Cholera is an acute intestinal infection with a short incubation period (from 1 to 5 days), and produces an enterotoxin causing copious amounts of watery diarrhea (WHO, 2001). Untreated, cholera can quickly result in severe dehydration and death. Treatment includes oral rehydration salts (ORS) and, for severe cases, both intravenous fluids and antibiotics. Prevention is based on the public health infrastructure of safe water and sanitation, and cultural beliefs and behavioral practices based on a reliable supply of water and security in its use. Once cholera is introduced into a community, endemic control necessitates the hygienic removal and disposal of feces, the provision of a reliable supply of clean water, and an understanding and the practice of safe food hygiene.
While cholera is an ancient disease, it continues to emerge and re-emerge. In 1991, the cholera epidemic that began in Peru and for two years spread across South America, was the first time in 100 years that cholera was diagnosed on that continent. Before it was over, more than 9,000 people had died and many more were sickened by it (Guthman, 1995). During an earlier cholera pandemic, a London physician named John Snow identified the mode of transmission. In his classic 1853 study, Snow demonstrated that a single source of water was implicated in the cholera outbreak in a particular neighborhood. The people who became sick drank water from a common public water source, the Broad Street pump. Others living in the same neighborhood did not become sick when they used water sources other than the Broad Street pump. Snow decided that the water being pumped from the Broad Street well was contaminated and had the pump handle removed. Within days the number of cases was reduced, and the outbreak was over. Snow correctly deduced that the well was contaminated and that the contaminated water was making people sick, even though it was not until later that they learned a contaminated cesspool had leaked cholera bacteria into the well (Diamond, 1992).
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