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ANTC68H3 (59)
Lecture

Lecture 5

by OneClass8099 , Winter 2011
5 Pages
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Department
Anthropology
Course Code
ANTC68H3
Professor
Ingrid L.Stefanovic

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ANTC68 Lecture 5: Deconstructing Cholera
Cholera
Acute intestinal bacterial disease of
Vibrio cholerae 01 (classical and El Tor biotypes) & 0139
Bacteria sensitive to high temperatures, acidity, dry conditions
Incubation period of 1-2 days; transmission through contaminated food, water, utensils;
importance of seasonality
Cholera bacteria adheres to small bowel and produces a toxin that inhibits the absorption of
liquids by the body (stimulates over- secretion of water and electrolytes) - kills via dehydration
Note: most strains of Vibrio do not carry the genes to make toxin
Pathogen multiplies in the gut of the carrier and are excreted
Majority of cases - mild (90%); many infected have no symptoms (carriers); 5-8% get mild to
moderate diarrhea; 2-5% get severe cholera gravis: severe diarrhea, vomiting, and dehydration
Malnourished people and those who are carrying many intestinal parasites may be more
susceptible than healthy people: it takes 100 billion vibrios in the gut of a healthy person to cause
disease, because large numbers are immobilized by acids in the stomach, but in someone whose gut
is less acidic, because of heavy parasite burden, it takes only 1 million organisms
Risk Factors: hygiene, sanitation, health care resources, SES
ORIGINS? Interaction with humans probably began with agriculture, as populations grew and
polluted their water sources with human and domesticated animal waste which created nutrient-
rich ecosystems that allowed pathogens to thrive
First recorded historical outbreak: 1817, India
Innumerable epidemics around the world; end of 20th century some of most extensive epidemics
in recent times, esp. during refugee crisis in Central Africa (Rwanda, Burundi, DR Congo) in
1994/5: 40,000 cases, case fatality rates exceeding 30% in some areas (limited med facilities); also
South Africa, 2001, 86,000 cases
7 successive pandemics; 7th one in 1960s, El Tor strain (which later led to 1991 epidemic in Peru)
May be 8th pandemic in future, with new strain 0139 Bengal causing high mortality in South Asia
in 1992
ORT and RIT
Mortality resulting from severe dehydration may be >50% if left untreated (< 2% with ORT)
Oral rehydration treatment (ORT) and rapid intravenous rehydration therapy (RIT)-effective
Chemoprofilaxis and vaccination are not recommended: mass treatment with antibiotics may lead
to emergence of drug resistance and vaccination has been effective in only 50% of cases
Being vaccinated may also give a false sense of protection
The key to effective control is environmental sanitation
Cholera in Peru, 1991
POSSIBLE CAUSES OF THE 1991-2 EPIDEMIC:
Dumped bilge water from an Asian freighter
Sea current El Niño: is a hot current coming from the north to the south along the South American
coast in Pacific Ocean (usually takes place at the end of December and beginning of January)
1991: this current produced higher temp. than usual in that part of Pacific
Zooplankton that inhabit cold waters can carry large number of cholera vibrio on their bodies
(zooplankton feed by grazing on phytoplankton which bloom with sunshine and warm conditions;
thus, a phytoplankton bloom leads to increase in pop. of zooplankton which carry the vibrio )
A warmer than usual El Niño may have created ideal conditions along the Peruvian coast for
humans to become infected with cholera
www.notesolution.com
Zooplankton also live in water of ponds and rivers that people drink
Fish and shellfish eat zooplankton
Shellfish consumption can also lead to cholera if contaminated with the bacteria (ceviche….though
not clear connectionlime acid)
Globally (1970s, 80s)
Improvements in child survival, longer lifespans
Increased population, urbanization
Economic recession with oil crisis of 1970s
Debt crisis of 1980s
Resulted in depleted capital, which Third World countries needed to maintain and expand the
public health infrastructure (esp. w / urbanization)
Peru: 1970-1990
Public health infrastructure (water/sewage) overwhelmed by socio-economic factors:
oUnprecedented growth in urban populations
oChronic inflation and associated losses of capital for investment
oUnsustainable public sector employment and subsidies
Effects on Peru: Resurgence of infectious diseases
Social and Economic Factors:
1950 : 35% of pop. lived in cities: by 1990 70%; 1991: more than 25% of countrys population lived
in the capital, Lima (6.5 million), where 1/3 of the residents lived in squatter settlements
1950-1965 : low inflation of 8%, compared with 31% in Brazil, 25% in Argentina; by 1980: inflation
increased steadily, reaching 10,000% by the end of the decade..poverty rose: in Lima, rate went
from 17% of city (1986) to 44% by 1990
Public employment (½ of all salaried workers) and subsidies for food, public transportation and
water/electrical supplies depleted foreign exchange reserves and left insufficient funds for
maintenance and expansion of basic public services , as well as adequate health care (budget cuts)
and basic medical supplies
Scapegoating
Poor understanding of disease (pathogen, causation, transmission, etc.)
Poor understanding threat to power structures
Patterns of blame that prevail in different periods reflect the social stereotypes, fears, and
political biases that are associated with threats of social or political change (376)
Blame: way to create order, reassert control over perceived threats, or preserve existing social
institutions
Douglas (1992L 87): accusations of illness used strategically to perpetuate cultural regimes and
control those who are threatening, problematic or hated/feared
Scapegoating in Late 19th Century Gibraltar (Sawchuk and Burke 2008)
IMP of disease in defining power imbalances/weaknesses
British fortress colony with strategic imp.; military rule
After 1783 : high pop. growth of 6% per year for 2 decades
Flourishing economy, foreign immigration; diverse pop.
Linked to Malta as British colonies; high immigration from 1860s to 1890s, especially single males
Numerous recurring epidemics: yellow fever, cholera
British efforts to limit population growth
Common beliefs regarding disease:
www.notesolution.com

