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Health Studies
Caroline Barakat

Lecture 9: Chorea th Until the 19 century Contagionists -Believed in the ‘germ theory’ announced by Pasteur (1862) - Koch and Hansen -Diseases spread from person to person by an infectious agent Miasmatists -Pettenkofer (1818 – 1901) -factor in air (X) and factor in soil (Y) didn’t independently cause disease but when reacted together caused miasma that caused disease -steadfastly refused to believe in the germ theory -drunk a vial of bacteria contaminated water -may had have experienced chlorea and had some sort of immunity -Disease caused by ‘bad vapors’ Epidemiology -History of cholera is described as the history of pandemics 7 pandemics 1) 1816 – 1821: originated in India (River Ganges) and was spread by mainly by British troops, headquarters in Bengal 2) Second pandemic: 1829 – 1851: more widespread, reaching Europe, Canada, and the US - 1831 – mortality of 13% in Cairo, Egypt - 1832 – 3: 60,000 death in England – disease known as ‘King Cholera’ - In 1849 – called ‘America’s greatest scourge’ 3) 1852 – 1859: Scientific advances in understanding Cholera 4) 1863 – 1873 5) 1881 – 1896: microbe for chlorea discovered; hygienic measures stopped its spread to N America because of of increased hygene 6) 1899 – 1923: for the most part missed the western hemisphere 7) 1961 – ongoing; Haiti, Dominican republic and Cuba Series of epidemics: -1961: Celebes Islands, Asia, Middle East -1992: aboard a flight from S America to the US -1990s: 200,000 in SE Asia -1994: Zaire, killed 50,000 Rwandan refugees in 21 days -2000: Africa -Chlorea imported from various diseases -Countries/areas reporting cholera and cases reported, by year, 1993–2003 -decrease in trend; .:. end of 7th pandemic -Reported Cases -resurfacing in northern hemisphere but lower compared to Europe Etiology -During the 5 epidemic (1883) -Koch dispatched to Egypt to isolate the microbe -Able to see the bacteria in feces of 12 patients -Vibrio cholerae (due to its vibrating wiggles) -Incubation period – few hours to 5 days -139 different serogroups -V. cholerae must itself be infected with two viruses: -One has a gene that codes for the cholera toxin (cause of diarrhea) -Other must have a gene that codes for the receptor that allows the toxin-coding virus to enter the bacterium Infection with Cholera -Trillion V. cholerae excreted each day -Indirect transmission: fecal – oral route of transmission -Bacteria can survive on food for up to 5 days at ambient temperatures, and up to 10 days at 5-10 C - Often found in the aquatic environment -Stomach gastric juice is lethal to V. cholerae -Low stomach acidity implies high susceptibility to cholera -Bacteria may become dormant in between epidemics Clinical Manifestations -Severe diarrhea, dehydration and shock -Vomiting -Convulsions -Muscle cramps -Death sometimes within hours -90% of cases are mild or moderate severity -Less than 10% of ill persons develop typical cholera with severe dehydrati
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