Suspected cholera outbreak in east

While some 200 suspected cases of cholera have been reported in the eastern province of Nangarhar, a World Health Organisation (WHO) official told IRIN only two cases had been confirmed thus far. "We have two confirmed cases of cholera," acting national health coordinator, Dr Tera Wal said in the provincial capital, Jalalabad. The suspected outbreak, discovered earlier this week, has affected the Ghala Khel and Chinar Kalay villages in the district of Kot, some 50 km southeast of Jalalabad. More than 200 people were suffering from mild to chronic diarrhoea in the villages - a symptom of the potentially fatal disease. In collaboration with the local ministry of public health (MoPH), the world health body provided a medical team travelling to the villages with cholera kits to treat up to 100. "We have given them chlorine tablets, antibiotics and rehydration salts," Wal said. The team of seven will conduct assessments in the villages for three days, with another team sent in later if need be, he said. Although the exact source of the suspected outbreak has yet to be determined, Wal said it appeared to be due to water contamination. "We think that the problem stems from dead animals being thrown in the streams," MoPH deputy director Dr Golo Jan added. Wal said that people did not have access to clean drinking water and those in affected villages were not boiling their water. "The priority is to give people health education on how to avoid such diseases," he added. While there have been no reported deaths in the villages so far, doctors fear the situation could worsen if there is no health awareness. Kot is one of the worst drought-affected districts of Nangarhar, with insufficient drinking water, as well as a lack of basic health facilities. Fuelling the problem, according to health officials, could be the number of returnees settling in the area, further stretching already limited resources. "The district is poor and they are in desperate need of assistance," Wal said. Meanwhile, some villagers have dug their own springs with no health or safety measures taken, while fresh flowing streams were also being used by animals. According to the WHO, cholera, spread by contaminated water and food, is an acute intestinal infection caused by the bacterium vibrio cholera. With a short incubation period of less than one to five days, it produces an enterotoxin that causes a copious, painless, watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not promptly given. Vomiting also occurs in most patients. Most persons infected with vibrio cholera do not become ill, although bacterium is present in their faeces for seven to 14 days. When illness does occur, more than 90 percent of episodes are of mild or moderate severity and are difficult to distinguish clinically from other types of acute diarrhoea. Less than 10 percent of ill patients develop typical cholera with signs of moderate or severe dehydration. In terms of transmission, sudden large outbreaks are usually caused by a contaminated water supply. Only rarely is cholera transmitted by direct person-to-person contact. In highly endemic areas, it is mainly a disease of young people although breastfeeding infants are rarely affected. WHO says that when cholera occurs in an unprepared community, case-fatality rates may be as high as 50 percent - usually because there are no facilities for treatment, or because treatment is given too late. In contrast, a well-organised response in a country with a well established diarrhoeal disease programme can limit the case-fatality rate to less than one percent.