The cholera pandemic is the longest running global pandemic. Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. The classic symptom is large amounts of watery diarrhea, including potential muscle cramps. This often leads to severe dehydration. The individual may show signs of deep, sunken eyes and decreased skin elasticity.
When was the first cholera pandemic outbreak?
In India in 1817, the disease spread to Southeast Asia, the Middle East, Europe, and Eastern Africa via common trade paths. The rise of a second global pandemic affected North America and Europe as advancements in transportation increased. The third pandemic from 1846 until 1860, extended to North Africa and South America for the first time. The fourth pandemic starting around 1863 spread from India to Naples and throughout Spain. The fifth pandemic was from 1881–1896 starting in India and spreading to Europe, Asia, and South America. A sixth world pandemic started in India lasting from 1899–1923. The seventh global cholera pandemic originated in 1961 in Indonesia the new deadly variation nicknamed El Tor, which remains in developing countries to this day.
The first cholera pandemic 1817–1824
The first cholera pandemic, though previously restricted, began in Bengal, and then spread across India by 1820. Hundreds of thousands of Indians and ten thousand British troops died during this pandemic. The cholera outbreak extended as far as China, Indonesia (where more than 100,000 people succumbed on the island of Java alone) and the Caspian Sea in Europe, before receding.
Transmission of cholera
Transmission is through the fecal-oral route of food or water as a consequence of minimal sanitation. Food transmission can be through seafood, such as oysters in waters infected with sewage, as Vibrio cholerae accumulates in planktonic crustaceans. People infected with cholera often have diarrhea, which can contaminate water used by others, especially in countries with under developed sewage systems. Drinking any contaminated water or consuming shellfish living in the affected areas, will spread the disease.
Vibrio cholerae also exists outside the human body in natural water sources, through interacting with phytoplankton, zooplankton. Pressures exist in the aquatic environment that may reduce the virulence of vibrio cholerae. In certain circumstances, the transcriptional profile of the pathogen changes as it enters the environment. This prevents vibrio cholerae from being cultured, referred to as ‘viable but non-culturable’ (VBNC) or ‘active but non-culturable’ (ABNC).
The second cholera pandemic 1829–1837
A second cholera pandemic reached Russia, Hungary and Germany in 1831. Deaths were recorded at approximately130,000 people in Egypt that year. The following year it reached London and Paris. In London, the disease claimed over 6000 lives. In 1833, a cholera epidemic killed significant numbers of Pomo people, a Native American tribe. The epidemic spread to Quebec, Ontario, Nova Scotia and New York. Mexico was severely hit in 1833 and 1850.
In France doctors believed cholera was associated with poverty. The United States linked the disease to recent immigration, specifically the Irish. Epidemiologists understand they were carrying disease from British ports. The government had a direct role in the development and application of science and this was demonstrated through their support of efforts to control the epidemic.
WASH program in Yemen, prevention of cholera by World Health Organisation (WHO)
In Yemen a staggering 20 million people are in need of water, sanitation and hygiene (WASH) and access to clean and safe drinking water. This is heightened due to the sheer number of displaced families because of conflict, natural disasters and compounding food shortage. The country is only just recovering from another great outbreak in 2017. 1.3 million people were infected and 3000 died, mainly children. Improved sanitation and hygiene in health facilities are crucial to ensure the quality of care for patients and health workers. In 2019, Yemen has seen yet another increase of cholera cases, rising beyond 400,000. Conflict and war in the region stifle efforts to eradicate the disease.
The Yemen Solution
UNICEF has scaled-up to prevent and control diseases. The WASH, Health and Communication for Development (C4D) and response plan focuses on high-risk areas, chlorination of water sources and rehabilitation of wastewater systems, including education around hygiene awareness.
The third cholera pandemic 1846–1860
The third cholera pandemic deeply affected Russia, with over one million recorded deaths. A two-year outbreak began in England and Wales in 1848, and claimed over 50,000 lives. In London, it was the worst outbreak in their history, claiming over twice as many as the previous outbreak. In 1849, cholera also claimed over 5,000 lives in Liverpool, the central port for immigrants to North America.
An outbreak in North America took the life of former U.S. President James K. Polk. Cholera, believed to have spread from Irish immigrant ships, spread throughout the Mississippi river system, killing thousands in St. Louis and New Orleans. Cholera was transmitted along the California, Mormon and Oregon Trails as thousands died on their way to the California Gold Rush.
In 1852, cholera spread east to Indonesia and on to Japan. It is estimated between 100,000 and 200,000 people died in Tokyo between 1858–60.
The 1854 Broad Street Cholera outbreak in London ended after the physician John Snow identified a neighbourhood street pump as contaminated, convincing officials to remove its handle. His study proved contaminated water was spreading the disease.
