Cholera, travel, and infection control

The spread of cholera is a testimony to our inability to provide a consistently decent standard of living to the peoples of the world. Simply separating human sewage from potable water sources would curtail, if not eliminate, the disease. Even persons who acquire cholera would not die if they were given access to rehydration. American travelers should follow sensible food and water precautions, but need not curtail their travels to countries that have cholera.     

Cancer on Guam, especially among Micronesians

The Guam Cancer Registry (GCR) collects data on cases of cancer in Guam residents whether their initial diagnosis is made on Guam or as a result of a referral to an off-island medical facility. It also collects data on cancer of non-residents diagnosed on Guam. Although including non-Guam resident cancer cases in statistical tables will have the effect of raising local cancer rates, this probably only partially compensates for the number of Guam-resident cancer cases that are diagnosed off-island and not reported to the registry. Cases are also collected by a periodic review of death certificates filed with the Guam Office of Vital Statistics. To test this hypothesis GCR records were reviewed to determine the number of reported cancer cases for each ethnic group that claimed to be Guam residents. Since a high proportion of cancers seen among Micronesians on Guam represent cases referred from their home islands, it may also be that these cases only represent those cancers most likely to be referred to Guam rather than being representative of the cancers most commonly occurring within these ethnic groups in their home islands.     

Cholera studies. II. Prevention and control

In discussing prevention, the author deals first with the provision of permanently safe water, supplied from waterworks or wells, and with other improvements in environmental sanitation. Control of food and drinks, public health propaganda and education, and vaccination are also considered under this heading.     

2000年钦州市钦南区霍乱流行病学调查分析

目的：了解钦州市钦南区2000年霍乱流行病学特点,为进一步控制霍乱的流行提供依据。方法：采用卫生部统一制定的霍乱调查表对2000年霍乱的散发病例、爆发病例和带菌者进行问卷调查,然后做描述性统计分析。结果：2000年钦州市钦南区共报告霍乱病例25例,其中16例为散发病例,9例为爆发病例,发病率为6．64／10万,疫情波及5个乡镇,18个村;男性13例,女性12例,年龄最小为4岁,最大82岁,50岁以上人群占绝大多数（76％）。农民24例,学生1例;临床分型,轻型病例15例,中型3例,重型7例。血清学及噬菌体——生物分型为小川1b型。结论：2002年钦州市钦南区霍乱以散发为主,轻型病例占多数,发病人数趋向于中老年群体。     

Toward Cholera Elimination,Haiti

This study describes the apparent discontinuation of cholera transmission in Haiti since February 2019. Because vulnerabilities persist and vaccination remains limited, our findings suggest that case-area targeted interventions conducted by rapid response teams played a key role. We question the presence of environmental reservoirs in Haiti and discuss progress toward elimination.     

Vector introduction and malaria infection on Guam

The Mariana Islands lie well within the vast "malaria-free" region of the central and south Pacific Ocean. However, Anopheles indefinitus was discovered on Guam in 1948, and an additional four species of Anopheles were collected on the island during 1970-75. Early malaria cases on Guam were diagnosed as relapsing infections with the disease having been contracted in other areas. Small outbreaks of malaria were recorded on Guam in 1966 and 1969, and autochthonous cases were indicated in both. Since vector capability for malaria does exist on Guam, quarantine procedures at the air and seaports combined with public health disease surveillance and an integrated anopheline control program are recommended for the island.     

Progress in global measles control, 2000-2010

In 1980, before widespread global use of measles vaccine, an estimated 2.6 million measles deaths occurred worldwide. In 2001, to accelerate the reduction in measles cases achieved by vaccination, the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) developed a strategy to deliver 2 doses of measles-containing vaccine (MCV) to all children through routine services and supplementary immunization activities (SIAs) and improved disease surveillance. After implementation of this strategy, the estimated number of annual measles deaths worldwide decreased from 733,000 in 2000 to 164,000 in 2008. In 2010, the World Health Assembly endorsed the following measles objectives for 2015: 1) raise routine coverage with the first dose of MCV (MCV1) for children aged 1 year to ≥90% nationally and ≥80% in every district or equivalent administrative unit, 2) reduce and maintain annual measles incidence at <5 cases per million, and 3) reduce measles mortality by ≥95% from the 2000 estimate. During 2000-2010, global MCV1 coverage increased from 72% to 85% with approximately 1 billion children vaccinated during measles SIAs. Reported measles cases decreased from 2000 to 2008, remained stable in 2009, and increased in 2010. By the end of 2010, 40% of countries still had not met the incidence target of <5 cases per million. Key challenges must be overcome to meet the 2015 objectives, including 1) declining political and financial commitments to measles control, 2) failure to reach uniform high coverage with 2 doses of MCV through routine services or SIAs, and 3) inadequate monitoring subnationally of coverage with the first and second dose of MCV to guide interventions to increase coverage.     

