Tag Archives: Cholera

Climate Change, Perspectives from Nepal

As a molecular biologist, my mind is frequently focused highly at the microscopic level.   I rarely consider the impact of large-scale environmental or cultural events on the very small molecules or microorganisms which coexist along side us.  Since reading Influence of environmental factors on the presence of Vibrio cholerae in the marine environment: a climate link, I now have an appreciation for the link between infectious diseases and the ecosystem; that is, how the visible affects the invisible or will eventually affect the visible.

 

The interaction between the weather and infectious disease status is an important area of research.  Many examples throughout history show how weather pattern changes and natural disasters lead to catastrophic disease outbreaks.  One recent example is the current outbreak of chloera in Haiti which occurred following the earthquake of 2010 (Kelvin AA JIDC 2011).  The earthquake, which devastated the country’s already weak water sanitization system, created a habitable environment for the colonization of the Cholera bacterium and facilitated the spread of the disease.  Perhaps my favorite article which reviews the interaction between climate change/weather and infectious disease outbreaks is an article by V. Sedas.  In this article, Sedas reviews how environmental factors have significant influence on the outbreak potential and pathogenesis of V. cholerae and other disease causing agents (Seda VT JIDC 2007).  As the fecal-oral transmission route of V. cholera relies heavily on the ecology of the native water supply, seasonal water cycles have been shown to affect the emergence and re-emergence of V. cholerae, thereby affecting the health of local populations (Seda VT JIDC 2007).  This article I highly recommend reading.

In this JIDC Postcard, Yadav Prasad Joshi reflects on how anthropocentric climate change is influencing health, lifestyle and ecosystems globally.  Yadav Prasad Joshi is a PhD student from Nepal and his post provides an invaluable perspective on climate change.

Alyson

Climate Change, Perspectives from Nepal

Have you ever thought about what might be considered the worst event to affect this planet? From wars to terrorism to nuclear emissions, the list is long, but few people would point out the events of climate change. Tsunamis, floods, heat waves, glacial melting and threats to biodiversity are all disasters that affect not only the people in the regions experiencing them, but everyone worldwide.

Weather and climate play a significant role in people’s health. Changes in climate affect average weather conditions. Warmer average temperatures will likely lead to hotter days and more frequent and longer heat waves, which could increase the number of heat related illnesses and deaths. Increases in the frequency or severity of extreme weather events such as storms could accelerate the risk of dangerous flooding, high winds, and other direct threats to people and property. Warmer temperatures could increase the concentrations of unhealthy air and water pollutants. Changes in temperature, precipitation patterns, and extreme events could enhance the spread of some diseases.

Global climate change has become one of the most visible environmental concerns (Bioterrorism) of the 21st century.  Climate change has brought about severe and possibly permanent alterations to our planet’s geological, biological and ecological systems. The Intergovernmental Panel on Climate Change (IPCC) now contends that “there is new and stronger evidence that most of the warming observed over the last 50 years is attributable to human activities”.1 These changes have led to the emergence of large-scale environmental hazards to human health, such as ozone depletion, the greenhouse effect, acid rain, loss of biodiversity, stresses to food-producing systems and the global spread of infectious diseases.1,2 The World Health Organization(WHO) estimates that 160,000 deaths, since 1950, are directly attributable to climate change.3

During the last 100 years, human activities related to the burning of fossil fuels, deforestation and agriculture have led to a 35% increase in CO2 levels in the atmosphere, causing increased trapping of heat and warming of the earth’s atmosphere. Eleven of the last 12 years (1995-2006) rank among the 12 warmest years in the instrumental record of global surface temperature. The IPCC reports that the global average sea level rose at an average rate of 1.8 mm per year from 1961 to 2003. The total rise in the sea level during the 20th century was estimated to be 0.17 metres and projected increase in temperature range is 1.8oC to 4.0oC by the end of this century .1,4

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These IPCC reports changes point to the drastic effects that climate change could have onlife in tropical counties and islands such as Vietnam, Mongolia, Laos, Philippines, Papua New Guinea, Nauru, Micronesia, and Tonga among others. Some of these Islands are only two to three metres above sea level and by viewing this trend of climate change, it is very difficult to predict the future of these countries.  The most common observed phenomena are increasing sea level, acidification, alteration in weather conditions, droughts, cyclones, extreme ENSO (El Nino Southern Oscillation) and EI Nino effects, etc.

