Fingers to Ashes: The Millennial Disconnect with HIV

Tyler Curry Become a fan Freelance columnist and fiction writer; creator, The Needle Prick Project

Posted: 06/11/2014 5:17 pm EDT Updated: 06/11/2014 5:59 pm EDT 

http://www.huffingtonpost.com/the-blog

It is hard to imagine that it was only 34 years ago when the first case of HIV was first documented in the United States. Shortly after, the virus seemed to spread like wildfire, burning a path of hysteria, frustration and sadness across the U.S. and throughout the world. In a short period of time, and thanks to a series of political blunders from the Reagan administration and many other political figures across the nation, HIV went from hundreds to millions and became the closest we have ever come to a modern plague.

Although there is still no cure for the virus, this plague is now classified as a chronic illness with those who are HIV positive living long and healthy lives. So the obscene terror that lived in the hearts of every gay man in the world merely three decades ago has all but been erased in the mines of the millennial age. In its place now lives a vague but often-impenetrable fear of those who carry HIV and a diluted sense of safety based on the idea that the transmission of HIV is related to a character flaw of promiscuity. This blind faith that the virus is relinquished to "other" types of people has allowed for this disease to continue affecting the millennial generation at staggering rates.
According to the Center for Disease Control's National Progress Report of 2013, an estimated 1.1 million people are living with HIV in the United States with 50,000 more becoming infected each year. One out of every six people living with the virus are unaware that they are infected, thus continuing the cycle of transmission. And worse, one out of every five gay men are living with HIV, yet the millennial generation often treats the disease as if it is only reserved for the history books.
But beyond the numbers, just what exactly does it mean to live HIV in today's world? For starters, HIV is now officially classified as a chronic disease. Although most people assume that treatment involves a series of toxic cocktails that HIV positive men and women take throughout the day, a person diagnosed today will most likely be on one daily pill to manage the virus. And reports suggest that, given a person is compliant with their medication; they can expect the same estimated lifespan as they did when they were HIV negative.
"A person who is 20-years-old and diagnosed today can expect to live into their 70s, roughly the same lifespan they would expect prior to being diagnosed," says Dr. Gary Blick, HIV Specialist and Founder of World Health Clinicians, an international HIV treatment organization.
However, it isn't all good news. The span of your life may be the same, but your worries certainly are not. People living with the virus run an increased risk of developing other life-threatening diseases such as cancer, heart attack and stroke. Combined with other STI's, these risks are even bigger, making it even more important for a person living with HIV to manage all aspects of their health, not just their pillboxes. However, an HIV positive diagnosis is merely a charge to be drastically more responsible with a person's health instead of an order to make arrangements for a pending funeral.
To many of the people living with the disease, it is also a scarlet branding that induces emotional and psychological symptoms that far outweigh the side effects listed on the side of their medication bottles.
The organizations charged with delivering the message of HIV awareness and prevention have grappled with advancing their messaging with the advancements of modern medicine. Managing HIV is a drastically different animal than it was merely a decade ago, but many still view the virus with the same gravity that they did in the 1990s. The few organizations who have tried to modernize the approach to HIV education have been lambasted for "making light" of the disease, trying to "make HIV cool," or downplaying the severity of living with the virus.
This struggle over messaging has never been more contentious then in the present as institutional juggernauts like the AIDS Healthcare Foundation (AHF) battles with more progressive activists and organizations over the promotion of PrEP, or pre-exposure prophylaxis. This new drug, nicknamed the birth control pill for HIV, now personifies the crux in HIV treatment debate.
PrEP is an Antiretroviral Therapy drug that, if taken correctly by an HIV negative individual, has a 99 percent efficacy rate in preventing the transmission of HIV from someone who is HIV positive. This drug has been on the market since 2012, but several prominent organizations such as AHF, the largest HIV treatment provider in the U.S., have taken an active stance against the HIV prevention pill.
Michael Weinstein, the Executive Director of AHF, has publicly referred to PrEP as a party drug and suggested that the "people who would be taking the drug" could not be trusted to be compliant with their dosage. This stigmatizing rhetoric, combined with the pharmaceutical company, Gilead's, unwillingness to advertise the drug to at-risk populations, has led to a virtual standstill in people seeking a prescription for the prevention pill.
People like J Nick Shirley, a 24-year-old gay man from Dallas, represent the most at risk demographics for HIV transmission, and yet has never heard of PrEP. When asked about the new form of prevention, he was shocked that this was the first time he was hearing about it.
"I just can't believe that we have such a ground-breaking tool at our disposal and so many people don't know about [PrEP]," Shirley said. "I am pretty sure none of my friends know about it. We have never talked about it before."
Long term HIV survivor, activist and former reality T.V star, Jack Mackenroth, is mortified that organizations like AHF have taken on such a damaging approach to PrEP.
"If this were the '90s, people would be lining up down the streets to take PrEP," says Mackenroth. "It is so sad that the fear that we went through has given way to the judgment and stigma from gay men onto other gay men. HIV isn't going anywhere if we don't wake up and realize that condom-only messages don't work."
Which leads us to the use of the problem; organizations using worn out methods of education and prevention, further stigmatizing others looking for prevention methods beyond condoms and leaving the vast majority of millennial, at-risk individuals to believe that HIV is a virus that "other" people get.
Movies like The Normal Heart serve as history lessons, leading young gay men to cry, "Never forget," while failing to realize the dangers they face. LGBT youth are left grappling for connection, because most of the visible reminders of the risk of HIV are only ashes, while the living, more relevant examples prefer to remain in silence for fear of public ridicule and castigation. Sadly, the community that was once unified under the call to fight the virus is now complacent in a pseudo-class system of HIV status that only serves to perpetuate transmission.
But change is on the horizon. Grassroots campaigns such as HIV Equal, The Stigma Project, The Needle Prick and several others have worked to change the climate of HIV stigma for those living with the virus and educate the public on the real vs. perceived danger of HIV transmission. A new wave of young, HIV positive faces, such as Josh Robbins, Cory Lee Frederick and Jake Forth are making their presence known in the public eye, humanizing the virus for the millennial generation while serving as living examples that HIV is still an issue for their age group. And this year, as the Obama Administration unveiled the HIV Care Continuum at the third annual HIV/AIDS Strategy, President Obama's HIV prevention policy recognized Antiretroviral treatment as a valid form of prevention, giving authority to the fact that HIV positive men who achieve undetectable viral load levels are actively preventing the spread of HIV.
While the level of danger has waned over the past three decades, the threat of HIV still remains. Unlike the generations first affected by the virus, the millennial age is now armed a wealth of information and a variety of prevention tools to change the course of HIV for good. And this young generation should take note that these tools came at a very heavy cost.
If you have had sex even once since your last HIV test without a condom, it is worth it educate yourself on PrEP and determine if it is right for you. It only takes one time to transmit the virus, and it only takes one pill a day to stop it. The millennial generation no longer has to face a multitude of limitations when concerning HIV, so there is no excuse to get tested, know your status and pick up the slack in the fight against HIV. After all, most of the heavy lifting has already been done.

