Boiling drinking water, chlorinating fruits and vegetables, not consuming raw meat and fish, washing hands after going to the bathroom, and not defecating in the open air, are actions that we have heard and read about dozens of times in the media. But why is it so important to insist on promoting these behaviors? Simply because our health and that of others depend on them.

By implementing these actions, many gastrointestinal diseases such as amoebiasis, salmonellosis, and, above all, cholera can be prevented. The following lines will deal with the latter. Over the years, cholera has been one of the major public health concerns in Mexico, since its characteristics make the country ideal for its spread.

History of cholera

Cholera is a disease that has been recorded since ancient times, originating in the delta of the Ganges River. On seven occasions it has spread to a large part of the planet in what are known as pandemics. The first pandemic occurred from 1804 to 1817, when the British army contracted it in Bangladesh, affecting mainly Asian and African countries. The second took place from 1826 to 1832, covering part of Asia and Europe, from where it reached North and Central America. The third is considered one of those that has claimed the most lives, with 140,000 deaths; it was recorded between 1848 and 1862 and affected part of Europe, the Middle East, and North America.

The fourth pandemic affected Equatorial Africa and some countries in South America from 1864 to 1875. The fifth pandemic, between 1883 and 1896, spread to all continents except Oceania. By that time, the international community had already held five sanitary conferences, with the objective of investigating the origin of such a destructive disease. In 1884, Robert Koch discovered that a bacterium, which he named Vibro cholerae, was the cause of the terrible disease. The sixth pandemic occurred between 1899 and 1923, mainly in Asia and Africa.

During the next forty years, cholera retreated to its habitat in the Ganges, with isolated records of outbreaks in several countries. The seventh pandemic, which we are still living, originated in Indonesia in 1961, from where Vibrio cholerae has been "exported", first to Asian, European, and African countries, to arrive later, in 1991, to the coasts of Peru and begin its proliferation throughout the continent. In Mexico, the first case of cholera occurred that same year, in a town in the State of Mexico.

Vibrio cholerae

The cholera bacterium can live in different environments, however, it is best found in warm seawater, where it can survive for up to sixty days. It seems that although the bacterium can live as a host in other organisms, it is in humans where its presence causes havoc.

What is cholera infection

The route of entry is always the mouth, by drinking water or food contaminated with feces or vomit of a sick person. This does not mean that the passage from one person to another is direct; vibrios are easily spread through water sources such as rivers, wells, and food handled without hygiene. The possibility of a person becoming infected with this bacterium depends on several circumstances: availability of basic sanitary measures, gastric acidity, immunity due to previous exposure to the germ, and nutritional status.

Vibrio cholerae is an organism sensitive to environmental changes and once it is ingested it has to survive, like all pathogenic germs, to gastric acidity. So a person suffering from the disease had to consume between one million and one hundred million vibrios. Those that pass the gastric test, settle in the upper part of the small intestine. Once there, the reactions are diverse, depending on the immunity and nutritional conditions of the infected person.

Because in Mexico the lack of basic sanitary services and malnutrition are practically a constant, the process of infection normally follows the following course installed in the small intestine, the bacteria multiply and penetrate the intestinal mucosa. In reaction to the harsh environment around them, they produce a toxin that stimulates the secretion of water and salts, producing for many hours copious diarrhea and vomiting characteristic of the disease. If not attacked quickly, dehydration occurs so severely that in a very short period of time it can cause death.

Treatment for cholera infection

Thanks to the "fragility" of Vibrio cholerae, it is feasible to attack it relatively easily in several ways. Chlorine and high temperatures break the cell wall of the bacteria, disintegrating it, therefore it is necessary to chlorinate the water or boil it, and cook the food well. When the symptoms of the disease appear, there are several antibiotics that control the bacteria, the only thing left to do is to rehydrate immediately.

To date, cholera has been registered in almost all the states of the country, but the central and southern regions have the highest number of cases. The cholera outbreak in Mexico has once again shown the great social problems suffered by the majority of the population. This disease has been identified as the "evil of poverty", since the people with the most nutritional problems, lacking basic sanitary services and with the highest illiteracy rates are the most affected, which speaks of the deep inequality that exists in Mexico.

Prevention of cholera infection

As part of the activities to prevent and control cholera, several strategies were implemented, such as epidemiological encirclements to detect cholera cases and their causes, and family encirclements to get close to the family of the sick person and detect other possible cases. It is clear, however, that in the search for cholera control, efforts to find effective and economic therapeutic measures must converge with social measures, such as the provision of drinking water, latrine and drainage construction programs, and, above all, education. It is important to insist on encouraging these behaviors to avoid possible cholera infection:

Boil water for drinking.
Chlorinate fruits and vegetables.
Do not consume raw meat and fish.
Washing hands after going to the bathroom.
Do not defecate in the open air.