Climate change has dramatically and negatively affected human health in the form of increased  burden of diseases of all types, in particular vector-borne illnesses such as dengue and malaria. Changes in climate increase the temperature, which in turn accelerates the multiplication of vectors by breeding, causes droughts which kill crops in some areas or floods which cause cholera in others, thus contributing either directly or indirectly to other diseases such as malnutrition and water-borne, air-borne, and food-borne diseases.

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Climate change associated with increasingly frequent and severe weather events and causes extensive infrastructure damage, economic slowdown, and interruptions of medical and psychiatric care, all which are likely to affect mental health in several ways. These events, and the lifestyle changes that can result, are associated with increased mental health burdens.5

Basically, there are two ways to  contend with climate change: adaptation and mitigation. The former is as a short-term solution that addresses only how to protect ourselves from adverse condition, whereas the latter is  a long-term process. Therefore, both should run simultaneously. Research area in the sectors of climate change should be highly prioritized and awareness program should be initiated from local levels. For all these activities, governments of all nations should responsible, and develop and implement proper national action plans for climate change.

Who is responsible for these overall hazardous conditions caused by climate change? The answer is human beings. Now the time has come to protect our lovely earth and to think about what we are leaving for our future generations. It is not the time to look for blame for problems such as increasing CO2 concentrations, clear-cutting of the forests and so on. t This is the time  for  all nations and human beings to unite with integrity to save the earth and protect the earth for our progeny.

It is my hope that every human will commit to protecting our planet from changing climate and its disastrous effects on human health.

More opinions in this context are highly welcomed. For further information, please contact the author at yadavjoshi@gmail.com

References

  1. McMichael AJ (2003) Global Climate Change and Health: An Old Story Writ Large. A. J. McMichael et al. editors. World Health Organization Geneva. 1-17.
  2. Sahney, S, Benton MJ, Ferry PA (2010) Links between the global taxonomic diversity and expansion of vertebrates on the land, Biology letters 6: 544-547. Available at: http://rsbl.royalsocietypublishing.org/content/6/4/544.full.
  3. McMichael AJ, Woodruff R, Hales S (2006) Climate change and human health: Present and future risks. Lancet  367: 859-869.

4. Climate change and health in Cambodia (2008) A vulnerability and adaptation assessment, WHO/MoH.

5. Roth P ( 2010) Climate change and health: mental health effects, News and views on climate, public health and environment. Available at: http://climatechangehealth.com/tag/ptsd. Accessed on: 1 March 2010.

Slide1Mr. Yadav Prasad Joshi is Nepalese and graduated from Tribhuvan University, Nepal, in Zoology and Psychology. He is extremely interested in infectious diseases and climate change. He joined the JIDC in 2007 as a Reviewer and Editorial Board member in 2012. Mr. Yadav Prasad Joshi has more than 10 years’ teaching experience in biological science to college, university, and medical students. He  participates equally in research activities, seminars, and book writing.  He has done research in tuberculosis, malaria, and many other public health issues.

Currently, he is a PhD student at Sungkyunkwan University, South Korea, in the department of Social and Preventative Medicine. His research topic is climate change and health.

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Filed under Cholera, Countries, Environmental Issues, Environmental Postcard, Infectious Disease, Nepal, Postcards

Marie Anne and the WHO investigate Cholera in Sierra Leone

I believe accurate reporting of infectious diseases, including diarrhoeal diseases, to be a significant issue of consideration in both developed and developing nations.  Accurate reporting by the individual, as well as by medical and government institutions, is imperative for analysis of infectious disease epidemiology. With accurate reporting, especially of cholera cases and cholera typing, appropriate therapeutic and preventative measures can be put in place. 

