Central America Without Cholera:
The Story of a Health-Care Endeavor
Washington, DC, December 4, 2003 (PAHO)—The Pan American Health Organization reports that Central America now is a region without reported cases of cholera.
The last recorded case of cholera in Central America was identified in Guatemala in March of 2002.
The day coincides with the fifth anniversary of the Costa del Sol Declaration, signed in El Salvador on Dec. 6, 1998, in the aftermath of the destructive and deadly Hurricane Mitch.
PAHO director Dr. Mirta Roses Periago said during a meeting in Panama of the Central American heath ministers last August that the significant progress made in achieving the goal of controlling this disease is the result of five years of intense and joint work.
The fight against cholera, a serious bacterial infection of the small intestine, is proof that joint commitment and work by nations can achieve success.
After a century without cholera, in 1991 began the spread of the seventh cholera pandemic into the Western Hemisphere. After the first cases were detected in the Peruvian village of Chancay, cholera quickly spread throughout the Americas and within one year as many as 400,000 cases were detected in 14 countries.
"Cholera was the accusing indicator that showed the growing inequities in the continent when it came to the access to drinkable water. It was a warning shot to a continent that leads in the exports of food," said Roses.
PAHO has drafted a report on health fairness and epidemiological information in Latin America entitled, A Central America Without Cholera, Lessons From Joint Work and Challenges for Building Health With Fairness in the Americas.
According to that report, at the beginning of the 1990s conditions were favorable in the region for the spread of cholera. The supplies of drinkable water were deficient in their scopes and quality, especially when it came to disinfectants (67 percent in the Andean region and 68 percent in Central America) and sewage systems.
PAHO's efforts in those years concentrated mainly on the strengthening of health services, the expansion and improvement of water disinfectant systems and the control of used water, in addition to improving monitoring and education. "Enormous progress was made thanks to community-based activities and the nations' political commitment. Other key factors were such issues as the improvement in epidemiological monitoring and social communication," Roses said.
Until 1997, the cases of cholera had been reduced by half and only four percent of the initial cases were reported. However, cholera had acquired signs of an epidemic in that occasional outbreaks reflected the perseverance of vulnerability.
And that delicate balance threatened to collapse in 1998 when two natural meteorological events happened: Hurricane Mitch, which ravaged parts of Central America, and the El Niño current, which affected the coasts of Peru and Ecuador. Both events threatened to reverse the health progress achieved in lowering the number of cholera cases.
That's why the Central American health ministers met in El Salvador five years ago and signed the Costa del Sol Declaration, which became a pivotal tool in the fight against cholera.
With PAHO's support, sanitation efforts were carried out and drinkable water was guaranteed. These efforts helped to prevent cholera from again becoming a serious threat. These sustained efforts over time lessened the risks of serious cholera outbreaks.
The collective efforts of the region's nations and the work of international organizations succeeded in preventing another epidemic. Despite the damaged done by Mitch, only 10 percent of all cholera cases reported in the Western hemisphere in 1998 were in Central America. The last reported case was in Guatemala in March 2002. There haven't been any reported cases in the other nations of the Americas over the past two to eight years.
The coverage of drinkable water and sanitation has improved markedly. However, there are still about 8 million people (23 percent) without water supplies and some 4 million people (11 percent) who don't have water connection and availability in their homes. In Central America, according to the report, between 60 percent and 80 percent of all communicable diseases can be traced to deficient drinkable water and sanitation.
But this is not a reason to let down the defenses, said Dr. Marlo Libel, PAHO's expert on communicable diseases. "We will remain alert and continue to recommend that all communities store their water in safe containers, use boiled or disinfected water, and cook food. It's necessary to keep up the experience of having healthy markets and a number of places that greatly improved their health and sanitary measures in the aftermath of the experience gained from the cholera outbreak," he said.
PAHO believes that to keep Central America without cholera and, in addition, move forward in the sustainable human development and fairness in the health field, it's necessary to renew commitments. Among them are:
- Reduce the inequities in the access to and quality of drinkable water and sanitation, and to guarantee the quality of food.
- Improve health education, with emphasis on health promotion.
- Promote social participation and vigilance, with emphasis on issues of rights.
- Maintain epidemiological vigilance and monitor the quality of water.
- Strengthen, at all levels, the capabilities of communications and the management of risks.
- Continue to improve the efforts at sub regional integration and decentralization process, including the initiatives of the Central American and Dominican Republic Forum for Drinkable Water and Sanitation.
The Pan American Health Organization (PAHO) was established in 1902 and is the world's oldest public health organization. PAHO works with all the countries of the Americas to improve the health and quality of life of its people. PAHO serves as the Regional Office for the Americas of the World Health Organization (WHO).
PAHO Member States today include all 35 countries in the Americas. France, the United Kingdom of the Netherlands, and the United Kingdom of Great Britain and Northern Ireland are Participating States. Portugal and Spain are Observer States. The U.S. Commonwealth of Puerto Rico is an Associate Member.
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