Cholera Outbreak Gripping Mexico, 171 Confirmed Cases

October 21, 2013

Image Credit: Thinkstock.com

 

Lawrence LeBlond for redOrbit.com – Your Universe Online
Last month, Mexico was affected by a hurricane and tropical storm that dumped heavy rain on the region, causing floods, landslides and displacement of large numbers of people. Health experts noted that the disaster may have contributed to the growing number of cholera cases that are now also affecting the region, which first became evident around the second week of September.
Mexico’s Ministry of Health has reported a total of 171 cases of infection with cholera to the World Health Organization (WHO) between Sept 9 and Oct 18, 2013.
Of the confirmed cases of cholera, the largest outbreak has occurred in the state of Hidalgo, accounting for 157 cases. An additional nine cases have occurred in the state of Mexico. Two cases have been reported from the Federal District, as well as two from the state of Veracruz. A single case has also been reported in the state of San Luis Potosi.
Cholera infection has occurred in 86 women and 85 men, with ages ranging from three months to 88 years old. A total of 39 cases have resulted in hospitalization and there has been one death linked to the infection.
Health authorities in Mexico continue to investigate the outbreak, stepping up surveillance methods at a national level and working to ensure that quality care is available at medical units throughout the region. Experts are training health professionals on how best to handle the outbreak, with information on prevention, treatment and control of the disease.
Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. The infection is known to cause watery diarrhea and volatile vomiting. Transmission of the bacteria occurs primarily by drinking water or eating food that has been contaminated by the feces of infected persons. In severe cases hospitalization is required. Severe cholera can lead to dehydration and electrolyte imbalance and, in rare cases, death can occur if not treated.
Primary treatment of cholera consists of oral rehydration therapy with a typical rehydration solution to help replace vital nutrients lost during illness. If oral rehydration is not tolerated or does not provide relief quickly enough, intravenous methods are used. In some cases, antibacterial medicines are used to shorten the duration and severity of the illness.
Cholera affects upwards of five million people each year around the world and has caused between 100,000 and 130,000 deaths annually since 2010.
In Mexico, the Ministry of Health said that treatment of cholera is continuing and currently eight in 10 cases are treated successfully. The Ministry said another 3,075 “probable cases” have also been detected, according to a Reuters report last week.
The source of the outbreak is believed to be the Rio Tecoluco in Hidalgo, which has recently tested positive for cholera. The Rio Tecoluco provides fresh water to local residents, David Korenfeld, head of Mexico’s national water commission, told Reuters.
According to the WHO report, this is the first local transmission of cholera recorded since the 1991-2001 cholera epidemic in Mexico. Genetic analysis of the bacterium obtained from patients in the current outbreak presents a 95 percent similarity with the strain that is currently circulating in three Caribbean countries (Haiti, Dominican Republic and Cuba). The current strain is different from the strain that caused the 1991-2001 epidemic in Mexico.
Based on current information, the WHO does not recommend any travel or trade restrictions with Mexico in respect to this outbreak.

Source: Lawrence LeBlond for redOrbit.com - Your Universe Online 

 

 

1854 Broad Street cholera outbreak

From Wikipedia, the free encyclopedia

Broadwick Street showing the John Snow memorial and public house.

The Broad Street cholera outbreak was a severe outbreak of cholera that occurred near Broad Street (now renamed Broadwick Street) in Soho district of London, England in 1854. This outbreak is best known for the physician John Snow's study of the outbreak and his discovery that cholera is spread by contaminated water. This discovery came to influence public health and the construction of improved sanitation facilities beginning in the 19th century.

Contents

• 1 Background
• 2 Outbreak
• 3 John Snow investigation
• 4 Henry Whitehead involvement
• 5 See also
• 6 References
• 7 External links

Background

In the mid-19th century, the Soho district of London had a serious problem with filth due to the large influx of people and a lack of proper sanitary services: the London sewer system had not reached Soho. Many cellars (basements) had cesspools of night soil underneath their floorboards. Since the cesspools were overrunning, the London government decided to dump the waste into the River Thames. This action contaminated the water supply, leading to the cholera outbreak.

Outbreak

On 31 August 1854, after several other outbreaks had occurred elsewhere in the city, a major outbreak of cholera struck Soho. John Snow, the physician who eventually linked the outbreak to contaminated water, later called it "the most terrible outbreak of cholera which ever occurred in this kingdom."^[1]
Over the next three days, 127 people on or near Broad Street died. In the next week, three quarters of the residents had fled the area. By 10 September, 500 people had died and the mortality rate was 12.8 percent in some parts of the city. By the end of the outbreak, 616 people had died.

John Snow investigation

Original map by John Snow showing the clusters of cholera cases in the London epidemic of 1854. The pump is located at the intersection of Broad Street and Cambridge Street.

