Pro-MED reported today that a case of cholera has been diagnosed in New York City. This is not a major public health threat in itself, but it represents the first appearance of this severe infection in The City in decades, and could be a harbinger of what is to come. A reasonable hypothesis is that its appearance reflects travel patterns: the disease was transferred from Haiti’s island neighbor, the Dominican Republic. There is a great deal of travel between the DR and New York. Haiti is currently undergoing a major epidemic of cholera, largely because of the breakdown of public health measures following last year’s earthquake, and the concentration of thousands of displaced persons in refugee camps with only rudimentary sanitation facilities. Cholera can result in death within < 1 day in the most serious cases because of the electrolyte imbalances from uncontrolled diarrhea, and oral or IV rehydration, plus antibiotics (doxycycline or ciprofloxacin or similar drugs) are the only treatments. It all “boils” down to water.
Pro-MED is the “Program for Monitoring Emerging Diseases,” which is a “medium tech” listserve designed to report outbreaks to the global health community. It is sponsored by the International Society for Infectious Diseases, and can be found at promedmail.org. It represents the first attempt to include all interested subscribers in the “peoples’” surveillance system.