A lion in the village

The Cholera outbreak in Africa may finally have peaked:

The number of people dying and infected with cholera in Zimbabwe decreased for the second consecutive week, the United Nations said Wednesday.

The death toll in Zimbabwe has topped 4,000 with more than 89,000 cases since the outbreak of the waterborne disease in August. Its spread is blamed on the collapse of Zimbabwe's water and health infrastructure.

But:

The outbreak in Zimbabwe has put strain on health infrastructure in neighboring countries.

Cholera has doubled to 12,000 cases in South Africa, with the situation along the Zimbabwean border being of particular concern, according to the U.N report. Cholera cases have also almost doubled in Namibia and Zambia.

This week's New England Journal of Medicine contains an article by CDC′s Dr. Eric Mintz, leader of the Diarrheal Diseases Epidemiology Team in the Enteric Diseases Epidemiology Branch:
A Lion in Our Village — The Unconscionable Tragedy of Cholera in Africa that details the burden of cholera in Zimbabwe and other surrounding African countries in the past year.

Unlike the severe acute respiratory syndrome, avian influenza, and other infectious-disease threats that have emerged recently, cholera is easily avoided and easily treated. The failure of the global community to mobilize the resources needed to prevent and to treat cholera among the less fortunate reflects our lack of commitment to equity and social justice. Improving access to safe drinking water, adequate sanitation, and basic health services are among the core Millennium Development Goals agreed to by all United Nations member states.

Epidemic cholera represents a fundamental failure of governance, and bold and visionary leadership is required if we are to attack its root causes. Such leadership has been demonstrated in other contexts in Africa. For example, President Yoweri Museveni of Uganda began to change public attitudes toward the human immunodeficiency virus and succeeded in reducing the rates of AIDS in his country, in part by recharacterizing the disease as similar to any other threat to the community: "When a lion comes into your village," he said, "you must raise the alarm loudly."

It is time to sound the alarm again. Whereas reported case fatality rates for cholera in the rest of the world are now well below 1%, rates in excess of 5% are still commonly reported in many African countries.