Cholera Control and Cholera Case-Fatality Rates

Le résumé fourni par la source

To the Editor—Cholera control requires reduction of mortality rates along with vaccination programs. The article by Sack et al [1], contrasting cholera epidemiology in Bangladesh and Africa, describes possible strategies for cholera elimination by 2030. While most African outbreaks were short, high variability was noted, and effective vaccination control strategies will take time to achieve the desired results. The authors reported case-fatality rates (CFRs) of 10%–20% in the Cameroons, extremely high compared with the CFR of <1% achieved with standard intravenous and oral water and electrolyte replacement therapy [2, fig 2]. These excessive CFRs merit more research if the annual toll of cholera deaths in Africa is to be controlled. Questions needing answers include the following: (1) Is no adequate rehydration and maintenance therapy being provided? (2) If so, is this a failure of training or lack of supply provision (intravenous fluids, packets for oral water and electrolyte replacement therapy)? (3) What additional measures are needed to make treatment available? (4) Is Vibrio antibiotic resistance making treatment lengthier, costlier, less available, or less effective? (5) How is elimination of these high CFRs best achieved? It would be tragic if such CFRs continue while years of vaccination strategies are tested and developed. True cholera control will continue to require integrated treatment and vaccination programs.

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