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Louise Ivers, MD, MPH, DTMH: Advancements Toward Global Cholera Management
Author(s):
The UN and WHO aim to reduce the burden of cholera globally by 90% reduction in deaths by 2030.
Louise Ivers, MD, MPH, DTMH, Center for Global Health, Massachusetts General Hospital: Cholera cases are on the increase globally. And what we see is that especially in vulnerable communities, communities that are living in poverty, communities that are affected by a refugee situations and having to flee, living in displaced persons camps or people who are living in the countries where there's conflict are really, really vulnerable. The increasing number of large outbreaks, Yemen is one now, in Haiti there's been a massive epidemic of cholera, has prompted the UN and the World Health Organization and their partners to come together just yesterday, to make a call for reducing the burden of cholera globally, trying to do that by 90% reduction in deaths by the year 2030. So what we know about cholera is that it's completely preventable and it's completely treatable, and even though it's been a disease that's been around for hundreds of years, we know exactly what to do to treat it. So one of the ways that we look to try to make a big intervention in the number of cases is to really follow kind of a strategic plan. Number 1 saying we know where most of the cholera cases happen, they tend to happen in the same places every year. So we have big outbreaks like Haiti or Yemen, but also there's countries, where 47 countries in the world, where cholera happens routinely. And so the idea is that we should pay a special attention to those places within those countries we know certain areas are hotspots, they always have cholera outbreaks, we should focus on those and that way we can target with big investments in clean water, sanitation and also the use of cholera vaccines. There's been a lot of interest in cholera vaccines in the last 10 years or so. They have been hard to get, the production of vaccines has been limited. But we know that cholera vaccines are very useful, they're not perfect. Alone, they're not going to change the whole status quo of cholera but when used together with interventions to look at clean water and sanitation they're very helpful. And that's just really kind of new in the public health world, the older versions of cholera of vaccines were not that good, but now we have a lot of experience using them in outbreaks. They were used in the Haiti outbreak, they've been used in parts of sub-saharan Africa. There was a lot of interest in using cholera vaccine in Yemen, and it hasn't happened yet for a multitude of reasons, but it's one option to try, in the short term, stop the epidemic, or interrupt the epidemic, or at least blunt it, while you try to get people safe water.
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