Abstract

PIP: The low case fatality rates (1%) from the 1991 cholera epidemic in Peru was more a result of including diarrheas of a less virulent etiology than that of cholera. In fact, a study during the early phases of the cholera epidemic in Trujillo, Peru revealed that only 79% of suspected cholera cases were infected with vibrio cholera 01. Further other people contended that the government of Peru did not chlorinate many water supplies because studies by the US Environmental Protection Agency suggested that chlorine increases the cancer risk. It reacts with organic matter to make trihalomethanes. 1 study noted that this risk may explain as many as 700 cases of cancer/year in the US, yet cholera was responsible for nearly 40009 deaths in Latin America the 1st year. Besides in Trujillo, Peru the reason for not chlorinating the water supply was not due to a conscious decision to not do so on the part of the government, but because no funds had been made available to purchase chlorinators and chlorine. This is typical of many towns in developing countries. Further raw fish also played a role in transmitting cholera in Peru. Moreover the study in Trujillo indicated that water stored in containers in the home, and not the water supply, was the most important vehicle of transmission. Nevertheless chlorination of both the water supply and stored water would have prevented cholera transmission. In addition, cabbage irrigated with raw wastewater contributed to cholera transmission in Trujillo. But a concern arises if developing countries follow the advice of WHO of 1st treating wastewater in stabilization ponds. Aquatic blue green algae, other zooplankton, and phytoplankton from a microhabitat suitable for V. cholera. In fact, a study in Peru identified a seasonal pattern of the cholera epidemic with the seasonality of V. cholera non-01 from sewage lagoons in Lima.