: Facts, faqs, and how to help. https://www.worldvision.org/clean-water-news-stories/what-is-cholera-facts 

UNICEF. (2023, May 4). Cholera is endangering children globally. https://www.unicef.org/stories/cholera-is-endangering-children-globally 

World Health Organization. (2024, April 30). Cholera upsurge. https://www.who.int/emergencies/situations/cholera-upsurge 

 

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Cholera: A Brief

by Nicole Kraatz

 

Vibrio cholerae is a bacterium that infects the human gastrointestinal system. This bacteria causes the disease Cholera. Cholera is an acute, diarrheal disease rare to the United States and other industrialized regions with proper sanitation, water treatment and hygiene practices. It has been said that Cholera outbreaks have been documented in India beginning in the early 1800s. One of the first epidemics to be recorded happened in 1817 near the Ganges River.

 

The Vibrio cholerae bacterium is typically found in water sources that have been contaminated by fecal matter. Food sources can also inhabit the bacteria by coming in contact with fecal matter from other persons already infected. Because of this, many geographical regions and developing countries with poor sanitation, water treatment and hygiene practices have the highest risks of developing Cholera. Those that live in Africa, specifically those that live in Sub-Saharan Africa are at the highest risk of contracting Cholera because of their lack of basic health care and clean water practices. Vibrio cholerae has also been found in raw shellfish gathered from the Gulf of Mexico.

 

According to the World Health Organization, about 3-5 million Cholera cases are reported annually with 100,000-120,000 documented deaths. Cases of Cholera vary in terms of severity. The incubation period for Vibrio cholerae ranges from a few hours up to 5 days. Symptoms of Cholera include profuse watery diarrhea, vomiting, dry mucous membranes and lack of elasticity of the skin. If the progression of the disease is severe, Cholera can lead to acute renal failure, severe electrolyte imbalances and coma. If these symptoms go untreated, severe dehydration can quickly lead to shock and death.

 

Many cases of Cholera do not require medical treatment in order to recover, however 10% of patients will need some form of treatment in order to survive. Types of treatment for Cholera include prompt restoration of lost fluids and salts through rehydration therapy, antibiotic and zinc treatments. The Centers for Disease Control and Prevention have came up with five basic rules to follow in order to prevent the spread of Cholera including using and drinking safe water, washing hands often and using latrines or burying fecal matter instead of defecating in bodies of water.

 

nkraatz@masonlive.gmu.edu  

Cholera in Lebanon

by Ava Nazemian

Paul Farmer, Slowing Down the Cholera Epidemic in Haiti


By Jason Zheng


Dr. Paul Farmer is one of the renowned infectious disease doctor and passionate promoter of decent heath care for the poor. Partners in Health is non-governmental organization that he participates to promote positive advocacy of making healthcare more accessible to region all around the world that are not able to practice this general human right.


It can be said that a total of 8,927 people from Haiti alone died from cholera as of April 2015. Haiti is one of the countries that Dr. Farmer assists to provide medical assistance with no cost. He also gives his personal account on how to slow the cholera epidemic down.


Dr. Farmer states that it is important to identify and treat everyone with symptoms. The most efficient way to do this is to fully utilize the community health workers to help identify these cases. It would not be a safe to approach it by letting patients show up to see a doctor when the time may be just too late for them.

Dr. Farmer argues that the sick needs to be treated with antibiotics and make oral cholera vaccine readily available for patients. It would be wise to administer the vaccine first before rehydration of the patient because it can be problem some if the patient isn’t properly treated. It would also be a good idea to spread advocacy of the vaccinations that are available to the general public, that way people would be more engaged.


Providing safe drinking water quality is essential to prevent the spread of cholera. Cholera is a feared by the public as a waterborne disease. Establishing informal settlements and refugee camps are inefficient, because they lack the proper sanitized location needed to treat patients.


This also means that it is necessary for people to practice proper personal and food hygiene. In addition, properly disposing human excrements. This also falls into the category of making an effort to deal with other transmissible diseases (e.g. HVI/AIDS). There should be a better focus on strengthening the country’s overall health care system, because this would be the first step for prevention and assistance.


Dr. Farmer also states that it is a primary importance to raise the bar on health care goals in Haiti. Cholera does not remain local for long; it spreads like any other disease. To raise awareness and effort of any type of disease it would require the participation of the community as well.


jzheng7@masonlive.gmu.edu 

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