Snow was a skeptic of the then-dominant miasma theory that stated that diseases such as cholera or the Black Death were caused by pollution or a noxious form of "bad air". The germ theory was not created at this point (as Louis Pasteur would not create it until 1861), so Snow was unaware of the mechanism by which the disease was transmitted, but evidence led him to believe that it was not due to breathing foul air. He first publicized his theory in an essay On the Mode of Communication of Cholera in 1849. In 1855 a second edition was published, with a much more elaborate investigation of the effect of the water-supply in the Soho, London epidemic of 1854.
By talking to local residents (with the help of Reverend Henry Whitehead), he identified the source of the outbreak as the public water pump on Broad Street (now Broadwick Street).^[2] Although Snow's chemical and microscope examination of a sample of the Broad Street pump water was not able to conclusively prove its danger, his studies of the pattern of the disease were convincing enough to persuade the local council to disable the well pump by removing its handle. Although this action has been popularly reported as ending the outbreak, the epidemic may have already been in rapid decline, as explained by Snow himself:

There is no doubt that the mortality was much diminished, as I said before, by the flight of the population, which commenced soon after the outbreak; but the attacks had so far diminished before the use of the water was stopped, that it is impossible to decide whether the well still contained the cholera poison in an active state, or whether, from some cause, the water had become free from it.

Snow later used a spot map to illustrate how cases of cholera were centred around the pump. He also made a solid use of statistics to illustrate the connection between the quality of the source of water and cholera cases. Snow's efforts to connect the incidence of cholera with potential geographic sources centered on creating what is now known as a Voronoi diagram. He mapped out the locations of individual water pumps and generated cells which represented all the points on his map which were closest to each pump. The section of Snow's map representing areas in the city where the closest available source of water was the Broad Street pump circumscribed most cases of cholera.^[3]
There was one significant anomaly - none of the monks in the adjacent monastery contracted cholera. Investigation showed that this was not an anomaly, but further evidence, for they drank only beer, which they brewed themselves.
Snow also showed that the Southwark and Vauxhall Waterworks Company was taking water from sewage-polluted sections of the Thames and delivering the water to homes with an increased incidence of cholera. Snow's study was a major event in the history of public health and health geography, and can be regarded as the founding event of the science of epidemiology.
In Snow's own words:

On proceeding to the spot, I found that nearly all the deaths had taken place within a short distance of the [Broad Street] pump. There were only ten deaths in houses situated decidedly nearer to another street-pump. In five of these cases the families of the deceased persons informed me that they always sent to the pump in Broad Street, as they preferred the water to that of the pumps which were nearer. In three other cases, the deceased were children who went to school near the pump in Broad Street...
With regard to the deaths occurring in the locality belonging to the pump, there were 61 instances in which I was informed that the deceased persons used to drink the pump water from Broad Street, either constantly or occasionally...
The result of the inquiry, then, is, that there has been no particular outbreak or prevalence of cholera in this part of London except among the persons who were in the habit of drinking the water of the above-mentioned pump well.
I had an interview with the Board of Guardians of St James's parish, on the evening of the 7th inst [September 7], and represented the above circumstances to them. In consequence of what I said, the handle of the pump was removed on the following day.

—John Snow, letter to the editor of the Medical Times and Gazette

It was discovered later that this public well had been dug only three feet from an old cesspit that had begun to leak fecal bacteria. A baby who had contracted cholera from another source had its nappies (diapers) washed into this cesspit, the opening of which was under a nearby house that had been rebuilt farther away after a fire had destroyed the previous structure, and the street was widened by the city. It was common at the time to have a cesspit under most homes. Most families tried to have their raw sewage collected and dumped in the Thames to prevent their cesspit from filling faster than the sewage could decompose into the soil.
After the cholera epidemic had subsided, government officials replaced the Broad Street Pump Handle. They had responded only to the urgent threat posed to the population, and afterward they rejected Snow's theory. To accept his proposal would have meant indirectly accepting the oral-fecal method transmission of disease, which was too unpleasant for most of the public to contemplate.^[4]

Henry Whitehead involvement

Rev. Henry Whitehead

The Reverend Henry Whitehead was an assistant curate at St. Luke's church in Soho, London, during the 1854 cholera outbreak.
A former believer in the miasma theory of disease, Whitehead played to disprove false theories, eventually focusing on John Snow's idea that cholera spreads through water contaminated by human waste. Snow's work, particularly his maps of the Soho area cholera victims, convinced Whitehead that the Broad Street pump was the source of the local infections. Whitehead then joined with Snow in tracking the contamination to a faulty cesspool and the outbreak's index case.^[5]
Whitehead's work with Snow combined demographic study with scientific observation, setting important precedent for the burgeoning science of epidemiology. ^[6]

See also

• Filippo Pacini
• Great Stink
• Joseph Bazalgette
• William Budd
• Epidemiology of tuberculosis
• The Ghost Map

Cholera outbreaks and pandemics

From Wikipedia, the free encyclopedia

Hand bill from the New York City Board of Health, 1832. The outdated public health advice demonstrates the lack of understanding of the diseases and its actual causative factors.

Although much is known about the mechanisms behind the spread of cholera, this has not led to a full understanding of what makes cholera outbreaks happen some places and not others. Lack of treatment of human feces and lack of treatment of drinking water greatly facilitate its spread. Bodies of water have been found to serve as a reservoir, and seafood shipped long distances can spread the disease. Cholera did not occur in the Americas for most of the 20th century after the early 1900s in New York City. It reappeared in the Caribbean toward the end of that century and seems likely to persist.^[1]
Deaths in India between 1817 and 1860, in the first three pandemics of the nineteenth century, are estimated to have exceeded 15 million people. Another 23 million died between 1865 and 1917, during the next three pandemics. Cholera deaths in the Russian Empire during a similar time period exceeded 2 million.^[2]

Contents

• 1 Pandemics
  • 1.1 First
  • 1.2 Second
  • 1.3 Third
  • 1.4 Fourth
  • 1.5 Fifth
  • 1.6 Sixth
  • 1.7 Seventh
• 2 Notable outbreaks (1991–2009)
• 3 Notable outbreaks (2010–present)
• 4 False reports
• 5 See also
• 6 References

Pandemics

First

• 1816–1826: 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.^[3] 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.

