NePal EartQuake
The
earthquake that killed more than 5,000 people has set the stage for a
potential cholera crisis in Nepal — the same country that unwittingly
exported the devastating disease to Haiti after its quake five years
ago.
Cholera, a deadly
bacterial infection that causes rapid loss of bodily fluid, is endemic
to Nepal, where there have been at least two outbreaks in recent years.
And last week's quake
created conditions under which cholera and other water-borne diseases
thrive: compromised water supply, lack of sanitation, and survivors
crowded into tent camps, health officials say.
Watch: 
Man pulled alive from rubble in Nepal
"When you have people on
the move, when you have people away from home, or they live in a
shelter, there is a disruption in the water and sanitation system and
that increases the risk of cholera," said Tarik Jasarevic, a spokesman
for the World Health Organization.
That was the situation
after Haiti was ravaged by a quake in 2010. Ten months later, the island
nation faced a misery never seen there before: cholera exploded in Mirebalais and quickly spread to all corners of the country and even beyond the borders.
U.N. peacekeepers from
Nepal who were stationed in Mirebalais are widely believed to be the
source of the long-running epidemic, which has sickened more than
730,000 Haitians and killed nearly 9,000, according to the Pan-American
Health Organization.
"The conditions are certainly right for cholera to take hold"
In Nepal, which has
documented cholera cases stretching back to 1823, cases tend to spike
during the rainy season, which begins in just a few weeks. The cycle is
vicious: the bug causes constant diarrhea, and the infected waste gets
into the water supply.
The elderly and young
children are the most susceptible, and patients who can be rehydrated
quickly usually survive. But those who come down with a severe form of
the illness and cannot get help fast enough — a danger in remote regions
— can die.
"It kills you within 10
hours," said David Sack, a professor at Johns Hopkins' Bloomberg School
of Public Health and director of its cholera-vaccine project. "And it's a
disease that affects the poorest of the poor."
Altaf Qadri / AP
Altaf Qadri / AP
WHO says it has no reports
of cholera in Nepal right now and is focused on traumatic injuries from
the 7.8-magnitude jolt that left swaths of Kathmandu and remote areas
outside the capital in rubble.
Sack said not all cases
are necessarily reported to WHO, so public health workers on the ground
must be vigilant and proactive — not just for cholera, but for outbreaks
of e.coli, typhoid and other illnesses.
WHO has epidemiologists
on the ground in Nepal, Jasarevic said. And groups like the
International Medical Corps are rushing to get water-purification kits
and other sanitary aids to the affected communities.
"It kills you within 10 hours ... and it's a disease that affects the poorest of the poor."
One
aid worker told NBC News that there were about 14,000 people camped out
in Tundikhel parade ground on Tuesday, double the previous day with
more expected Wednesday — with no fresh water supply and only a handful
of toilets at one end of the mile-long stretch.
"The conditions are certainly right for cholera to take hold," the worker said.
A vaccine for cholera was approved by WHO in 2011 but "production is not yet ramped up," Sack said.
The Indian manufacturer
can only make 2 to 3 million doses a year for the entire world, and
Nepal has only a few thousand doses on hand — not nearly enough to stop
an epidemic in its tracks in a country of 28 million people.
If a cluster of cases is
identified in a particular area, however, health authorities could try
to use the global stockpile to vaccinate 100,000 to 200,000 people and
keep the infection confined, Sack added.
He added that cholera can be unpredictable, and the threat is never realized in some disaster areas.
After the 2004 quake and tsunami in Indonesia,
one of the most prone countries, an influx of bottled water helped keep
cholera at bay, according to one federal study. Yet Haiti, which had no
modern history of the disease, couldn't keep it from galloping out of
control.
"What leads to a major outbreak in one country but not another is something we're still trying to figure out," Sack said.
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