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Cholera Outbreaks Surge Worldwide as Vaccine Supply Drains

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A record number of cholera outbreaks around the globe, driven by droughts, floods and armed conflicts, has sickened hundreds of thousands of people and so severely strained the supply of cholera vaccines that global health agencies are rationing doses.

Outbreaks have been reported in the Caribbean, Africa, the Middle East and South Asia, putting the health of millions at risk and overwhelming fragile health systems. Untreated, the disease, which is commonly spread through contaminated water, can cause death by dehydration in as little as one day, as the body tries to expel a virulent bacteria in gushes of vomit and watery diarrhea.

Cholera is typically fatal in about 3 percent of cases, but the World Health Organization says it is killing at an accelerated rate in recent outbreaks, even though it is relatively cheap and easy to treat. It is most often fatal in children, who progress swiftly to severe illness and organ failure.

Cholera outbreaks tend to follow displacement: When droughts, floods, famines or the threat of violence force large groups of people to move, and they lose access to clean water and adequate sanitation facilities, cholera bacteria can race through a population. This year has seen cholera both in places where it is a familiar threat, and in countries that have not confronted it for decades.

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In Nigeria, a million people have been displaced by floods in recent weeks, and there are at least 6,000 cases of cholera. The authorities in Kenya are reporting suspected cholera in people fleeing violence in Somalia and arriving at the mammoth Dadaab refugee camp, where tens of thousands of children are at risk.

In Haiti, cholera has broken out as whole neighborhoods of people displaced by violence are packed into small open patches in Port-au-Prince, sharing a single cracked pipe of water that runs through untreated waste. Cholera is also festering in the country’s severely overcrowded prisons.

In Syria, millions of people displaced by the civil war lack access to clean water, while the years of fighting have destroyed sanitation infrastructure. Raw sewage is being pumped into the Euphrates River, which hundreds of thousands of people depend on for water. The United Nations reports more than 20,000 suspected cholera cases and 75 deaths there.

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But demand for vaccination is so high that the World Health Organization has suspended the recommended two-dose vaccination regimen and switched to a single dose, in an effort to stretch supply so enough is available to be able to respond to more outbreaks that could occur in the coming months.

“We have never had to make a decision like this about vaccination before, that’s the severity of this crisis,” Dr. Barboza said.

If enough single doses are given in a region, it should be enough to quell an outbreak, he said. But the length of the protection is significantly shorter. A single dose of the cholera vaccine gives between six months and two years of immunity, while the full regimen of two doses delivered a month apart gives adults four years of protection, she said. If a second dose can be delivered within six months, it should give three years of protection. But the evidence on the exact duration of protection is limited; it is known to be much shorter in children.

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