In the middle of the summer vacations season, no one really wants to face last minute obstructions to the months ago planned leave. One such obstacle at the moment appears to be the cholera outbreak in Cuba.
Cuba continues to report cases of cholera for the first time in nearly 150 years. As of 12 July 2012, 85 cases of Vibrio cholerae were confirmed by the Cuban Ministry of Health. According to available information, the outbreak appears to be mainly localised in the Granma province, in south-western Cuba, mostly in Manzanillo City.
‘No worries, EU tourists!’ says the European centre for disease prevention and control (ECDC), a Stockholm based EU agency aiming at strengthening Europe's defence against infectious diseases.
The centre conducted a rapid risk assessment on 12 July in order to examine the potential risk for European travellers to Cuba after an outbreak of cholera. According to the risk assessment, ‘the outbreak appears to be mainly localised in the Granma province, mostly in Manzanillo city. Should the outbreak not spread beyond this area, the risk of infection for European tourists visiting Cuba is negligible’.
Furthermore, the centre is prepared to reassess the situation in case the disease spreads to other provinces. The agency concluded that ‘with appropriate precautionary measures, the overall risk of infection remains low, as is the risk for further spread of the infection upon return to Europe’.
Last but not least, the ECDC advised the Europeans visiting Cuba to ‘seek information on how to prevent cholera contamination prior to visiting affected areas’. In addition, clinicians should keep the possibility of cholera firmly in mind for travellers returning from Cuba who show clinical signs suggestive of this disease.
In 2010, more than 2.5 million tourists visited Cuba. Nearly 810 000 (32%) of them were European residents, coming mostly from Italy, Spain, and Germany.
The centre also provided interesting data, according to which approximately 2.8 million cholera cases occur annually on a global scale in endemic countries with nearly 91 000 deaths. In non-endemic countries, the number of cases is estimated at 87 000 with 2 500 deaths. The major burden of cholera is located in southern Asia and Africa.
Cholera is an acute diarrhoeal infection caused by the bacterium Vibrio cholerae from two toxigenic serogroups, namely O1 and O139 among a total of 200 serogroups. These two serogroups are related to cholera epidemic. Symptomatic cases of human infection are characterised by acute secretory watery diarrhoea (rice water stools), commonly with vomiting, nausea and abdominal discomfort. Fever is uncommon.
Transmission to humans is usually through the consumption of contaminated water and food items (i.e.: seafood from contaminated water, fruits and vegetables irrigated with contaminated water etc.), but also through direct exposure to faeces/vomit of an infected person. The most common risk factors for cholera outbreaks are water source contamination, poor sanitation and lack of sewage treatment, and to a lesser extent, heavy rainfall, flooding events and population displacement.
The last cholera outbreak was in Haiti after the devastating earthquake in 2010.