Second

• 1829–1851: A second cholera pandemic reached Russia (see Cholera Riots), Hungary (about 100,000 deaths) and Germany in 1831; it killed 150,000 people in Egypt that year.^[4] In 1832 it reached London and the United Kingdom (where more than 55,000 people died)^[5] and Paris. In London, the disease claimed 6,536 victims and came to be known as "King Cholera"; in Paris, 20,000 died (of a population of 650,000), and total deaths in France amounted to 7,000.^[6] The epidemic reached Quebec, Ontario and New York in the same year, and the Pacific coast of North America by 1834. In the center of the country, it spread through the cities linked by the rivers and steamboat traffic.^[7]

In 1846, cholera struck Mecca, killing over 15,000 people.^[8] A two-year outbreak began in England and Wales in 1848, and claimed 52,000 lives.^[9]
In 1849, a second major outbreak occurred in Paris. In London, it was the worst outbreak in the city's history, claiming 14,137 lives, over twice as many as the 1832 outbreak. Cholera hit Ireland in 1849 and killed many of the Irish Famine survivors, already weakened by starvation and fever.^[10]Template:Needs better source In 1849, cholera claimed 5,308 lives in the major port city of Liverpool, England, an embarkation point for immigrants to North America, and 1,834 in Hull, England.^[6]
An outbreak in North America took the life of former U.S. President James K. Polk. Cholera, believed spread from Irish immigrant ship(s) from England, spread throughout the Mississippi river system, killing over 4,500 in St. Louis^[6] and over 3,000 in New Orleans.^[6] Thousands died in New York, a major destination for Irish immigrants.^[6] Cholera claimed 200,000 victims in Mexico.^[11]
That year, cholera was transmitted along the California, Mormon and Oregon Trails as 6,000 to 12,000^[12] are believed to have died on their way to the California Gold Rush, Utah and Oregon in the cholera years of 1849–1855.^[6] It is believed more than 150,000 Americans died during the two pandemics between 1832 and 1849.^[13][14]
In 1851, a ship coming from Cuba carried the disease to Gran Canaria. It is considered that more than 6,000 people died in the island during summer, out of a population of 80,000.
During this pandemic, the scientific community varied in its beliefs about the causes of cholera. In France doctors believed cholera was associated with the poverty of certain communities or poor environment. Russians believed the disease was contagious, although doctors did not understand how it spread. The United States believed that cholera was brought by recent immigrants, specifically the Irish, and epidemiologists understand they were carrying disease from British ports. Lastly, some British thought the disease might rise from divine intervention.^[15]

Third

• 1852–1860: The third cholera pandemic mainly affected Russia, with over one million deaths. In 1852, cholera spread east to Indonesia, and later was carried to China and Japan in 1854. The Philippines were infected in 1858 and Korea in 1859. In 1859, an outbreak in Bengal contributed to transmission of the disease by travelers and troops to Iran, Iraq, Arabia and Russia.^[8] Japan suffered at least seven major outbreaks of cholera between 1858 and 1902. The Ansei outbreak of 1858-60, for example, is believed to have killed between 100,000 and 200,000 people in Tokyo alone.^[16]

1854: An outbreak of cholera in Chicago took the lives of 5.5% of the population (about 3,500 people).^[6][17] In 1853–4, London's epidemic claimed 10,738 lives. The Soho outbreak in London ended after the physician John Snow identified a neighborhood Broad Street pump as contaminated and convinced officials to remove its handle.^[18] His study proved contaminated water was the main agent spreading cholera, although he did not identify the contaminant. It would take many years for this message to be believed and acted upon. Throughout Spain, cholera caused more than 236,000 deaths in 1854–55.^[19] In 1854 and 1855, it entered Venezuela; Brazil also suffered in 1855.^[11] During the third pandemic, 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 South in areas of black populations. Current researchers note their populations were underserved in terms of sanitation infrastructure, and health care, and they lived near the waterways by which travelers and ships carried the disease.^[20]

Fourth

The following text needs to be harmonized with text in Fourth cholera pandemic (1863–75).

• 1863–1875: The fourth cholera pandemic spread mostly in Europe and Africa. At least 30,000 of the 90,000 Mecca pilgrims died from the disease. Cholera ravaged northern Africa in 1865. Traveling southeastward, cholera reached Zanzibar, where 70,000 people are reported to have died in 1869–70.^[21] Cholera claimed 90,000 lives in Russia in 1866.^[22] The epidemic of cholera that spread with the Austro-Prussian War (1866) is estimated to have taken 165,000 lives in the Austrian Empire.^[23] Hungary and Belgium each lost 30,000 people, and in the Netherlands, 20,000 perished. In 1867, Italy lost 113,000 lives.^[24] That same year, cholera traveled to Algeria and killed 80,000.^[21]

1892 cholera outbreak in Hamburg, hospital ward

1892 cholera outbreak in Hamburg, disinfection team

Outbreaks in North America in 1866–1873 killed some 50,000 Americans.^[13]

In London,^[when?] a localized epidemic in the East End claimed 5,596 lives, just as the city was completing construction of its major sewage and water treatment systems (see London sewerage system); the East End section was not quite complete. William Farr, using the work of John Snow, et al., as to contaminated drinking water being the likely source of the disease, relatively quickly identified the East London Water Company as the source of the contaminated water. Quick action prevented further deaths.^[6] Also, a minor outbreak occurred at Ystalyfera in South Wales, caused by the local water works using contaminated canal water. Workers associated with the company and their families were most affected, and 119 died. In the same year, more than 21,000 people died in Amsterdam, The Netherlands. In the 1870s, cholera spread in the U.S. as an epidemic from New Orleans along the Mississippi River and to ports on its tributaries; thousands of people died.

