Treatment and Vaccination Strategies to Control Cholera in Sub-Saharan Refugee Settings

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Abstract
WORLDWIDE, crowded refugee camps with contaminated water sources and inadequate sanitation have been well described as foci for cholera outbreaks.1-6 The rapidly growing number of refugees resulting from war, civil strife, famine, and natural disasters is expected only to add to the number who have already died as a consequence of such cholera epidemics. The provision of an adequate quantity of purified water and the establishment of suitable facilities for defecation pending appropriate sanitation systems are important measures to help prevent outbreaks of cholera in refugee settings. Appropriate case management with oral rehydration therapy, community outreach to improve case finding and access to treatment, and hospital management for severe cases can reduce the case-fatality ratio (CFR) in cholera epidemics from more than 50% to less than 1%.4,7-12 In the last decade, however, the CFR in cholera outbreaks in refugee settings, even within the same country, has varied from less than 1% to as high as 25%. Such variation is in part a consequence of the disparate availability of resources needed to effectively manage such outbreaks.12,13