Cholera. Maybe it conjures up images of 1854 London with its poor neighborhoods wracked with death and disease. Only the beer-producers seemed immune. Or perhaps you remember just a few years back, how a cholera epidemic swept through Haiti on the heels of massive flooding. Perhaps you think of Bangaladesh today. There are still three to five million cases a year worldwide. In the absence of good supportive medical care, the diarrhea of cholera is deadly.
A public service announcement from 1866. Workers at the beer factories didn’t get cholera — they didn’t drink the water. (4)
What is cholera?
In a nutshell: A potentially very nasty case of diarrhea. The bacterium Vibrio cholerae naturally lives wild, mostly in sea water. When it takes up residence in a human gut, it produces a toxin that poisons a very important cellular transport protein. The victim may the ability to pick up salts and water from the gut and develop a fatally bad case of watery diarrhea. There may also be vomiting. Loss of salts in the diarrhea can lead to muscle cramps, too.
Some people can harbor the bacterium in their gut without it overpopulating and making them sick. About 10% of infections produce a very severe diarrhea. The dehydration from the diarrhea is the real risk. Current stats show a bit over 10% of diagnosed cases to be fatal. (2)
Symptoms usually appear 2-3 days after drinking contaminated water. A span of anywhere from a few hours to five days is plausible. (3) Rehydration is the main treatment. I plan on doing a more thorough treatment of rehydration options soon, but you can find some ideas here. Antibiotics can shorten the course of the disease, but they definitely play second fiddle to the rehydration.
Most cases of cholera come from drinking fecal-contaminated water.
Is cholera a prepping problem in the modern world?
In the modern world, cholera outbreaks don’t just randomly pop up in developed areas. By ‘developed’ I mean “with well-developed water supplies and sanitation arrangements”. They’re currently happening only in the poorest communities with the worst sanitation. As bad, for example, as that famous 1854 London outbreak, where the neighborhood cesspit was draining into the neighborhood well. So do you need to think about it if you don’t live in such a place?
If you’re a prepper you do … because you understand that disasters happen anywhere.
Cholera follows other disasters
Cholera is one of those diseases that ‘shouldn’t happen’ as an epidemic. Give people clean water and decent sanitation, and you get only the odd case acquired from natural water sources. Introduce another disaster, however, and the little Vibrio cholerae bacterium thrives and runs through entire populations.
Tsunamis and floods are the prime movers, as they expose many people to sea-borne bacteria. Really though, it only takes one naturally acquired case. If that person releases into a bad sanitation and water purification system, begin the second wave of disaster. It’s thought, for example, that the cholera problem of modern Haiti was started in 2010 when U.N. peacekeepers from Nepal brought it in. Bad sanitation let it get into the local water supply. Heavy flooding spread the contaminated waters widely … and there you are. Epidemic. (1) Now the bacterium is endemic in Haiti and fresh outbreaks often accompany floods that let untreated sewage into people’s sources of ‘potable’ water.
Refugee camps often house the displaced after disasters. Can you imagine a better environment to spread disease? (5)
Coastal areas are at greatest risk
Vibrio cholerae bacteria naturally live in sea water. They can be found in and on many other things marine. The bacteria coat the surfaces of shellfish and marine plants, float in the ballast water of ships from infected waters, arrive as a free bonus carried on ocean-fresh fish. Cholera epidemics hit coastal areas hardest and most often. (2) It’s easiest to start a fire when there are matches lying all over the place.
Here’s a map of where the bacteria that cause cholera can be found. Coastal areas are the high risk zones. (2)
Once established in an area, the bacteria are also ok with living in brackish or even fresh water. That makes eradication about impossible. The best answer is to re-establish good water purification and sewage treatment. It’s really the diarrhea of the sick that ups the bacterial count of the water and the transmission risks.
Preventing cholera
Purify your water. And use that purified water for everything that involves ingestion: washing dishes, toothbrushing, etc. Wash your hands with soap before you eat or handle food. That’ll pretty much do it.
There are vaccines for cholera prevention. They’re even oral, so no needles required. And they’re effective (about 85%) for the first four months, and useful (maybe 50% effective) for the first year or two. They just don’t give the lifelong protection of some other vaccinations, though. Blame our immune systems. The defense cells for cholera happen to not be very long-lived. (3)
Prepping considerations for cholera
Here are some of the takeaways I got regarding cholera from a prepping standpoint:
- Risk is low until some other disaster disturbs sanitation.
- Coastal areas are more likely to have problems than inland areas. (Too bad such a high percentage of humans live in coastal areas…)
Add these two together and you get: Big cities would be high risk zones if they lost good sanitation. They’re not only coastal so have exposure, but they’re very crowded and all using the same water.
- Inland areas aren’t immune, as local water sources can be infected by a migrant (human or imported seafood).
- Good water purification is key to avoiding and interrupting epidemics.
- Cholera causes very nasty diarrhea. Rehydration strategies are critical patient support.
- Vaccination is not a long-term effective defense.
References
1) Piarroux, R., Barrais, R., Faucher, B., Haus, R., Piarroux, M., Gaudart, J., Magloire, R., … Raoult, D. (2011). Understanding the cholera epidemic, Haiti. Emerging infectious diseases, 17(7), 1161-8.
2) Luis E. Escobar, Sadie J. Ryan, Anna M. Stewart-Ibarra, Julia L. Finkelstein, Christine A. King, Huijie Qiao, Mark E. Polhemus. A global map of suitability for coastal Vibrio cholerae under current and future climate conditions, Acta Tropica. Volume 149, 2015, Pages 202-211, https://www.sciencedirect.com/science/article/pii/S0001706X15300218
3) Cholera — Vibrio cholerae infection. 2018. Centers for Disease Control. https://www.cdc.gov/cholera/vaccines.html
4) Wellcome Collection gallery (2018-03-27): https://wellcomecollection.org/works/n2ykxrzm CC-BY-4.0
5) Mark Knobil from Pittsburgh, usa [CC BY 2.0 (https://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
History shows in war zones like Bosnia and Syria that while violence causes much danger and death, failure of basic sanitation causes the most casualties. Human waste too close to water supplies and food stuffs. You cannot shoot your way out of disease. Do you have a good field sanitation manual to recommend? Do you have it in hardcopy? Even now in California failure of sanitation diseases are occurring during what we would call “good times”. Most cities require weekly deliveries of chlorine for water treatment. If your water source is questionable do you have pool shock and the knowledge to use it to clean a well or your cistern? Cholera a reminder why safe water is so important to survival.
Thank you for the great information!