Fifth

• 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. Cholera claimed 267,890 lives in Russia (1892);^[25] 120,000 in Spain;^[26] 90,000 in Japan and over 60,000 in Persia.^[25] In Egypt, cholera claimed more than 58,000 lives. 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.

Sixth

• 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 in the Russian Empire of cholera during the first quarter of the 20th century, which was also a time of social disruption because of revolution and warfare.^[27]

The 1902–1904 cholera epidemic claimed 200,000 lives in the Philippines.^[28] Twenty-seven epidemics were recorded among pilgrims to Mecca from the 19th century to 1930, and more than 20,000 pilgrims died of cholera during the 1907–08 hajj.^[27] 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.^[29][30][31]

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 saw the problem coming from the Philippines.^[32]

Seventh

• 1961–1975: The seventh cholera pandemic began in Indonesia, called El Tor^[33] after the strain, and reached East Pakistan (now Bangladesh) 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 were also many reports of a cholera outbreak near Baku in 1972, but information about it was suppressed in the USSR.^{[citation needed]} In 1970, a cholera outbreak struck Sağmalcılar district of Istanbul, then an impoverished slum, claiming more than 50 lives; eventually the incident led to the renaming of the district as present-day Bayrampaşa by the authorities who were harshly criticized.

Notable outbreaks (1991–2009)

• January 1991 – September 1994: Outbreak in South America, apparently initiated when a ship discharged ballast water. Beginning in Peru,^[34] there were 1.04 million identified cases and almost 10,000 deaths. The causative agent was an O1, El Tor strain, with small differences from the seventh pandemic strain. In 1992 a new strain appeared in Asia, a non-O1, nonagglutinable vibrio (NAG), which was named O139 Bengal. It was first identified in Tamil Nadu, India and for a while displaced El Tor in southern Asia. It decreased in prevalence from 1995 to around 10% of all cases. It is considered to be an intermediate between El Tor and the classic strain, and occurs in a new serogroup. Scientists warn of evidence of wide-spectrum resistance by cholera bacteria to drugs such as trimethoprim, sulfamethoxazole and streptomycin.

• A persistent strain of Gulf Coast cholera, 01, has been found in the brackish waters of marshes in Louisiana and Texas in the United States, leading to a situation of possible transmission by shipments of seafood from those areas to other parts of the country. Medical personnel were advised to think of cholera when assessing symptoms for people who had not been traveling. There have been occurrences in the South but no major outbreaks because of good sanitation and warning systems. It was noted there were more cases in two years from the Latin American epidemic, the El Tor strain, than in 20 years from the Gulf Coast strain.^[35]

• In 2000, some 140,000 cholera cases were officially reported to WHO. Countries in Africa accounted for 87% of these cases.^[36]

• July–December 2007: A lack of clean drinking water in Iraq led to an outbreak of cholera.^[37][38] As of 2 December 2007, the UN had reported 22 deaths and 4,569 laboratory-confirmed cases.^[39]

• August 2007: The cholera epidemic started in Orissa, India. The outbreak affected Rayagada, Koraput and Kalahandi districts, where more than 2,000 people were admitted to hospitals.^[40]

• March–April 2008: 2,490 people from 20 provinces throughout Vietnam were hospitalized with acute diarrhea. Of those hospitalized, 377 patients tested positive for cholera.^[41]

• August–October 2008: As of 29 October 2008, a total of 644 laboratory-confirmed cholera cases, including eight deaths, had been verified in Iraq.^[42]

• November 2008: Médecins Sans Frontières reported an outbreak of cholera in a refugee camp in the Democratic Republic of the Congo's eastern provincial capital of Goma.^[43] Some 45 cases were reportedly treated between November 7 and 9.

By 12 February 2009, the number of cases of infection by cholera in sub-Saharan Africa had reached 128,548 and the number of fatalities, 4,053.

• January 2009: The Mpumalanga province of South Africa confirmed over 381 new cases of Cholera, bringing the total number of cases treated since November 2008 to 2276. Nineteen people died in the province since the outbreak.^[44]

• August 2008 – April 2009: In the 2008 Zimbabwean cholera outbreak, which continued into 2009, an estimated 96,591 people in the country were infected with cholera and, by 16 April 2009, 4,201 deaths had been reported.^[45][46] According to the World Health Organization, during the week of 22–28 March 2009, the "Crude Case Fatality Ratio (CFR)" had dropped from 4.2% to 3.7%.^[45] The daily updates for the period 29 March 2009 to 7 April 2009, list 1748 cases and 64 fatalities, giving a weekly CFR of 3.66% (see table above).^[47] Those for the period 8 April to 16 April list 1375 new cases and 62 deaths (and a resulting CFR of 4.5%).^[47] The CFR had remained above 4.7% for most of January and early February 2009.^[48]

Notable outbreaks (2010–present)

• August 2010: Cholera in Nigeria was reaching epidemic proportions after widespread confirmation of the disease outbreaks in 12 of its 36 states. 6400 cases have been reported with 352 reported deaths. The health ministry blamed the outbreak on heavy seasonal rainfall and poor sanitation.^[49]

• October 2010 - January 2012, Haiti and Dominican Republic: Late in October 2010, a cholera outbreak was reported in Haiti.^[50] As of November 16, the Haitian Health Ministry reported the number of dead to be 1,034, with hospitalizations for cholera symptoms totaling over 16,700.^[51] The outbreak was blamed on a camp of Nepalese United Nations peacekeepers, but this was disputed. Scientists have found that Vibrio cholera bacteria can survive between outbreaks in brackish warm water, and it exists in Haitian waterways. The outbreak started on the upper Artibonite River.;^[52] people first contracted the disease from this river.^[53] In addition, scientists think the hurricane and weather conditions in Haiti worsened the consequences of the outbreak, and damaged sanitation systems allowed it to spread.^[52] In the USA, a Florida woman who had recently moved from Haiti had cholera but was effectively treated. Officials noted that US water systems removed the risk of transmission by water supply.^[54] By November 2010, the disease had spread into the neighboring Dominican Republic. As of January 2012, the epidemic has sickened nearly 500,000 people and killed nearly 7,000 in Haiti.^[55]