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Description
ANTC68 Lecture 5: Deconstructing Cholera Cholera Acute intestinal bacterial disease of Vibrio cholerae 01 (classical and El Tor biotypes) & 0139 Bacteria sensitive to high temperatures, acidity, dry conditions Incubation period of 1-2 days; transmission through contaminated food, water, utensils; importance of seasonality Cholera bacteria adheres to small bowel and produces a toxin that inhibits the absorption of liquids by the body (stimulates over- secretion of water and electrolytes) - kills via dehydration Note: most strains of Vibrio do not carry the genes to make toxin Pathogen multiplies in the gut of the carrier and are excreted Majority of cases - mild (90%); many infected have no symptoms (carriers); 5-8% get mild to moderate diarrhea; 2-5% get severe cholera gravis: severe diarrhea, vomiting, and dehydration Malnourished people and those who are carrying many intestinal parasites may be more susceptible than healthy people: it takes 100 billion vibrios in the gut of a healthy person to cause disease, because large numbers are immobilized by acids in the stomach, but in someone whose gut is less acidic, because of heavy parasite burden, it takes only 1 million organisms Risk Factors: hygiene, sanitation, health care resources, SES ORIGINS? Interaction with humans probably began with agriculture, as populations grew and polluted their water sources with human and domesticated animal waste which created nutrient- rich ecosystems that allowed pathogens to thrive First recorded historical outbreak: 1817, India Innumerable epidemics around the world; end of 20 century some of most extensive epidemics in recent times, esp. during refugee crisis in Central Africa (Rwanda, Burundi, DR Congo) in 19945: 40,000 cases, case fatality rates exceeding 30% in some areas (limited med facilities); also South Africa, 2001, 86,000 cases 7 successive pandemics; 7 one in 1960s, El Tor strain (which later led to 1991 epidemic in Peru) th May be 8 pandemic in future, with new strain 0139 Bengal causing high mortality in South Asia in 1992 ORT and RIT Mortality resulting from severe dehydration may be >50% if left untreated (< 2% with ORT) Oral rehydration treatment (ORT) and rapid intravenous rehydration therapy (RIT)-effective Chemoprofilaxis and vaccination are not recommended: mass treatment with antibiotics may lead to emergence of drug resistance and vaccination has been effective in only 50% of cases Being vaccinated may also give a false sense of protection The key to effective control is environmental sanitation Cholera in Peru, 1991 POSSIBLE CAUSES OF THE 1991-2 EPIDEMIC: Dumped bilge water from an Asian freighter Sea current El Nio : is a hot current coming from the north to the south along the South American coast in Pacific Ocean (usually takes place at the end of December and beginning of January) 1991: this current produced higher temp . than usual in that part of Pacific Zooplankton that inhabit cold waters can carry large number of cholera vibrio on their bodies (zooplankton feed by grazing on phytoplankton which bloom with sunshine and warm conditions; thus, a phytoplankton bloom leads to increase in pop. of zooplankton which carry the vibrio) A warmer than usual El Niomay have created ideal conditions along the Peruvian coast for humans to become infected with cholera www.notesolution.com
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