Cholera Overview – National , Regional and Global : A Narrative Review

الملخص

This narrative review aims to provide an updated overview of cholera and describe its situation in Yemen at the national level, in Arab countries at the regional level, and globally at the continental level. Cholera is a bacterial infection of the small intestine caused by Vibrio cholerae (V. cholerae). Initially confined to Asia, the disease spread globally in 1817, triggering the first pandemic from India. In 1854, a cholera outbreak in  Soho, London, was investigated by English physician John Snow (1813–1858), whose findings contributed to understanding disease transmission. The causative agent of cholera was identified twice—first by Italian physician Filippo Pacini during an outbreak in Florence, Italy, in 1854, and later, independently, by Robert Koch in India in 1883.In Yemen, cholera was first reported in 1971, with smaller outbreaks occurring in 2010. Since 2015, the country has faced an ongoing humanitarian crisis, compounded by the worst global cholera epidemic since 2016. The outbreak spread to 92% of the country, affecting 305 districts and 22 of 23 governorates, with Hodeidah experiencing the highest burden. Cholera is primarily transmitted through the fecal-oral route via contaminated food or water, often due to poor sanitation. In healthy adults, an infectious dose of approximately 100 million bacteria is required to cause illness, though this threshold is lower in individuals with reduced gastric acidity. Children, particularly those aged two to four, are especially vulnerable. The infection leads to the rapid loss of large volumes of watery stool due to cholera toxin, resulting in severe dehydration and shock. Symptoms vary from asymptomatic to mild, moderate, or severe cases. The hallmark symptom is profuse watery diarrhea lasting several days, often accompanied by vomiting and muscle cramps. Severe diarrhea can cause life-threatening dehydration, electrolyte imbalances, and acute renal failure. Other signs include sunken eyes, cold skin, decreased skin elasticity, and wrinkled hands and feet. In extreme cases, dehydration may lead to a bluish skin tone. Symptoms typically appear between two hours and five days after infection. A rapid dipstick test can detect V. cholerae, and clinical diagnosis is based on patient history and examination. Stool and swab samples collected during the acute phase, before antibiotic treatment, are crucial for laboratory confirmation. The most common strains responsible for outbreaks are V. cholerae O1 and O139. Treatment primarily involves fluid replacement therapy, which reduces the mortality rate from over 50% to below 0.2%. Antibiotic therapy is recommended for moderate to severe dehydration, as it can decrease both the volume and duration of diarrhea by 50%. Preventative measures include ensuring access to clean water, improved sanitation, and oral cholera vaccines (OCVs).