• In January 2011, about 411 Venezuelan citizens attended a wedding in the Dominican Republic, where they ate ceviche (raw fish cooked in lemon juice) at the celebration. By the time they returned to Caracas and other Venezuelan cities, some of these travelers were suffering from symptoms of cholera. By January 28, almost 111 cases had been confirmed by the Venezuelan Health Authorities, who quickly set up an 800 number for people to call who wondered whether they were infected. Internationally, Colombia secured its eastern border against immigrants and probable transmission of the disease. Dominican officials started a nationwide study to determine the cause of the outbreak, and warned residents of the imminent danger associated with the consumption of raw fish and shellfish. As of January 29, 2011, none of the cases in Venezuela proved fatal, but two patients were hospitalized. Since the victims had quickly sought help, the outbreak was detected and contained.^[56]

• 2011: Nigeria and Democratic Republic of Congo have had outbreaks; the latter has suffered years of disruption from warfare. Somalia has suffered a double hit of cholera and famine, associated with the refugee camps, limited sanitation, and severe drought causing famine and lowered resistance.^[57]

• Cholera has returned to southern India in 2012, once thought to be eradicated, in relatively affluent Kerala, ironically, due to efforts to improve sanitation, toilets were constructed. While these toilets were under construction, workers defecated and contaminated community wells, causing the outbreak.^[58]

• Cholera outbreak in 2011 and 2012 in multiple African nations, in all regions except North Africa, among them Ghana has led to intense campaign for handwashing.^[59] In Sierra Leone, some 21,500 cases with 290 deaths have been reported in 2012.^[60]

• Since 2010, fatal cholera outbreaks, not just travelers, have been reported in Haiti, Dominican Republic, Cuba, Venezuela, Iraq, Nepal, Pakistan, Iran, Bangladesh, Myanmar, Laos, Cambodia, Vietnam, Afghanistan, India, China, Nigeria, Sierra Leone, Kenya, Uganda, Zimbabwe, Zambia, Angola, Somalia, Ethiopia, Ivory Coast, DRC, Congo, Mozambique, Ghana, Guinea, Mali, Ukraine, and Niger.

• On August 21, 2013 the United States State Department issued a security message warning U.S. citizens in or traveling to Cuba about an outbreak of cholera in Havana, that may be linked to a reported outbreak of cholera in eastern Cuba.^[61]

False reports

Main article: Chicago 1885 cholera epidemic myth

A persistent urban myth states 90,000 people died in Chicago of cholera and typhoid fever in 1885, but this story has no factual basis.^[62] In 1885, a torrential rainstorm flushed the Chicago River and its attendant pollutants into Lake Michigan far enough that the city's water supply was contaminated. But, as cholera was not present in the city, there were no cholera-related deaths. As a result of the pollution, the city made changes to improve its treatment of sewage and avoid similar events.

See also

• List of epidemics

2010–13 Haiti cholera outbreak

From Wikipedia, the free encyclopedia

2010–13 Haiti cholera outbreak

Date	October 2010
Location	Artibonite Valley, Haiti
Casualties
8,547+ dead (all countries)  Haiti 8,132 dead (19 Jun 2013)[1]  Dominican Republic 412 dead (Dec 2012), 19 confirmed in 2012 and 66 suspected.[2][3]  Cuba 3 dead (Jun 2012)[4]
366,125 hospitalised (Haiti)[1] 20,852 hospitalised (DR) of which 4,486 in 2012.[2]
cases: 660,820 (Haiti) cases recorded in:  Florida Venezuela Haiti Cuba Dominican Republic

The ongoing Haiti cholera outbreak is the worst epidemic of cholera in recent history, according to the U.S. Centers for Disease Control and Prevention.^[5] After the 2010 earthquake, in little over two years, as of August 2013, it has killed at least 8,231 Haitians and hospitalized hundreds of thousands more while spreading to neighboring countries including the Dominican Republic and Cuba.^[6] Since the outbreak began in October 2010, more than 6% of Haitians have had the disease.^[7]
The outbreak began in mid October 2010 in the rural Center Department of Haiti,^[8] about 100 kilometres (62 mi) north of the capital, Port-au-Prince, killing 4672 people by March 2011^[9] and hospitalising thousands more.^[10] The outbreak occurred ten months after a powerful earthquake which devastated the nation's capital and southern towns on 12 January 2010. By the first 10 weeks of the epidemic, cholera spread to all of Haiti's 10 departments or provinces.^[11]
As of 12 December 2012, hospitalizations (2,300 per week) and deaths (40 per week) are roughly triple since Hurricane Sandy struck the island in what was expected to be a quiet cholera season, causing more deaths than the cyclone took in all countries combined.^[1] In November 2010, the first cases of cholera were reported in the Dominican Republic and a single case in Florida, United States; in January 2011, a few cases were reported in Venezuela. The epidemic came back strongly in the 2012 rainy season, despite a localised delayed vaccine drive. In late June 2012, Cuba confirmed three deaths and 53 cases of cholera in Manzanillo,^[4] in 2013 with 51 cases in Havana.^[12] Vaccination of half the population is urged by the University of Florida to stem the epidemic.^[13][14]

Contents

• 1 Background
• 2 Sources
  • 2.1 Domestic reactions
• 3 Initial spread
• 4 Casualties over the years
• 5 Political reactions
• 6 Further reading
• 7 References
• 8 External links

