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Challenges in Enteric Epidemics: Barometers of Inadequate Water and Sanitation

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Challenges in Infectious Diseases

Part of the book series: Emerging Infectious Diseases of the 21st Century ((EIDC))

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Abstract

Infectious diarrheal illnesses, markers of inadequate water and sanitation systems, rank among the leading causes of morbidity and mortality worldwide, disproportionately so in low-income countries and among children [1–3]. Following the recognition of water as a vehicle for enteric pathogen transmission, a sanitary revolution swept across Europe and North America, reducing the burden to primarily sporadic outbreaks of limited extent [4–6]. For the majority of the world’s population, however, the health benefits of clean water and “flush” toilets are far from reach. The most recently headlined barometer of inadequate water and sanitation came roaring out of deplorable sanitary conditions in earthquake-devastated Haiti in October 2010. In a matter of 8 weeks, an introduced cholera epidemic (caused by Vibrio cholerae O1) surged through the Haitian population, causing an astonishing 121,518 cases where the disease had not existed for decades [7, 8]. The use of intravenous and oral rehydration therapy (ORT) for patients with rapid dehydration kept the epidemic case fatality rate (CFR) to 2.1 % and was a reminder of the simple yet vital importance of fluid resuscitation [8]. Shown to be effective in 80 % of cholera cases as well as for other acute diarrheal diseases, ORT has likely saved more than 40 million lives since its advent in the 1960s and thus has made more contributions to reducing mortality due to cholera and other diarrheal illnesses globally than any other therapy [9]. Yet, 2.6 billion people (42 % of the world’s population) remain at risk of life-threatening diarrheal illness simply for lack of clean water and sanitation [4, 10]. Moreover, morbidity due to epidemic and endemic infectious diarrhea may actually be increasing [2]. Contributing to the overall burden of diarrheal disease is the recently recognized long-term deleterious sequelae of enteropathogens on impaired early childhood development and associations with malnutrition even in the absence of loose stools [11]. The myriad potential of enteric pathogens to viciously ravage susceptible populations, as well as to stealthily rob at-risk children of their maximum potential, poses one of the greatest challenges of the twenty-first century.

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Abbreviations

AIDS:

Acquired immunodeficiency syndrome

APOE:

Apolipoprotein E

cAMP:

Cyclic adenosine monophosphate

CFR:

Case fatality rate

CTC:

Cholera treatment center

CTU:

Cholera treatment unit

CTX:

Cholera toxin

DALY:

Daily adjusted life years

EAEC:

Enteroaggregative E. coli

ICDDR-B:

International Centre for Diarrhoeal Disease Research Bangladesh

IDP:

Internally displaced population

IHR:

International health Regulations

MSPP:

Ministère de la Santé Publique et de la Population

PAHO:

Pan American Health Organization

PEM:

Protein energy malnutrition

ORS:

Oral rehydration solution

ORT:

Oral rehydration therapy

RO-ORS:

Reduced-osmolar oral rehydration solution

SSH:

Sea surface height

SST:

Sea surface temperature

TCP:

Toxin-coregulated pilus

VBNC:

Viable but non-culturable

UN:

United Nations

WHO:

World Health Organization

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  1. Divisions of Infectious Disease and Gastroenterology and the Center for Global Health, University of Virginia, Charlottesville, VA, USA

    Luther A. Bartelt M.D., D.T.M. & H.

  2. The Center for Global Health, University of Virginia, Charlottesville, VA, USA

    Richard L. Guerrant M.D.

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    I.W. Fong

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Bartelt, L.A., Guerrant, R.L. (2013). Challenges in Enteric Epidemics: Barometers of Inadequate Water and Sanitation. In: Fong, I. (eds) Challenges in Infectious Diseases. Emerging Infectious Diseases of the 21st Century. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4496-1_5

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