Tuesday, 14 February 2017

History of Cholera and its burden on Developing Countries



In modern history, cholera occupies an important place as a public health challenge. It was the first pandemic of the 19th century. It’s an infectious and life-threatening diarrheal disease which is endemic in many Asian and African countries. Initially originated in the swamps of Bangladesh, it spread across the world from its reservoir which is part of the Ganges River Delta. The existent brackish waters were the birthplace of vibrio cholerae, a bacterium that infects the waters and when ingested emits a toxin so virulent that all the human body’s fluids are forced to flush out.  Deprived of electrolytes, people begin to die of shock and organ failure, sporadically, within six hours of the first abdominal rumbling. 


History of Cholera and its burden on Developing Countries 

Since 1871, pandemics of cholera has affected millions. As per researchers at World Health Organization, cholera contributes to 1.3 to 4 million cases each year. (WHO, 2016) The increase in access to safe drinking water and sanitation facilities has eliminated the transmission in high-income countries. However, the causative agent, Vibrio cholerae continues to affect millions of people in less developed countries where, unfortunately, clean water and sanitation infrastructure is not available in abundance. 

Over the last 25 years, major cholera epidemics have seen to originate in coastal areas. Currently, the regions of cholera endeminity include the coasts surrounding the Bay of Bengal, both Bangladesh and the Indian subcontinent. In these geographical regions, the patterns of the frequency of the disease show a similar trend that are explained by same physical or environmental drivers. The diarrheal disease, caused by bacteria that lives in water and faeces, is not spread by contact with an infected person. A large number of the population is infected due to drinking this contaminated water. Experts suggest an occurrence of 4,50,000 - 1,000,000 cases of cholera in Bangladesh each year, whereas Data from population-based diarrhea surveillance in an endemic area of Kolkata, India, revealed a cholera incidence of 2.2 cases per 1000 person-years.  

For effective aversion of cholera transmission, it’s imperative the afflicted countries are provided with safe drinking water through a well-maintained water and sanitary infrastructure. Oral cholera vaccines are additional ways to control the disease but should be used in conjunction with improvements in water & sanitation. Even though the disease is preventable and can be controlled despite the existence of a vaccine, many countries still remain affected.

“HILLCHOLTM  - This low-cost Cholera vaccine can be used to create a healthy stockpile to be used in epidemic situations.”  Says Dr Tarun Sharma, Associate Director, R&D, Hilleman Laboratories


Representing a significant healthcare burden globally, Hilleman Laboratories is awarded global patents for Oral Cholera Vaccine (OCV) in offices including USA, European Union, Australia, China, Canada and South Africa. Mass vaccination would be made a reality in cholera endemic zones due to ease of manufacturing and low cost. Hilleman Labs single-strain vaccine with process and manufacturing optimisation significantly reduces the cost of the vaccine production, thus, aiding in improving vaccine affordability and accessibility.


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