Background

Poor neighborhood in Port-au-Prince

During the 19th and 20th centuries, six major cholera pandemics had spread around the world. At the time of this outbreak, the world was experiencing the seventh, caused by a new strain of the Vibrio cholerae bacterium, El Tor. Epidemics involving this strain started in 1961 in Indonesia, and spread rapidly elsewhere in eastern Asia and then to India and Bangladesh, the USSR, Iran and Iraq.^[15] This was the first outbreak in Haiti ever recorded of El Tor.^[16] Professors at Duke University have argued that none of the previous pandemics affected Haiti either.^[17]
On 21 October 2010, the Haiti National Public Health Laboratory confirmed that cases of diarrheal illness that hospitals in the Artibonite region had been receiving had been identified as cholera.^[18] Haiti has not had a cholera outbreak in recorded history, so it triggered panic and confusion in the populace, complicating relief efforts.^[19]
The spread was partially blamed on the poor distribution of health supplies due to logistical problems.^[11] The Pan-American Health Organization said there was also a lack of access to untainted drinking water.^[11] According to the US CDC, in most instances cholera does not spread widely within countries where drinking water and sewage treatment are adequate. When water and sewage treatment is inadequate, as in Haiti after the 2010 earthquake, cholera can spread rapidly.^[20]
On 28 October, the head of Haiti's health department, Gabriel Thimoté, said 4,147 people were being treated. WHO's cholera chief, Claire-Lise Chaignat, said the epidemic was not contained and that she thought it had not yet "reached the peak", so Haitian authorities should be prepared for a "worst case scenario" of cholera spreading in the capital, Port-au-Prince.^[21]
On 10 November, Gabriel Thimote, Haiti's senior health official, said that the outbreak was "no longer a simple emergency, it's now a matter of national security."^[22]
The outbreak of cholera became an issue for candidates to answer in the 2010 general election.^[23] There were fears that the election could be postponed. The head of MINUSTAH Edmond Mulet said that it should not be delayed as that could lead to a political vacuum with untold potential problems.^[24]

Sources

Artibonite River

The suspected source for the epidemic was the Artibonite River, from which most of the affected people had drunk water.^[10] Suspicion among Haitians centered on a UN military base on a tributary of that river home to peacekeepers from Nepal. On October 26, MINUSTAH officials issued a press statement denying the possibility that the base could have caused the epidemic, citing stringent sanitation standards.^[25] The next day, October 27, reporter Jonathan M. Katz of the Associated Press visited the base and found gross inconsistencies between the statement and the base's actual conditions. Katz also happened upon UN military police taking samples of ground water to test for cholera, despite UN assertions that it was not concerned about a possible link between its soldiers and the disease. Neighbors told the reporter that waste from the base often spilled into the river.^[26] Later that day, a crew from Al Jazeera English including reporter Sebastian Walker filmed the soldiers trying to excavate a leaking pipe; the video was posted online the next day and, citing AP's report, drew increased awareness to the base.^[27] MINUSTAH spokesmen later contended that the samples taken from the base proved negative for cholera. However, an AP investigation showed that the tests were improperly done at a laboratory in the Dominican Republic with no experience testing for cholera.^[28]
The U.S. Centers for Disease Control and Prevention said its tests of "DNA fingerprinting" showed various samples of cholera from Haitian patients were identified as Vibrio cholerae serogroup O1, serotype Ogawa, a strain found in South Asia.^[29][30]
For three months, UN officials, the CDC, and others argued against investigating the source of the outbreak. Gregory Hartl, a spokesman for the World Health Organization (WHO), said finding the cause of the outbreak was "not important". "Right now, there is no active investigation. I cannot say one way or another [if there will be]. It is not something we are thinking about at the moment. What we are thinking about is the public health response in Haiti."^[31] Jordan Tappero, the lead epidemiologist at the CDC, said the main task was to control the outbreak, not to look for the source of the bacteria and that "we may never know the actual origin of this cholera strain."^[32] A CDC spokesperson, Kathryn Harben, added that "at some point in the future, when many different analyses of the strain are complete, it may be possible to identify the origin of the strain causing the outbreak in Haiti."
Paul Farmer, co-founder of the medical organisation Partners In Health and a UN official himself who served Bill Clinton's deputy at the Office of the Special Envoy for Haiti, told the AP's Katz on November 3 that there was no reason to wait. "The idea that we'd never know is not very likely. There's got to be a way to know the truth without pointing fingers." A cholera expert, John Mekalanos, supported the assertion that it was important to know where and how the disease emerged because the strain is a "novel, virulent strain previously unknown in the Western Hemisphere and health officials need to know how it spreads." The Swedish ambassador to Haiti said the epidemic had strains originating in Nepal.^[33] However, Nepal's representative to the United Nations "categorically refuted" the hypothesis that Nepali peacekeepers were the source of the outbreak.^[34]
Under intense pressure, the UN relented, and said it would appoint a panel to investigate the source of the cholera strain.^[35] That panel's report, issued in May 2011, confirmed substantial evidence that the Nepalese troops had brought the disease to Haiti. However, in the report's concluding remarks, the authors hedged to say that a "confluence of circumstances" was to blame.^[36] Even so, the report presented no alternate hypotheses about how the strain could have arrived in a remote river far outside the earthquake zone, where few foreigners visit or work.
Some US professors have disagreed with the contention that Nepalese soldiers caused the outbreak. Some said it was more likely dormant cholera bacteria had been aroused by various environmental incidents in Haiti.^[37] Before studying the case, they said a sequence of events, including changes in climate triggered by the La Niña climate pattern and unsanitary living conditions for those affected by the earthquake, triggered bacteria already present to multiply and infect humans.^[37] However, a study unveiled in December and conducted by French epidemiologist Renaud Piarroux contended that UN troops from Nepal had started the epidemic as waste from outhouses at their base flowed into and contaminated the Artibonite River.^[38] A separate study published in December in the New England Journal of Medicine presented DNA sequence data for the Haitian cholera isolate, finding that it was most closely related to a cholera strain found in Bangladesh in 2002 and 2008. It was more distantly related to existing South American strains of cholera, the authors reported, adding that "the Haitian epidemic is probably the result of the introduction, through human activity, of a V. cholerae strain from a distant geographic source."^[39] Rita Colwell, former director of the National Science Foundation and climate change expert, still contends that climate changes were an important factor in cholera's spread, stating in an interview with UNEARTH News in August 2013 that the outbreak was "triggered by a complicated set of factors. The precipitation and temperatures were above average during 2010 and that, in conjunction with a destroyed water and sanitation infrastructure, can be considered to have contributed to this major disease outbreak."^[40]