Here, Marie Anne Chattaway, a microbiologist from the UK, describes her experiences working with the WHO in Sierra Leone establishing an Enteric Bacteria Laboratory in Sierra Leone.  Their goal was to aid cholera diagnosis and reporting in this region.  I can’t thank Marie Anne (marie.chattaway@hpa.org.uk) enough for sharing her project.  I wish her and the taskforce every success in the future.

Thank you to Marie Anne, WHO and Sierra Leone.      

Alyson

Marie Anne and Cholera in Sierra Leone

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Picture 1: Map of Sierra Leone

I first became interested in developing countries when I started to volunteer for JIDC (The Journal of Infection in Developing Countries) a couple of years ago as a scientific editor and reviewer where the focus was mentoring scientists to publish their research in a scientific journal. I have been working with enteric pathogens for over five years at the Health Protection Agency of the UK and now realise just how much of an impact bacterial enteric infection has in developing countries. Until now, I had only managed to help from the UK, but the outbreak in Sierra Leone provided me with an opportunity to really use my microbiological skills where it was needed the most.

Cholera outbreak in Sierra Leone

Sierra Leone (Picture 1) has recently battled its worst cholera outbreak in 15 years. In

Picture 2: Crowded housing at risk of cholera

Picture 2: Crowded housing at risk of cholera

July and August 2012, the epidemic rapidly spread to all but one of Sierra Leone’s 13 districts. With a combination of crowded housing (Picture 2), unsafe water supplies, poor sanitation and the rainy season ahead, intervention was paramount. On 16 August 2012, the Sierra Leone government declared the outbreak to be a public health emergency, and established the Presidential Taskforce on Cholera. As of 2 October 2012, there had been 20,736 cases, including 280 deaths (case fatality rate or CFR=1.35%). The western area of the country where the capital city of Freetown is located was the most affected area with more than 50% of total cases. Initial training and some supplies were provided to the Central Public Health Reference Laboratory (CPHRL), Lakka and Connaught Hospital, in Freetown by the World Health Organization (WHO) and International Centre for Diarrhoeal Diseases Research, Bangladesh (ICDDR,B).  The Global Outbreak Alert Response Network (GOARN) later requested a microbiologist to further evaluate laboratory facilities and provide technical advice and assistance to strengthen laboratory services for detection of cholera cases, capacity for confirmation by laboratory identification and for conducting differential diagnosis for main enteric pathogens (e.g., Vibrio cholera, Shigella, Salmonella, E. coli). The Health Protection Agency (HPA), UK, sent a microbiologist from the Gastrointestinal Bacteria Reference Unit (GBRU) to undertake this task from 10 October to 8 November 2012.

Travel to Freetown

The HPA was already involved with the cholera outbreak with a focus on epidemiology and case management; Sarika Desai and William Welfare from the HPA had already been deployed as WHO consultants. The specific request for a microbiologist to go to Sierra Leone for the month came later and though I had volunteered to go, in the end I had only 24 hours’ notice that I was on the flight the next day and that urgent supplies were needed. Needless to say, my two large suitcases were filled with consumables as well as clothes, a ridiculous amount of a range of pharmaceutical products (which I did end up using – unfortunately), and insect repellent (the insects still got me, though). I’m not sure what part of the journey was the worst: the bad turbulence on the plane with the woman behind me screaming; the small speedboat trip across the sea in the pitch black;  the jolting of the spine across the dirt tracks in the jeep;, or the sickness on arriving when adapting to the humidity and heat (as you know, we English are used to the cold). Either way, I did make it in one piece and was so happy that I didn’t crash in the plane and impressed by the stunning views (Picture 3) that actually I didn’t mind the bumpy roads.

Picture 3: One of the many stunning views in Freetown

Picture 3: One of the many stunning views in Freetown

Assessment of the laboratory

I was fortunate that there was a dedicated laboratory which had been selected to develop testing based at the Central Public Health Reference Laboratory (CPHRL) in Lakka. It was an hour away from the WHO office. Prior to intervention the department was faced with challenges of the lack of supplies, shortage of available trained staff, poor processing systems, and inadequate Health and Safety protocols in the enteric bacteria section of the CPHRL. The icddr-b had done a fantastic emergency response but further work was now required to establish and maintain an enteric bacteria laboratory in Sierra Leone.

