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Countries fail to report cholera outbreaks

20th March 2012

A recent report from the World Health Organisation (WHO) says that many countries are failing to report cholera outbreaks, meaning that worldwide figures for the disease may be far higher than previously thought.

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The actual rate of global cholera infections is estimtated to be 10 times higher than the number of cases that actually get reported to the Geneva-based body.

New estimates of the global disease burden were published in the Bulletin of the World Health Organisation this month by researchers from the International Vaccine Institute in South Korea.

Cholera causes severe dehydration and watery diarrhoea, and is caused by contamination of water or food with the bacterium, Vibrio cholera.

The study showed that the world sees as many as three million cases of cholera annually and that the majority of the 93,000 deaths every year are of children under five years old.

Researchers said that many governments either lacked the capability to acquire accurate data, or that they were unwilling to report the true number of cases and deaths. Reliable reporting of outbreaks is mandatory under international law.

The research team led by Mohammad Ali looked at cholera figures reported to the WHO and combined them with separate data from previous studies in a number of different countries, as well as media and government reports in the public domain.

Each country was evaluated individually, and many countries were found to have been under-reporting their cholera outbreaks. One reason could be that governments are reluctant to make such knowledge public for fear it could affect foreign trade and tourism revenues.

Mohammad Ali said that world health experts would be unable to fight cholera in the absence of accurate information.

G Balakrish Nair, executive director of the country's Translational Health Science and Technology Institute, said that the under-reporting of cholera is a major problem in India, because the disease implied that there was a lack of hygiene, or that sewage was getting mixed up with drinking water supplies.

Some cases go undiagnosed in remote areas because of a lack of resources, he added.

African countries are also plagued more by a lack of funding and resources than by falsification of figures.

Martin Mengel, project coordinator for Africhol, which aims to improve cholera prevention and treatment in Africa, said that many countries simply could not afford to implement prevention and treatment programmes.

The areas at risk of cholera are clustered in China, India, Indonesia and African countries, and around 1.4 billion people are thought to be a risk of contracting the disease.

Previously, researchers had hoped to eradicate the disease within 10 years, with the help of a cheap vaccine and improvements to water and sanitation.

The WHO is currently working to assess the effectiveness of a cholera vaccination programme in the Zanzibar Islands, which could be used, if successful, as a model for other countries, Ali said.



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