Cholera outbreak declared in Virac, Catanduanes
Health official says 748 Virac residents were confirmed to have contracted the bacteria that causes cholera in the past 6 months

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MANILA, Philippines – The health department on Friday, June 15, declared a cholera outbreak in Virac, Catanduanes.

This is after 748 individuals were confirmed to have contracted Vibrio cholerae–the bacteria that causes cholera–from Jan. 1 to June 13, 2012, a ranking health official said.

Health undersecretary Ted Herbosa said that of these cases, 8 individuals were confirmed to have died from cholera in the province.  Six of those who died were from Virac while 1 each were from the towns of San Miguel and Pandan.

“There were other deaths but not in hospitals,” Herbosa said. Because of this, he said, it could not be confirmed if the deaths were due to cholera.

Cases in other towns

The 748 cases are part of some 1,370 presumed cholera cases recorded in the entire Catanduanes during this period, according to Herbosa.

The rest of the presumed cases came from 11 other towns, with 307 cases from San Andres; 82 from San Miguel; 27 from Viga and 52 from Pandan.

But while the victims in these towns were manifesting cholera-like symptoms, the DOH is still waiting for the results of the laboratory tests to validate if it was, indeed, cholera.

“Right now, there is a diarrhea outbreak in towns outside of Virac.  It is not yet cholera outbreak,” he said. (See copy of the latest report below)

Unusually high

“When you say it’s presumed, that’s based on clinical findings. Confirmed cases are those established to  have been caused by the bacteria, based on laboratory growth,” Herbosa explained to Rappler in a phone interview.  

Herbosa said the health department decided to declare an outbreak because the number of incidents were unusually high.

“You should understand that in rural areas like Virac, Catanduanes, cholera is endemic,” Herbosa added.  

Herbosa said this means there are usually a number of cases any given month. He attributes this to the fact that unlike Metro Manila, where there is an established water distribution system, the water source in rural areas still include deep wells in many cases.

Deep wells, according to Herbosa are prone to contamination from fecal material.

Confirmed sources of contaminated water

The health department’s surveillance system usually tracks such cases through regular surveillance reports. “When there’s a big jump in the number of cases, they verify the bacteria that’s causing it and check the contaminated water source.”

Usual number of cases over a 6-month would be less than a hundred, depending on the population size, according to Herbosa. “This number–now running to over a 1,000 is unusually high, hence declaration of outbreak.”

“We declared cholera outbreaks in Virac but not in other towns because we are still waiting for laboratory confirmation. There is only diarrhea outbreak in other towns,” Herbosa said. 

Two areas in Virac were confirmed to have contaminated sources of water, according to Herbosa.

Local authorities alerted

Herbosa said the purpose of declaring disease outbreaks is to prevent epidemics. 

“An outbreak is like typhoon signal number one, so everything is acted upon, locals are warned, and educated on what to do to prevent spread of disease.”

When there is an outbreak, he said, health officials closely coordinate with local officials on what to do address the problem. The source of contamination is identified. 

Local health officials, such as barangay health workers and volunteers are tapped to help educate residents on how to further prevent transmission of the disease. 

In the case of cholera, the usual transmission is via fecal contamination through poor sanitation and poor hygiene. 

Efforts include teaching local residents proper sanitation and encouraging frequent handwashing.

More aggressive than ordinary diarrhea

Cholera infection, according to the Atlanta-based Centers for Disease Control is often mild or without symptoms.

Approximately one in 20 (5%) infected persons, however, will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

Herbosa, in another interview said the “interventions” for cholera is different from diarrhea since the former is more “aggressive.”

“Cholera kills faster because patients can be dehydrated faster.  Cholera patients are given IV (intravenous) and antibiotic.  Pero habang naghihintay kami ng confirmation, ang lahat ng diarrhea cases ay kino-consider naming cholera para masiguro that they get the proper treatment,” Herbosa said. 

It can take anywhere from a few hours to 5 days for symptoms to appear after infection, according to information on cholera published by the CDC. Symptoms typically appear in 2-3 days.

Read more about cholera here. –