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Governments call on WHO to improve cholera control

BMJ 2011; 342 doi: (Published 26 January 2011) Cite this as: BMJ 2011;342:d513
  1. John Zarocostas
  1. 1Geneva

Governments want the World Health Organization to take the lead on measures to control and prevent cholera, in response to the ongoing outbreak of the disease in Haiti.

At its meeting last week in Geneva WHO’s governing executive board said that cholera “is not being adequately addressed despite its prevalence in epidemic form in many areas.” Member states called on WHO’s head, Margaret Chan, to respond “expeditiously and effectively” to the needs of nations affected by or at risk of cholera outbreaks.

The board also asked Dr Chan to strengthen the coordination of international assistance—in terms of equipment and human and financial resources—during cholera epidemics to ensure an effective and quick response.

WHO is being asked to provide technical support to affected countries so that they can build their capacity for control and prevention, including surveillance, early warning and response, laboratory capacity, risk assessment, case management, data collection and monitoring, and deployment of vaccine.

“Cholera is a re-emerging disease that has to be dealt with,” Claire-Lise Chaignat, chief of WHO’s global taskforce on cholera control, told the BMJ.

Dr Chaignat said that 250 000 cases of cholera were reported to WHO in 2010. But she said that this excluded the 500 000 to 700 000 cases of acute watery diarrhoea that are reported every year, so labelled because countries “don’t want to call it cholera because they are afraid of trade sanctions.”

She warned that countries in parts of Asia don’t report or even mention cholera, because they don’t want repercussions.

WHO estimates the actual number of cases of cholera to be between three million and five million a year—much higher than the number reported, it says—and the number of deaths to be 100 000 to 130 000 a year. In 2009 a total of just over 220 000 cases were reported to WHO by 45 countries, a 16% rise on the number notified in 2008.

WHO’s executive board urges member countries to give greater attention to health, hygiene, water, and sanitation. It recommends that countries improve surveillance and reporting of cholera in accordance with international health regulations and that national surveillance be integrated into overall surveillance systems.

It recommended that the World Health Assembly, WHO’s main decision making body, adopt the proposed steps when it meets in May.

Meanwhile the Haitian Ministry of Health said that to 16 January the number of people admitted to hospital with cholera was 109 015 and that 3889 had died since the outbreak began in mid-October.


Cite this as: BMJ 2011;342:d513


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