南京市雨花台区1991～2000年肝炎防治效果评价

病毒性肝炎是江苏省主要传染病之一 ,上世纪 80年代末至 90年代初发病强度一直居法定报告传染病之首。自1994年开始采取对高危人群广泛接种甲、乙型肝炎疫苗的防治对策以来 ,发病率持续下降 ,至 90年代末 ,发病率已从全国之首降至全国平均水平以下 ,取得了显著的社会效益和经济效益。南京市雨花台区积极贯彻上级部门工作部署 ,开展了肝炎防治工作。本文对南京市雨花台区 1991～ 2 0 0 0年肝炎发病情况进行分析。1　材料和方法　　资料来源于南京市雨花台区传染病疫情年报。2　结果2 1　肝炎发病率变化情况　　病毒性肝炎报告发病率呈现逐渐…     

Cholera

Cholera, an acute infectious disease characterized by massive gastrointestinal loss of isotonic fluid, is prevalent throughout large parts of the world today. Although this disease can be effectively treated under ideal conditions, the mortality rate in most cholera-affected areas remains quite high. The only certain protection against this disease is provided by adequate water supply and sewage disposal facilities. In the absence of such facilities, careful personal hygiene can provide a very high level of protection. Chemoprophylaxis is potentially effective only for small,relatively isolated population groups. Currently available commercial cholera vaccines provide only limited protection for a relatively short period of time. Although experimental data suggest that a new toxoid vaccine, currently being tested in the field, may provide a higher degree of protection, the duration of immunity provided by this vaccine will probably also be of relatively short duration.     

Cholera and living conditions, Brazil

INTRODUCTION: Factors associated with precarious living and environmental conditions are frequently cited as major obstacles for the control of cholera outbreaks and epidemics. The purposes of the study are to evaluate the contribution of factors associated with the population living conditions and correlate the environmental problems with the onset of cholera and its subsequent impact. METHODS: Using a multiple linear regression by the backward stepwise method, and with the researcher's interaction, the study correlated socioeconomic indicators with cholera incidence rates in some counties of Pernambuco State, Brazil, during the year of 1992. RESULTS/CONCLUSIONS: The results of the adjusted model showed that the proportion of households without tap water was the variable that contributed the most to the increasing fluctuation of cholera incidence rates. Two other factors, the proportion of households without sewage and the proportion of householders with an income less than or equal to the minimum wage, also revealed a positive association with cholera incidence rates with statistically significant regression coefficients. The proportion of households with no sanitary installations whatsoever showed a negative association with cholera incidence rates, suggesting that sewage disposal, such as open-air sewage ditches, that is not part of the public sewage disposal system, increases the risk of environmental contamination The results indicate that having an adequate tap water supply is of maximum priority for cholera prevention.     

Understanding the Cholera Epidemic, Haiti

After onset of a cholera epidemic in Haiti in mid-October 2010, a team of researchers from France and Haiti implemented field investigations and built a database of daily cases to facilitate identification of communes most affected. Several models were used to identify spatiotemporal clusters, assess relative risk associated with the epidemic’s spread, and investigate causes of its rapid expansion in Artibonite Department. Spatiotemporal analyses highlighted 5 significant clusters (p<0.001): 1 near Mirebalais (October 16–19) next to a United Nations camp with deficient sanitation, 1 along the Artibonite River (October 20–28), and 3 caused by the centrifugal epidemic spread during November. The regression model indicated that cholera more severely affected communes in the coastal plain (risk ratio 4.91) along the Artibonite River downstream of Mirebalais (risk ratio 4.60). Our findings strongly suggest that contamination of the Artibonite and 1 of its tributaries downstream from a military camp triggered the epidemic.On October 21, 2010, the Haitian Ministry of Public Health and Population (MSPP) reported a cholera epidemic caused by Vibrio cholerae O1, serotype Ogawa, biotype El Tor (1). This epidemic was surprising as no cholera outbreak had been reported in Haiti for more than a century (1,2). Numerous media rapidly related the epidemic to the deadly earthquake that Haiti had experienced 9 months earlier. However, simultaneously, a rumor held recently incoming Nepalese soldiers responsible for importing cholera, along with accusations of illegal dumping of waste tank contents (3). A cholera outbreak was indeed reported in Nepal’s capital city of Kathmandu on September 23, 2010, shortly before troops left for Haiti (4,5). Two hypotheses then emerged to explain cholera in Haiti.Some researchers posited the transmission of an environmental strain to humans (6). Reasoning by analogy with cholera epidemiology in South Asia, they hypothesized that weather conditions, i.e., the La Niña phenomenon, might have promoted the growth of V. cholerae in its environmental reservoir (6). The second hypothesis suggested importation of the disease from a cholera-endemic country. The sequencing of 2 isolates of V. cholerae supported this second hypothesis by establishing an exogenous origin, probably from southern Asia or eastern Africa (7). Responding to a request from Haitian authorities to the French Embassy for the support of epidemiologists, we conducted a joint French–Haitian investigation during November 7–November 27, 2010, to clarify the source of the epidemic and its unusual dynamic.