4-5). Hand washing is also effective, especially when preparing food. Two WHO-recommended vaccines have been shown to be 60% and 67% percent effective against 01 El Tor, or 01 El Tor and 0139 strains, respectively. Both could be used to produce a 'herd effect' if only a portion of the at-risk population is vaccinated, and the latter vaccine is cheap enough (U.S.$2 dollars) for use in developing countries.

WHO Cholera Case Study: Somalia

During the first 31 weeks of 2011 there were 4272 cases of acute watery diarrhea (AWD) at the Banadir Hospital in Mogadishu, Somalia, of which 75% were children under the age of 5 (WHO Somalia, 2011). This rate is a reflection of what is occurring throughout Somalia, because health care personnel are unable to keep up with the countless new villages that form randomly due to the ongoing conflict and drought conditions. Gaining access to conflict zones is generally impossible, so many internally displaced persons (IDPs) have no access to medical care, potable water, or hygiene products. The magnitude of the problem is revealed by the fact that another 74,400 persons were displaced from their homes between June and July last year.

The percentage of AWD cases resulting from V. cholerae is unknown, but sporadic testing indicated that 60% were due to cholera in the lower and middle Juba regions (WHO Somalia, 2011). In August, 2011 the WHO announced cholera incidence was increasing in Somalia and began to mount a rapid response in anticipation of the rainy season (WHO and UNICEF, 2011). Cholera was considered to be under control at the time, but the most recent cholera epidemic, which occurred in 2006, caused an estimated 67,000 cases. With this recent history in mind, plans were executed to prepare for treating 80,000 moderate and 20,000 severe cases of cholera by strategically positioning diarrheal disease kits in the most at-risk regions.

Essentially, everything that can be done is being done given the available resources. Trained community health personnel are going door to door and providing hygiene education. Water sources serving approximately 500,000 residents and IDPs in the Mogadishu area are being chlorinated and household hygiene kits are being distributed. The hygiene kits include chlorine tablets, soap, and buckets. Based on United Nations estimates, U.S.$80 million is needed for health centers and another U.S.$78 million for water sanitation and personal hygiene products, but less than 40% of the needed funds have been raised.


Efforts to forestall the next cholera epidemic in Somalia are limited to the most at risk areas in the country, which seems appropriate given that cholera was considered under control at the time and funding for a vaccination program was lacking. Pre-rainy season preparations were based on the scale of the most recent cholera epidemic and limited to AWD treatment, community education, and household hygiene supplies for a limited section of the country. The current status of cholera epidemic prevention and treatment in Somalia is therefore limited primarily to crisis management, rather than prevention, and therefore could not meet demand if another cholera epidemic exceeded predictions.


Enserink, Mark. (2011). Cholera linked to U.N. forces, but questions remain. Science, 332, 776-777.

Mandal, Shyamapada, Mandal, Manisha D., and Pal, Nishith K. (2011). Cholera: A great global concern. Asian Pacific Journal of Tropical Diseases, 4, 573-580.

Weil, Ana A., Ivers, Louise C., and Harris, Jason B. (2012). Cholera: Lessons from Haiti and beyond. Current Infectious Disease Reports, 14, 1-8.

WHO Somalia. (2011). Emergency Humanitarian Action, Weekly Highlights 6 -- 12 August 2011. Retrieved 6 Feb. 2012 from

World Health Organization and UNICEF. (2006). Oral Rehydration Salts: Production of theā€¦