In Spain, over 236,000 died of cholera in the epidemic of 1854–55. The disease reached South America in 1854, with victims in Venezuela and Brazil. Tunisia, which had not been affected by the two previous pandemics, thought Europeans had brought the disease. They blamed their sanitation practices. Some United States scientists began to believe that cholera was somehow associated with African Americans, as the disease was prevalent in the deep South in areas of black populations.
Can you be vaccinated against cholera (UK)?
There is a vaccine for cholera in the UK (source NHS UK https://www.nhs.uk/conditions/cholera/). This is recommended if you are;
- travelling to an area where cholera is common and without access to medical care
- part of an aid or disaster relief agency going to an area where an outbreak is likely
The vaccine is given as a drink. For adults, 2 doses (given 1 to 6 weeks apart) can provide protection for up to 2 years.
The fourth cholera pandemic 1863–1875
This began in the Ganges Delta and traveled with Muslim pilgrims to Mecca. In its first year, the epidemic claimed 30,000 of 90,000 Mecca pilgrims. The pandemic reached Northern Africa in 1865 and spread to sub-Saharan Africa. Cholera claimed 90,000 lives in Russia in 1866. The epidemic of cholera that spread with the Austro-Prussian War (1866) is estimated to have taken 165,000 lives in the Austrian Empire, including 30,000 each in Hungary and Belgium and 20,000 in the Netherlands.
In London in June 1866, a localised epidemic in the East End claimed nearly 6000 lives, just as the city was completing construction of its major sewage and water treatment systems. Epidemiologist William Farr identified the East London Water Company as the source of the contamination. In 1867, Italy lost 113,000 lives and 80,000 died of the disease in Algeria. Outbreaks in North America in the 1870s killed some 50,000 Americans as cholera spread from New Orleans to other ports along the Mississippi River and its tributaries.
The fifth cholera pandemic 1881–1896
The fifth cholera pandemic, according to Dr A. J. Wall, the 1883–1887 part of the epidemic cost 250,000 lives in Europe and at least 50,000 in the Americas. The 1892 outbreak in Hamburg killed 8,600 people. Although the city government was generally held responsible for the virulence of the epidemic, it went largely unchanged. This was the last serious European cholera outbreak, as cities improved their sanitation and water systems.
Who discovered cholera?
Filippo Pacini, finally gained appreciation for his discovery of Vibrio cholera, only 82 years after his death, when the international committee on nomenclature in 1965 adopted Vibrio cholerae Pacini 1854 as the correct name. Previously, many credited Robert Koch with this discovery.
The sixth cholera pandemic 1899–1923
The sixth cholera pandemic had little effect in western Europe because of advances in public health, but major Russian cities and the Ottoman Empire were particularly hard hit by cholera deaths. More than 500,000 people died of cholera in Russia from 1900 to 1925, which was also a time of social disruption because of revolution and warfare. The sixth pandemic killed more than 800,000 in India. The last outbreak in the United States was in 1910–1911, when the steamship Moltke brought infected people from Naples to New York City. Vigilant health authorities isolated the infected in quarantine on Swinburne Island. Eleven people died, including a health care worker at the hospital on the island. In this time period, because immigrants and travelers often carried cholera from infected locales, the disease became associated with outsiders in each society. The Italians blamed the Jews and Gypsies, the British who were in India accused the “dirty natives”, and the Americans thought the disease came from the Philippines.
Related disorders to cholera
Escherichia coli are found in the intestines of humans and animals. Certain strains may cause inflammation and symptoms may include bloody and watery diarrhea followed by fever. In newborns, this is called Winckel’s Disease and can cause serious infection of the blood stream.
Salmonellosis is a form of inflammation of the small intestine (gastroenteritis). It is caused by food contaminated by a species of Salmonella bacteria.
Shigellosis (Bacterial Dysentery) is an infectious disease and is widely spread by contaminated food and water or by the bite of certain flies. Shigellosis usually infects children.
Typhoid Fever is an acute systemic infection caused by the bacteria Salmonella typhi. The fever is usually high and may occur along with an abnormally slow heartbeat. Neurological symptoms may include seizures, delirium, and psychotic episodes. Complications may be life-threatening.
Pancreatic Cholera is a rare gastrointestinal disease and is not a bacterial disease. It is characterised by abnormally low levels of potassium, and the abnormal accumulation of acid in the blood. The disorder is due to a pancreatic tumor that secretes a substance known as vasoactive intestinal polypeptide (VIP).
The seventh cholera pandemic 1961–1975
The seventh cholera pandemic began in Indonesia, called El Tor, after the strain, and reached East Pakistan in 1963, India in 1964, and the Soviet Union in 1966. From North Africa, it spread into Italy by 1973. In the late 1970s, there were small outbreaks in Japan and in the South Pacific. There was an outbreak in Odessa in July 1970 and there were also many reports of a cholera outbreak near Baku in 1972.
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