Domestic reactions

There were fears that following the discovery of 15 cases in the capital, the epidemic could spread further.^[41] On 15 November, a riot broke out in Cap-Haïtien following the death of a young Haitian inside the Cap-Haïtien UN base and rumours that the outbreak was caused by UN soldiers from Nepal.^[42] Protesters demanded that the Nepalese brigade of the UN leave the country.^[43] At least 5 people were killed in the riots, including 1 UN personnel.^[44] Riots then continued for a second day.^[45]
Following the riots the UN said the outbreak was being staged for "political reasons because of forthcoming elections", as the Haitian government sent its own forces to "protest" the UN peacekeepers.^[46] During a third day of riots UN personnel were blamed for shooting at least 5 protestors but denied responsibility.^[47] On the fourth day of demonstrations against the UN presence, police fired tear gas into an IDP camp in the capital.^[48] Riots following the election were a cause for concern in the ability to contain the epidemic.^[49]

Initial spread

Having lost their homes in the 2010 earthquake, many Haitians still live in precarious camps without water and sewage systems

By the end of October cholera had been confirmed in four of Haiti's ten departments: Artibonite, Centre, Nord and Ouest, including the capital Port-au-Prince,^[10][50] and the capital's Cité Soleil district,^[51] By 16 November it had spread throughout the country.^[44] In addition to those hospitalized, others were unable to receive treatment due to overcrowded hospitals.^[52] Health workers also feared the disease would spread after Hurricane Tomas hit the island causing more flooding.^[53]
There were also fears that the disease would further spread because many people were still living in unsanitary camps as a result of the earthquake earlier in the year.^[54][55] Those concerns came despite claims that the outbreak had been contained in the north and central parts of the country.^[56] The Pan American Health Organisation predicted that 270,000 people would be infected within a year of the outbreak.^[22]
The first outbreak of cholera was reported in the Dominican Republic in mid-November 2010,^[57] following the Pan-America Health Organisation's prediction.^[22] By January 2011, the Dominican Republic had reported 244 cases of cholera.^[58] The first man to die of it there died in the province of Altagracia on 23 January 2011.^[58][59]
On 15 November the director of programming for Catholic Relief Services in Haiti, said, "Some people have been reporting that we've gotten in front of it and are in control of the spread of cholera. Actually WHO does not believe that. There's such a severe underreporting of cases that they're not sure of all of the hot spots."^[11][60]
In late January 2011, more than 20 Venezuelans were reported to have been taken to hospital after contracting cholera after visiting the Dominican Republic.^[61][62] 37 cases were reported in total.^[58] Contaminated food was blamed for the spread of the disease.^[63] Venezuelan health minister Eugenia Sader gave a news conference which was broadcast on VTV during which she described all 37 people as "doing well".^[58] The minister had previously observed that the last time cholera was recorded in Venezuela was twenty years before this, in 1991.^[58]
On 15 March 2011, a report was issued by the University of California that predicted total infections would number up to 779,000 and total deaths up to 11,000 by November 2011, compared with earlier UN estimates that around 400,000 people would end up infected.^[64] The revised numbers were based on more factors than the UN's estimates, which assumed a total infection rate of between two and four percent of the population.^[64] In a statement released at the same time, the WHO said total deaths thus far had reached 4,672, with 252,640 cases reported.^[64]

Casualties over the years

Even before the outbreak Haiti has suffered from infectious diseases due to crowded living conditions and lack of clean water and sewage disposal. There is also a chronic shortage of health care personnel, and hospitals lack resources, a situation that became readily apparent after the January 2010 earthquake.^[65]
Some aid agencies have reported that the toll may be higher than the official figures because the government does not track deaths in rural areas where people never reached a hospital or emergency treatment center.^[60] In 2011, reports suggested over 6,700 people had been killed during the outbreak.^[66]
By March 2011, after the initial intense flare up, some 4,672 people died and as of March 2012, cholera has killed more than 7,050 Haitians and sickened more than 531,000, or 5 percent of the population.^[64][67]
The next years there was significant progress reduction of caseloads and deaths, with solid backing of international medical efforts and preventative measures, including latrines installed and changes in Haitian behaviors, such as thoroughly cooking food and rigorous handwashing. However, roughly 75% of Haitian households lack running water and thousands still live in camps or similar substandard conditions. Despite all these efforts, every rainy season or hurricane has caused a temporary spike in cases and deaths. Per the Haitian Health Ministry, as of August 2012, the outbreak had caused 7,490 deaths and caused 586,625 people to fall ill.^[68]

Political reactions

On 12 November, the United Nations issued an appeal for around US$160 million to fight the spread of the disease, saying that "all our efforts can be outrun by the epidemic" and warned of a lack of space for patients in hospitals.^[69] It also denied that the Nepali contingent were responsible for the outbreak.^[44] In November 2011, the UN received a petition from 5,000 victims for hundreds of millions of dollars in reparations over the outbreak thought to have been caused by UN members of MINUSTAH.^[66]
In 2012, Bureau des Avocats Internationaux head Mario Joseph and Institute for Justice & Democracy in Haiti Director Brian Concannon filed suit against the United Nations, seeking reparations on behalf of victims of the outbreak.^[70] In 2013, the United Nations responded by invoking its immunity from lawsuits under the Convention on the Privileges and Immunities of the United Nations.^[71]

Further reading

• Katz, Jonathan M. The Big Truck That Went By: How the World Came to Save Haiti and Left Behind a Disaster. New York: Palgrave Macmillan, 2013. ISBN 978-0230341876
• Wilentz, Amy Farewell, Fred Voodoo: A Letter from Haiti. New York: Simon & Schuster, 2013. ISBN 978-1451643978