The cholera outbreak in Lahore, Pakistan: challenges, efforts and recommendations

Abstract

The Punjab health authorities have declared a cholera outbreak with over 2000 acute diarrheal cases being reported in Lahore in April 2022 and 25 laboratory-confirmed cases as of 27 May 2022. Overpopulation, poor sanitation, and a substandard water drainage system contribute to the spread of cholera. The increasing hydro-toxicity of underground water is another challenge to the disease spread. The lack of public awareness about the disease and their poor hygiene practices serve as a portal for the disease to spread to humans. There is a need to establish an effective surveillance system, increase public awareness, and implement the WHO-recommended plan for cholera control. This includes the provision of drugs and diagnostic kits to healthcare centres, the supply of clean water, and the development of a drainage system for sewage and rainwater.

The Threat of Cholera in Africa

“…Cholera is caused primarily by toxin producing strains of V. cholerae serogroup of O1, biotype El Tor, and O139 Bengal, which are motile, comma shaped, gram negative and single polar f lagellum bacteria. Epidemiologically, cholera transmission is associated with contaminated water, environmental sanitation, and vulnerable communities (affected by natural disasters, famine, or displacement because of war, local conf lict or f loods); the areas typically at risk include urban and peri-urban areas, overcrowded refugee camps and remote rural locations where sanitation and clean water are limited [14]. The mode of transmission for cholera infection is the fecal-oral route, in which infection spreads through a population when feces containing bacteria contaminate water, which is ingested by individuals.…”

Post-flood outbreaks of Cholera in Pakistan; Endemic-to-epidemic

“…Dear Editor, Cholera persists in low economical countries due to their poor hygiene, sanitation, and insufficient safe water [1]. It is an acute severe diarrheal disease caused by Vibrio cholerae serogroup O1 or O139 [2]. The profuse watery diarrhea is most commonly presented clinically with this infection, referred to as "rice water stools".…”

“…In 2005, the World health organization After the flood in 2010, the MOH reported 99 declared V. cholerae O1 cases across the country [6]. Cholera is linked to poor environmental and sanitation conditions, as well as the consumption of contaminated food and water as a result of natural disasters that have displaced thousands of people [2].…”

Cholera spike amidst a deteriorating humanitarian crisis in Afghanistan: a correspondence

“…The most recent update was on August 24, 2022, when 31,441 suspected cholera cases and 18 deaths were reported, while as of September 12, 2022, a total of 150,278 suspicious cases and 55 deaths have been reported [4] . Poor sanitation, a lack of clean water, lack of awareness, overpopulation, inadequate health facilities, poverty, floods, and earthquakes are thought to be major challenges to the rising number of cholera outbreaks [5,6] .Cholera broke out in over 26 countries as of November 2022, as per WHO it is the highest number on record [7] . The complete eradication of cholera has been difficult due to constant new emerging resistant strains, lower immunity, lack of water…”

“…The most recent update was on August 24, 2022, when 31,441 suspected cholera cases and 18 deaths were reported, while as of September 12, 2022, a total of 150,278 suspicious cases and 55 deaths have been reported [4] . Poor sanitation, a lack of clean water, lack of awareness, overpopulation, inadequate health facilities, poverty, floods, and earthquakes are thought to be major challenges to the rising number of cholera outbreaks [5,6] .…”