Based on our assessment, the risk for a
cholera outbreak is very high in some of the Earthquake affected districts. The
conditions (inadequate water supply, sanitation, and hygiene) are favourable
for cholera transmission in the communities. This has been demonstrated by
repeated outbreaks over the years. The risk for a cholera outbreak has increased
many folds following the recent earthquake. Infectious cholera strains are in
circulation and have been reported in numerous publications (both Kathmandu and
outside valley) (3). After the earthquake the ability to contain outbreaks is
strikingly diminished due to severe constraints in the health system. So, there
is increased probability of large if not catastrophic outbreaks similar to the
outbreak in Haiti after the earthquake in 2010. In contrast to Haiti, however,
some Nepali may be immune against cholera (from previous disease). Nonetheless,
considering that protection following cholera is not life-long, there is a
large probability that a large susceptible population has accumulated in high
risk northern districts most affected by the earthquakes. There is increased
concern that the risk for a cholera outbreak could be compounded by monsoon
season approaching in a few months. This will further constrain the public
health delivery mechanism, particularly in rural villages of the affected
districts.
Water supply, sanitation and hygiene are inadequate
and need to be improved in many sites we visited during our assessment. Early
appropriate treatment emphasizing rehydration is key for survival from severe
diarrheal illnesses like cholera. Currently the majority of health centers in
affected district headquarters have adequate stocks of IV fluids and ORS. The
centers, which are out of stock, need to be resupplied. These interventions are
appropriate to minimize the risk of deaths if an outbreak does occur.Based on our assessment, the risk for a
cholera outbreak is very high in some of the Earthquake affected districts. The
conditions (inadequate water supply, sanitation, and hygiene) are favourable
for cholera transmission in the communities. This has been demonstrated by
repeated outbreaks over the years. The risk for a cholera outbreak has increased
many folds following the recent earthquake. Infectious cholera strains are in
circulation and have been reported in numerous publications (both Kathmandu and
outside valley) (3). After the earthquake the ability to contain outbreaks is
strikingly diminished due to severe constraints in the health system. So, there
is increased probability of large if not catastrophic outbreaks similar to the
outbreak in Haiti after the earthquake in 2010. In contrast to Haiti, however,
some Nepali may be immune against cholera (from previous disease). Nonetheless,
considering that protection following cholera is not life-long, there is a
large probability that a large susceptible population has accumulated in high
risk northern districts most affected by the earthquakes. There is increased
concern that the risk for a cholera outbreak could be compounded by monsoon
season approaching in a few months. This will further constrain the public
health delivery mechanism, particularly in rural villages of the affected
districts.
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