Establishing an Enteric Bacteria Laboratory in Sierra Leone

Before training could even begin, a supplies stock system with the support of the WHO, HPA, CDC and Ministry of Health and Sanitation (MoHS) was set up to receive the required equipment and supplies. Molly Freemen from the Enteric Diseases Laboratory Branch of the CDC joined me for 11 days and the collaboration of all these organisations enabled the success of this mission. Intense training of multiple staff was necessary to maintain function after I left and the staff worked incredibly hard, even coming in at weekends and public holidays. A quality accredited process was set up, including the design of request forms for necessary information, the development of protocols for taking samples, receiving and logging the samples into CPHRL, and testing and recording results on the enteric result database for reporting (Picture 4). A surveillance link was also set up

Picture 4: Left to Right: Musu Abu entering laboratory results with Marie Anne Chattaway

Picture 4: Left to Right: Musu Abu entering laboratory results with Marie Anne Chattaway

so that regular weekly reporting of confirmed enteric pathogens is fed back. The two weeks of practical (Picture 5) and theoretical training was followed by intense three-day theory and practical competency testing. Staff were then certificated in “Isolation and identification of Vibrio cholerae, Salmonella typhi, non-typhoida, lSalmonella, Shigella sp. and E. coli O157” and “Health and Safety and Quality Systems in the enteric bacteria laboratory” (Picture 6).

Picture 6: Left to Right: Musu Abu, Fay Rhodes and Marie Anne Chattaway in Enteric Bacteriology, Quality and Health & Safety training

Picture 5: Left to Right: Musu Abu, Fay Rhodes and Marie Anne Chattaway in Enteric Bacteriology, Quality and Health & Safety training

Challenges and future Work

To sustain the new laboratory service, there is still much work to be done.  The supply system must be managed to ensure stock is available when needed.  Regular testing at the laboratory and reporting of results are essential for monitoring the cholera situation in the country. The biggest challenge will be the organisation and implementation of regular sample collection and transport to CPHRL.  Without regular samples from the districts, the testing competency and surveillance cannot be maintained. The impact of this part of the international response has been considerable; there is now a system for detecting and confirming cholera and other enteric pathogens within Sierra Leone.  If this laboratory component of surveillance is sustained it will lead to a better understanding of the incidence of cholera in the country and provide earlier recognition should the infection become epidemic again, thus enabling a rapid response.

Picture 6: Left to Right: Molly Freeman, Ahmed Foray Samba, Musu Abu, Slyvester Kamanda, Dr Abdual Kamara, Fay Rhodes and Marie Anne Chattaway. Other staff who participated and not in this photo include Eric Sefoi and Doris Harding.

Picture 6: Left to Right: Molly Freeman, Ahmed Foray Samba, Musu Abu, Slyvester Kamanda, Dr Abdual Kamara, Fay Rhodes and Marie Anne Chattaway. Other staff who participated and not in this photo include Eric Sefoi and Doris Harding.

Would I recommend this experience

Absolutely! It was an amazing experience, from networking and collaborating on an international scale with the most amazing and interesting people to experiencing the culture. I felt a real sense of achievement seeing how I can personally make a difference. It is hard work, working long hours with little breaks in sometimes difficult conditions, but the end result was worth any hardship. My favourite challenge was when I first opened the incubator to find lots of small ants favouring the Trypticase Soy agarplates. At first I didn’t think much of it, but when I looked at the plates carefully I saw tiny ant footsteps left by the insects that had walked on a cholera plate just after it had been inoculated. The ants had walked across the plate, dragging the bacteria with it (Picture 7). It is possible that perhaps there is a vector influence with the spread of some diseases that we wouldn’t normally consider!

By Marie Anne Chattaway

**Pictures taken by Marie Anne Chattaway, HPA.

Picture 8: Ant trail spreading cholera on a Trypticase Soy Agar plate (see line from top of plate to the bottom across the middle).

Picture 7: Ant trail spreading cholera on a Trypticase Soy Agar plate (see line from top of plate to the bottom across the middle).

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Filed under Countries, Infectious Disease, Postcards, Sierra Leone, Vibrio cholera